Body dysphoria is a feeling that there is something wrong with the configuration of the body, apart from any documented physical conditions. It is often contrasted with simple gender dysphoria, but some people instead portray gender dysphoria as a symptom of the same underlying condition. As I wrote a few years ago, there is an argument that body dysphoria is an innate “medical condition” deserving special protection. In that post I discussed multiple cases of body dysphoria appearing in adulthood, which contradict the idea that it is always innate.
So if not everyone with body dysphoria is born with it, how did those people get it? There is an alternative explanation for body dysphoria, based on the theory of semantic frames, that body dysphoria arises when gender dysphoria and transgender desire interact with the world. There is no reason to believe any of them are innate.
I also want to note that body dysphoria seems to be frequently triggered by the presence of others, or at least by people imagining how others would see them. The symptoms of body dysphoria – shock and distress – bear a strong resemblance to the feelings that many people feel when they are misgendered – classified by gender in a way that contradicts their intentions. The explanation that I give for body dysphoria also explains the reactions to misgendering. In fact, they are the same reaction, only with different triggers.
The way I’ve presented the concept in the past is that body dysphoria is a feeling of discomfort with the body, specifically the idea that there is something wrong with the body, that the way it appears is not the way it truly is or should be. By contrast, I’ve defined gender dysphoria as a discomfort with gendered expectations imposed by other people. I’ve also tried to separate gender dysphoria from transgender desire, the desire to be seen and accepted as a member of a different gender. Many people experience all three feelings, but some people only experience one.
What are frames?
Cognitive psychologists have a theory that in our minds we organize a lot of our information about the world in frames, collections of information often tied to particular situations. (Some prefer the term “schema” or “script,” which can have slightly different meanings, but the central idea is the same.) The classic example is the restaurant frame, which contains objects like a door, tables and forks; people like a host, servers and cooks; and actions like ordering, eating and paying. Frames are activated in our minds by direct experience, such as seeing the entrance to a restaurant, or the mention of certain words.
As I wrote in my linguistics blog, we use frames to choose between multiple potential meanings. If we have the restaurant frame activated, we are likely to see a particular image in our minds when we hear a sentence like “She put a check on the table.” But if instead someone has activated the bank frame in our minds, we get a very different picture, and the spreadsheet frame gives us a completely different image.
Frames are a way of understanding our expectations for a particular situation. Some elements of a frame are optional: a restaurant may not have liquor for sale, or large windows, but many do. If a restaurant has no website, or seating, or gas lines, we find it worth telling other people about. And what kind of restaurant doesn’t have restrooms or water, or make sure their cups and plates are clean, or serve steak or cheeseburgers or baked potatoes?
Victor Raskin has a great book (and a shorter article) using frames to explain humor. He observes that most successful jokes activate one frame during the setup and then abruptly reveal that the true frame is actually a different one. The shock of the frame change makes us laugh. You can try this yourself with one of my favorite jokes, “A guy walks into a bar and says ‘Ow.’”
There is a similar dynamic at work in horror stories, political persuasion and many other genres of communication that rely on shocking the audience. First set the stage by providing enough details to invoke certain frames, then allow the audience to imagine the remaining details from those frames. Finally, reveal details that tell the audience that the frames they have activated are wrong, along with many of the details they have filled in based on those frames.
Frames vary and change
It’s important to note here that the shock and/or discomfort arises from the clash between two frames. The first frame must be properly activated, or there is no shock. This is why so many people recognize the importance of the setup for jokes, horror and persuasive rhetoric.
It’s also important to note that while creating frames may be innate, the contents and organization of those frames is learned throughout the lifetime. And although most frames and their main elements are generally shared among many people in a society, there is wide variation across people and groups, as well as change over time. To go back to the restaurant frame, when I was little the only restaurants that had televisions were sports bars, but now they are common in many other restaurants. Pubs (a subclass of restaurant that inherits many of the features of restaurants) in the United States almost always have a server taking orders at the table, but in pubs in the United Kingdom, the common expectation is that customers will order at the bar. An American joke based on customers ordering at their table would not work as well in Great Britain, and vice versa.
Frames are sometimes formed and changed by instruction, but more often by repeated experiences, as well as salient experiences. An American who goes to a pub in Great Britain may have read in a guidebook about ordering at the bar, but they will eventually get in the habit of it. It may take several experiences of waiting at the table to revise their frame, or one particularly unpleasant experience. They may find themselves ordering at the bar when back in the US, or forgetting again on a subsequent visit to the UK, and eventually create a separate “British pub” subframe.
Frames for bodies
Frames help us to organize all our experience and expectations, so it shouldn’t be surprising that they organize our experiences of our bodies as well as other people’s bodies. When frames involve people being seen and making contact, they encode expectations about those people’s bodies.
We even have frames just for bodies, with their own set of expectations. Just as we would be shocked if we went into a fancy restaurant and there were no chairs or napkins, or if there was a giant television showing game shows, many of us are shocked to encounter bodies with less than two arms, or more than two ears.
These body frames can vary and change just like frames for places or situations. When large numbers of people needed limbs amputated during World War I, the people around them became more accustomed to bodies with amputated limbs. People expect adults to be a certain height in Norway or Kenya, and a different height in Guatemala or Japan.
The shock of unexpected body features explains the entertainment value of “the reveal” of unexpected features of other people’s bodies, such as hairlessness that was covered by a wig, a skin condition covered by makeup, a missing limb, even sometimes a different color skin – or in fiction, horns, fangs or lizard skin. It also explains people’s shock at encountering a penis on someone taking off a dress, or a vagina on someone with a beard. This shock is a major reason why trans people are so often the punch lines in jokes – and the monsters in horror movies.
After the shock, there is also often a further readjustment of understanding and expectation, which often produces longer-lasting distress. In one well-known film (can it be spoiled at this point?) the main character falls in love with a person in a dress and is then shocked when his lover reveals a penis to him. He later goes back to the club where he watched her sing, and notices other details that make him recategorize it as a drag bar. If he loves her, does this mean he has to recategorize himself as a gay man? What does this mean for his life?
Frames and transgender feelings
Now let’s imagine someone who experiences gender dysphoria or transgender desire. Some people go through life feeling one or both of these feelings, and never do anything about it. Some change their appearance to fit their image of their desired gender, for example through clothes, hair or hormones, but only for their own eyes (or other senses). Some change their appearance and then interact with other people.
Based on my own experiences and many conversations with others, it is common for people to develop feelings of body dysphoria after changing their appearance and interacting with others. This brings me to Lydia K.’s famous analogy between body dysphoria and failed Unix startup messages:
sd 7:0:0:1: Attached scsi generic Phallus sg3 type 0
sd 7:0:0:1: [sdb] Attached Phallus
sd 7:0:0:1: [sdb] hardware not supported, using generic driver, partial support only
sd 7:0:0:1: [sdb] Write cache: enabled, read cache: enabled, doesn't support DPO or FUA
UDP: short packet: From 220.127.116.11:53 1032/43 to 18.104.22.168:23117
The descriptions that people like Lydia K and others give of body dysphoria – looking for particular features, failing to find them, and raising an alarm – are identical to what cognitive psychologists say happens when one frame is invalidated and replaced with another. It seems likely that the person has established a frame for bodies of their target gender that include specific sex characteristics. When those body parts are not found (or unexpected parts are encountered) they are forced to invalidate that frame, producing a mental shock.
Imagine a person acting out of transgender desire, for example someone who’s been seen as a man all her life but wants others to see her as a woman. If she perceives a penis and invalidates a female body frame, that implies that she can’t even see herself as a woman, so how could she expect others to classify her as a woman? It’s clear why this would be very upsetting.
Now imagine a person motivated by gender dysphoria, for example someone who has been seen as a woman in the past, but desperately wants to not be seen as a woman. If they perceive a feature such as broad hips that is only compatible with their female body frame, that invalidates any other gendered frame and implies that they have failed to escape from being perceived as a woman. Again, it makes sense why they would be upset.
Third, imagine a person who has just been misgendered. He has told his friends and family that he is a guy, and they use the name and pronouns he requested. He has been out shopping with a friend, wearing a binder with slicked-back hair, and been called “sir.” Then they go to a restaurant, where the server greets them with “Hello ladies!” He is shocked by the greeting, and then feels awful.
This person has established a frame for “guy in a restaurant,” and put himself in the role of the guy, with all the expectations that go with it. When the server says “ladies,” that invalidates the frame and imposes one of “lady in a restaurant.” Whether he is acting out of gender dysphoria or transgender desire, or both, this frustrates his efforts and leaves him feeling like a failure.
In fact, we can think of body dysphoria as a form of unintentional self-misgendering. Remember that body dysphoria happens more frequently, and with greater distress, when the person knows – or even imagines – that someone else is present. Instead of being triggered by someone else’s words, it is triggered by their imagined words, or thoughts.
Why this matters
If frames are learned and then activated, this explains how body dysphoria can develop later in life. In order to experience the shock of the frame switch and the resulting distress, they must first have activated a frame with a space marked for their target gender, and put themselves in that space.
This frame activation is not automatic. To the contrary, the intensity of the shock people experience is related to what they expect to perceive, and the level of distress they feel is connected to the implications they draw from the new frame. These expectations and interpretations are not under complete conscious control, but as we have seen in individual cases, they can change in response to changes in circumstances, and even in response to changes in beliefs and attitudes.
This also offers a potential way to avoid, or at least minimize, the distress associated with body dysphoria and misgendering. If the severity of the shock comes from violated expectations, we can look to anticipate and manage our expectations, and those of other people If the depth of distress comes from contemplating the implications of a particular frame, we can anticipate that and avoid situations where the implications might be too distressing.
What does it mean to manage expectations? For one thing, it means spending time around people who know and understand trans bodies and clothes, and asking our loved ones to familiarize themselves with trans bodies and clothes.
Managing expectations also means taking time on a regular basis to try and see our bodies as others might see them. It means asking people we trust to filter their opinions less. I know this can be distressing, but it’s a lot less distressing in small doses with friends, under circumstances where we have more control.
How can we avoid distressing situations? We can think ahead when we are planning an activity. What could happen if someone notices this body part, or realizes that I don’t have that body part? What could happen if someone misgenders me? Am I prepared to deal with this?
For people who have made up their minds to transition, managing expectations and avoiding distressing situations means planning your transition carefully. Some people I know like to play it by ear, telling people on a case-by-case basis and letting hormones change their bodies. This is nice in theory, but often leads to dysphoria.
For people who haven’t decided, this means being aware that experimentation can have serious consequences. If you’re aiming to determine what will help you deal with your current level of dysphoria, it’s important to avoid increasing your level of dysphoria. That in turn means choosing your experiments carefully, and keeping the framing dynamic in mind when interpreting your experiences.
For people who have decided not to transition, this means being aware of what practices might increase your level of dysphoria, and finding activities that avoid both repression and dysphoria. I talk more about that in my long post on The Slippery Slope.
The bottom line is this: we can’t control dysphoria, but we can anticipate and manage it to a significant degree. Every trans person needs to know this and keep it in mind.