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Body Dysmorphic Disorder and FFS



FFS and Body Dysmorphic Disorder


Psychologically, it can be very distressing for a woman, cis or trans, to look into a mirror and see an overtly masculine face looking back at her. So having FFS to try to remove or reduce those masculinities is understandable. That doesn't mean all women should have their facial masculinities removed, but for those who are troubled by facial masculinity, FFS may be an option.

Even without a masculinity problem, we can all be a little down on our faces and ourselves from time to time - this is quite normal of course but I regularly come across women, both trans and cis, who are convinced that their faces are far more masculine or far more unattractive than they actually are. This kind of unrealistically negative view of your body or parts of it can often be down to a very common psychological problem called “Body Dysmorphic Disorder” (BDD). It is a problem that I suspect trans women are particularly prone to - spending so many years trapped in the wrong body and behind the wrong face can easily lead you into the habit of looking at yourself with disgust. This is all made worse by the fact that the societies we live in often mock, bully and abuse trans women.

BDD is nothing to be ashamed of - as I said, it is very common and it is very easy to fall into. It is thought to be a symptom of underlying anxieties about yourself and it's one of the ways that these anxieties can express themselves. So if you think you are inferior or worthless etc. this can cause you to focus on your physical appearance in a very critical way - so much so that you start to see big physical problems when they aren't really there or at worst are very slight.

It might be hard to believe that you could fall for this but the human brain is very vulnerable to this kind of thing and the way we see the world is always subjective and distorted. A trivial example might be when you look at an old photograph of yourself and you can't believe how you ever thought that outfit or that hairstyle looked good on you. But of course you did at the time.

Let me give you an imaginary example of normal concerns a person might have about their appearance compared to potential BDD behaviour: Look at Jennifer Aniston - technically, she has a bit of a square chin.


picture courtesy gdcgraphics

If she said to me that she didn't like it, that she thought it was masculine and that she was considering having surgery to make it more rounded, that would be reasonable. I would point out that most people would judge her to be exceptionally beautiful, and that although it is technically a masculine chin, it doesn't in any way make her look manly. If, on the other hand, she told me that her chin was repulsive, that she couldn't look in the mirror because she is so ugly, and that she will do anything to get rid of it, that would suggest that there was probably a psychological problem there like BDD.

Having surgical alterations made to your body is, of course, a matter of personal choice and I have no objection myself to people choosing to have even quite extreme things done like facial tattoos or having little horns put under their scalp etc. but choosing to have a surgical alteration with a clear mind, as a matter of personal choice and self-expression, is not the same as desperately seeking surgery to correct problems that are not really there or are at least greatly exaggerated in your mind.

The problem is that you cannot fix BDD with surgery and trying to do so can be very dangerous because the patient may very likely still feel awful afterwards even if she looks great. This is because the problem is not so much with the way the patient looks, as with the way she sees herself and to find yourself in this situation after surgery, with your money gone, and with no apparent options left is devastating. Surgery may be an option at some point to fix any actual problems that are there, but the BDD should be fixed first.

It concerns me greatly that many surgeons do not pay enough attention to BDD. Some may not even be aware of it. Consequently, they sometimes recommend surgery inappropriately and at great risk to the patient's mental health. I have seen this many times and have had to try very hard at times to try to protect a patient from her surgeon.

Fortunately, you can fix or greatly improve BDD with a type of therapy called “Cognitive Behavioural Therapy” (CBT). CBT is being used by more and more psychiatrists around the world to treat a wide range of psychological disorders like phobias, depression, anger, anxiety and panic attacks. It's a practical and common sense approach to identifying where your thinking habits are leading you in a negative direction and correcting them.

Let me give you an example: a common thinking error, and one that trans women are particularly prone to in my experience, is "mind reading". This, is exactly what it sounds. So, for example: someone looks at you in a shop and you immediately think you've been read as trans, but really, there could be many reasons why they looked at you - they might have thought you were attractive, or you might have reminded them of their aunt, or they might even have been looking past you at the shelves because they couldn't find the product they were after after. If you are prone to another thinking error called "all-or-nothing thinking", then you might immediately move on to feeling despair.

The object of CBT is to help you spot which particular thinking errors you are prone to and give you strategies to correct them. For example, with mind reading you are encouraged to think of the possible alternative explanations like the ones I gave above, and to remember that you are only actually guessing what the person was thinking.

Medication is sometimes prescribed for people with BDD to accompany CBT. The drugs are called "selective serotonin reuptake inhibitors" or SSRI's for short. Prozac is a well known example.


Typical symptoms of BDD:


Obsessing over a physical flaw.

Avoiding mirrors or continuously checking yourself in them.

Positioning yourself so that people can't see the flaws you are concerned about.

Feeling that you look like a man despite everyone, or almost everyone taking you for female.

Hating your face or body intensely.

Avoiding people who are attractive.

Avoiding social situations because of the way you look.

Describing yourself as "repulsive" or "hideous".

Seeking constant reassurance from other people that you look attractive or feminine.

Attempting DIY surgery on the problem area.


If you have BDD or think you might have it, or if someone like me suggests you might have it, then it is important to look into that before you have any surgery. You can go to a CBT therapist, but CBT is very logical and largely based on common sense, so many people find they can largely fix their problems themselves using guide books, and of course that's a lot cheaper than going to a therapist. However, some people are not suited to the book approach and go straight to a therapist, others combine the 2 or seek a therapist after trying books first.

A book I recommend to get you started with CBT is:

Cognitive Behavioural Therapy for Dummies

By Rob Willson and Rhena Branch:

I am not in any way associated with the writers or publishers of this book. I recommend it because it helped me deal with my own BDD and with problems I have had with depression and anxiety. I found it extremely helpful and got on top of those problems for the first time in years. It would also give you a very useful set of mental tools for dealing with many of the big traumas of transition.



The Body Dysmorphic Disorder Foundation, has lots of advice and information.

Wikipedia also has a useful article.