#ntsd

Proposed diagnostic construct. Not recognized by any legitimate diagnostic body, though widely reinforced by social institutions. Diagnostic Criteria A. Persistent pattern of cognitive, emotional, and social functioning characterized by a strong preference for normative coherence, rapid closure of uncertainty, and limited tolerance for sustained depth—intellectual, experiential, or…

Hi! Thank you for this ask, it gives me a chance to consolidate some of my previous posts/reblogs about this topic. I'll include some links at the bottom to my previous content on this 😊

1. Did top surgery really help with your dysphoria?

Yes, it helped me immensely, but I had created a rigorous, multi-year-long gatekeeping process for myself prior to following through with it. I wasn't a TRA, I didn't have a gender identity and had zero desire to distance myself from womanhood (honestly I never have), I was very much conscious of and at peace with my material reality, had been seeing a non-affirming therapist and gotten a second therapeutic opinion, had read numerous detrans regret stories to compare my reasons, thought process, & experiences to the ones that resulted in regret/dissatisfaction, and much more. 50 layers of caution and redundancy has always been how I work, and this was no different.

2. How do you feel about comparisons between dysphoric people undergoing surgery to feel better about their bodies vs anorexic or other dysmorphic people opting for surgery to relieve their discomfort?

I think the term "dysphoria" has been watered down and is as extremely subjective as one's sense of humor. Many trans-identified people say they experience an exacerbation ("trigger") of dysphoria in response to gendered things like wearing certain clothing, makeup, or being called "sir" or "miss" or whatever. Some even claim to "feel dysphoric" about enjoying hobbies stereotypically associated with their sex. These examples are to my experience of dysphoria what boomer humor is to my sense of humor: I simply don't get it and can't relate.

You asked a question about "dysphoric people undergoing surgery to feel better about their bodies," but to be clear, that's not what I did. I didn't feel bad about my body in the slightest; in fact, I loved my body. I really loved my breasts - they were genuinely uniquely remarkable breasts. They were wonderful, and a joyful signifier to me of my femaleness and connection to nature and the goddesses - something I've always taken great pride in, and I knew part of me would miss them. But dysphoria, for me (and the dysphoric people I tend to associate with irl), was/is a literal physical feeling in the same way that pain, itchiness, pressure, numbness, and tingling are physical sensations. It has nothing to do with my feelings about my appearance or my psychological relationship to my body. No matter how intense that sensation could be, I never loved my breasts any less.

As I expected, a part of me did and does miss them from time to time, but honestly it's a pretty superficial part - sometimes I miss their appearance and almost unnatural symmetry, or my nipple piercings, or the aesthetic of breasts on butch women, or goofing around with female friends about/with them. I do miss the bra pocket the most. Truthfully though, I never think about those things unless some specific relevant context prompts me to, and it's a totally cognitive "feeling" rather than an emotional one. It's also very mild and brief, and has never led to feeling regret.

I had body dysmorphia and anorexia for a fairly short time as a teen, but recovered quickly and very fully (I couldn't relapse if I tried, and being a good scientist, I did test that), and was totally mentally at peace with my body for years before even permitting myself to truly consider pursuing surgery. It was crucial to me that I be fully at peace with my body psychologically before doing so to minimize potential confounds. The sensation of relief I experienced post-op was more like the feeling I get after my pain management doctor injects lidocaine & steroids into my sacroiliac joints than the feeling I got at 17 when I could see my bones sticking out - in fact it was nothing at all like the latter. The mental space/energy it freed up for me was not at all emotional distress, but more akin to the mental space/energy freed up when I finally was put on the right medication for my POTS, reducing my fatigue and uncomfortable cardiac sensations immensely.

I never bothered with binding or anything because how others perceived me/how I looked in the mirror was never a factor in the slightest. Actually, if anything, binding would've made me hyperfocus on the sensation. The only relevant thing was the physical sensation and the fact that every other treatment I tried did absolutely nothing to alleviate it. I was able to heal cPTSD from multifaceted childhood abuse entirely on my own. A few years of EMDR had me far subclinical for PTSD after surviving the Pulse Nightclub mass shooting in Orlando in 2016. 4 weeks of PHP cured me permanently from severe anorexia. But nothing ever made a difference when it came to my dysphoria.

At the same time, I don't think most other people who call themselves dysphoric experience the same thing that I do. I think many - likely most - people who say they have dysphoria are gnc and struggling with stereotypes and expectations, have body image issues in general and think transition will help because of the rhetoric around it treating it as a silver bullet, are struggling to accept themselves for any number of potential reasons we often discuss here on radblr, are aroused by "cross-dressing" or cross-sex fantasies, or other things I'm definitely forgetting in my current half-asleep state.

3. Do you think some or even most dysphoric people could eventually reach body neutrality or acceptance with nonmedical support or treatment?

I know I'm reiterating here, but just to be very clear - I did reach a high level of body acceptance prior to my surgery, and total acceptance below the neck. My face (particularly being babyfaced & my nose) were the only things I was still a little self-conscious about, but not dysmorphic or anything severe. That's been resolved for a while now, too.

Absolutely 100% yes. I think the vast, vast majority of people who call themselves dysphoric or are diagnosed with "gender dysphoria" have zero business being approved for medical intervention, particularly surgery. The intense urgency to go under the knife that so many trans-identifying people express is a massive red flag for mental illness and non-intractible dysphoria, yet that urgency is often used to "prove" the medical "necessity" of such "treatments." The way so many people "come out" as trans and instantly want surgery as soon as humanly possible with as little preparation or gatekeeping as possible is extremely concerning, and in my eyes very much a sign that person is anything but a good candidate for medical intervention. Throwing a tantrum on Twitter because you have to wait a few years to get a major surgery is not a mentally healthy behavior... obviously. Those people need psychiatric intervention first and foremost, and goddesses we need more research.

The people I know who experience dysphoria as a physical sensation like I described are anecdotally far more cautious and thorough in considering medical intervention, much less likely to subscribe to gender ideology, and much more likely to attempt every possible alternative before deciding on surgery - an oddly parallel approach to that of most patients with chronic pain: try everything other than surgery/experimental medical intervention first.

Dysphoria means a hundred different things to different people these days. Maybe it always did, idk. I firmly believe we need to start separating these "types" of dysphoria, or ideally even separate them in name and concept altogether (stop calling all these different issues/symptoms/experiences by the same name). What do I have in common with a man who steals his sister's undergarments for a sexual thrill? What do I have in common with a teenage girl who thinks she must not be female because she hates skirts and loves cargo shorts? My experience is one of neurological dissonance, not emotional distress. This presents a major issue when it comes to research, though... if we aren't differentiating these drastically different varieties of "trans" and definitions of dysphoria, how can any research on dysphoric populations be remotely meaningful? The treatment plan for the man stealing his sister's undergarments and the treatment plan for the gnc teen girl and the treatment plan for me shouldn't all look the same. That seems glaringly obvious, and yet nobody seems willing to admit it.

My original I Don't Regret My Top Surgery post

"Radfems Misunderstanding Dysphoria" meme post discussion

Response to an ask about alternative ways to treat dysphoria

Whiners Click Here

We really need research to identify which patients are most likely to benefit from medical intervention (and which are most likely to be harmed by it)

Response to an ask: sex dysphoria vs gender dysphoria, and rare dysphoria as neurological with possible genetic/epigenetic components

Response to an ask: neurological dysphoria vs brain sex, part 1

Moody’s: Annual State Debt Medians in U.s. Experience First Decline in Nearly Three Decades

For first time in 28 years, the 50 states’ median net tax-supported debt (NTSD) declined in 2014, Moody’s Investors Service says in its annual state debt medians report. In 2014, the states’ median net tax-supported debt declined by $6.2 billion to $509.6 billion. While $5.3 billion of this change was attributable to Moody’s reclassification of the Texas’ general mobility fund debt to…