Why Anorexia is Just Like Gender Dysphoria...? A Conversation with Deanne Jade
European clinicians treating young patients with overlapping presentations of eating disorders and gender dysphoria will find this conversation particularly resonant. Deanne Jade, founder of the UK's National Centre for Eating Disorders, draws a compelling clinical parallel: both conditions can function as socially reinforced, identity-anchoring behaviours that resist improvement precisely because the patient's sense of self becomes fused with the diagnosis. As Sweden, Finland and the Netherlands revise their gender medicine protocols and look more closely at co-occurring mental health conditions, Jade's framework offers a timely vocabulary for clinicians trying to make sense of complex, overlapping presentations in their consulting rooms.
Deanne Jade has spent decades at the sharp end of eating disorder treatment. As the founder of the National Centre for Eating Disorders in the United Kingdom and a member of the Thoughtful Therapists network, she has watched both the clinical landscape and the cultural conversation around disordered eating shift profoundly — and she now sees striking similarities in how gender dysphoria is being understood and managed. This conversation with Stella O'Malley, Mia Hughes and Dr Bret Alderman brings her clinical expertise to bear on a comparison that many European practitioners are quietly making but rarely say aloud. The episode's organising idea is what Jade calls the golden thread linking eating disorders, self-harm and gender dysphoria. All three, she argues, can function as socially reinforced behaviours — patterns that persist, and even intensify, despite causing the individual significant harm. The reinforcement does not come only from peers or online communities; it is embedded in the therapeutic and medical systems themselves when those systems validate the symptom rather than investigating what lies beneath it. For clinicians in Sweden, Finland and the Netherlands who are now revisiting their gender medicine protocols, this framing offers a coherent explanation of why an affirmation-only approach so often proves insufficient. Central to Jade's analysis is the concept of the overvalued belief — a conviction held with such certainty that it resists ordinary clinical challenge. In eating disorder practice, the belief that thinness is the solution to an underlying problem becomes the lens through which the patient interprets every experience. Jade draws a direct parallel to the conviction that body modification is the necessary and sufficient answer to gender dysphoria. The risk, she argues, is not simply that the belief is wrong, but that clinicians who accept it uncritically foreclose the careful, gradual assessment that these complex presentations demand. The conversation also touches on the intersection of autism and conditions such as ARFID — avoidant restrictive food intake disorder — as well as the roles of competitiveness, social comparison and a drive toward purity or perfection. These are not incidental observations. European research has consistently found elevated rates of autism spectrum traits among young people presenting with gender dysphoria, and many clinicians across France, Germany and Scandinavia are asking how those traits interact with social contagion and with the particular appeal of an identity that feels precise and categorical. For practitioners across EU member states who are watching colleagues in the Nordic countries implement more cautious assessment pathways, Jade's framework has immediate practical relevance. Her argument is not that suffering is imaginary or that patients should be dismissed; it is that the complexity of these presentations deserves the same thorough, patient-centred enquiry that eating disorder specialists have developed over many years of frontline experience. The broader question the episode poses — whether a medical system can become part of the problem by reinforcing the very behaviours it is meant to treat — is one that European health regulators, professional bodies and individual therapists will increasingly need to confront. Jade's voice, grounded in clinical practice rather than ideology, is precisely the kind of expertise the European conversation needs more of.
