Clinical stories comprise gaps, missing pieces, and unknowable elements. In this paper, I revisit treatment with a transgender female patient through a traumatophilic and gender-expansive lens. Body dysmorphia and bulimarexic symptoms express the patient’s longing for a feminized body shape and size, the sequelae of her tortured relationship with her transgender body. Addressing her disordered eating and the underlying affect regulatory dimensions of her behavior are vital features of our analytic work. The patient’s traumatic experience, in the present, is viewed as a necessary living through her under-symbolized traumatic past, now a shareable event in our therapeutic relationship. However, questions linger about the patient’s underlying dissociative processes that needed deeper engagement. I argue that clinical writing creates space for reflection and mourning as therapeutic endeavors often leave much unsaid, unresolved, and unhealed in the patient, the analyst, and the therapeutic dyad.