In early October 2024, the head of the NHS’s only specialist service for children and young people with Body Dysmorphic Disorder (BDD) spoke at an anti-trans conference. Amita Jassi was one of several NHS clinicians to participate in an event put on by the Society for Evidence Based Gender Medicine (SEGM). Jassi’s talk was called ‘body dysmorphic disorder and gender dysphoria’. Following the presentation, she joined a panel for a Q&A session on ‘body image and control’. Appearing alongside her was Anastasis Spiliadis, inventor of ‘gender exploratory therapy’, and Alexander Korte, author of ‘Elective affinities? Trans-identification and anorexia nervosa as maladaptive attempts to solve developmental conflicts in female adolescence’. We don’t know what was said – there is no public record – but a close examination of Jassi’s recently published work paints a disturbing picture. Young people suffering from BDD need care, and support – including young trans people, who may face intense social stigma about their bodies. But is NHS BDD treatment safe for trans patients when approached like this?
Amita Jassi’s involvement with SEGM risks, at best, alienating patients within the BDD service who become aware of it. Jassi didn’t appear on a panel that reflected the current state of the field – even the moderator was an anti-transition radical.1 It also raises a question: what does a BDD specialist have to say about transition that SEGM would want to hear? Jassi’s fellow panel members both write about transition as a maladaptive response to other mental health pressures.2 If Jassi’s focus was similar, this could represent a disturbing development in the incorporation of conversion therapy practices into NHS trans youth medicine. Paragraph 5.38 of the Cass Review stated that, following treatment for BDD, “some young people say they no longer feel ill at ease with their birth-registered gender”. In response to a freedom of information request, NHS England provided me with the following summary of a Clinical Expert Group meeting:
“This was acknowledged to be a complex area with wide ranging views. Members brought to the discussion their professional experiences of gender dysphoria as well as other areas, such as body dysmorphic disorder, as they discussed the patient cohort. Treatments to manage distress were discussed, e.g. Cognitive Behavioural Therapy and Dialectal Behaviour Therapy; as were considerations in relation to the changing epidemiology and the unknowns surrounding the medical pathway.
Perhaps this is coincidence - or perhaps there are a group of clinicians working within NHS BDD services who believe that some young people expressing trans identities are actually suffering from BDD, and that CBT and medication will resolve their desire to transition.
On the 15th June 2024, Jassi published a paper (co-authored with Rebecca McLaren and Georgina Krebs) providing ‘for the first time’, ‘criteria for differentiating BDD [body dysmorphic disorder] and GD [gender dysphoria] in young people’.3 The paper states that while medical body modification ‘may be indicated in GD’, ‘medical body modifications (cosmetic procedures) are generally contraindicated in BDD’. The purpose of the article is to provide ‘criteria for differentiating BDD and GD in young people, enabling appropriate care planning’.
There are a lot of questions raised by the article. Is it reasonable to state that fear of being judged negatively or rejected because of one’s appearance is uniquely a characteristic of BDD not seen in GD? Are trans youth really unlikely to describe body parts as ‘ugly, abnormal or disgusting’ and ‘needing alteration’, instead saying ‘‘it’s not right for me or my gender identity’? In the current UK climate, it feels almost absurd to ask for ‘nothing about us without us’ - but a lack of (sub)cultural literacy runs through this paper like letters through a stick of rock. Perhaps more significantly, how is this diagnostic tool meant to be used? In light of Jassi’s involvement with SEGM, and the Cass Review’s troubling assertion that CBT for BDD can stop young people from identifying as trans, ‘differentiating BDD and GD’ starts to sound like creating space for a new way to tell young people who express trans identities ‘actually, you are mentally ill – and we can cure you’.
As WPATH put it in their SOC8 standards of care, ‘while gender dysphoria (GD) is still considered a mental health condition in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5-TR) of the American Psychiatric Association […] gender incongruence is no longer seen as pathological or a mental disorder in the world health community’. The conditions under which a clinician might confuse a patient expressing a desire to transition with a patient not expressing a desire to transition are surely spectacularly niche. As research coming out of the NHS continues to spiral away from international standards of research and scientific consensus, we must watch for potentially serious abuses. Trans kids deserve better.
Leslie Elliott Boyce, a counsellor specialising in ‘gender confusion, ‘detransition’, and ‘”DEI” discrimination’
Georgina Krebs’ professional focus is on young people’s mental health and CBT. Rebecca McLaren is a practicing consultant psychiatrist - the fact that she worked in the Tavistock’s GIDS service is not advertised on her professional profiles.