Notes on the gender of borderline personality disorder
From The Art and Popular Culture Encyclopedia
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"Feminist critics question why women are three times more likely to be diagnosed with borderline personality disorder than men, while other stigmatizing diagnoses, such as antisocial personality disorder, are diagnosed three times as often in men."--Sholem Stein |
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Feminist critics question why women are three times more likely to be diagnosed with borderline personality disorder than men, while other stigmatizing diagnoses, such as antisocial personality disorder, are diagnosed three times as often in men.
One explanation is that some of the diagnostic criteria of BPD uphold stereotypes about women. For example, the criteria of "a pattern of unstable personal relationships, unstable self-image, and instability of mood," can all be linked to the stereotype that women are "neither decisive nor constant". (Beauvoir, Simone. The Second Sex New York: Vintage, 1989). Women may be more likely to receive a personality disorder diagnosis if they reject the traditional female role by being assertive, successful, or sexually active. If a woman presents with psychiatric symptoms but does not conform to a traditional, passive sick role, she may be labelled as a "difficult" patient and given a BPD diagnosis.
Since BPD is a stigmatizing diagnosis even within the mental health community, some feminists argue that survivors of childhood sexual abuse who are diagnosed with BPD are thus re-traumatized by the negative responses they receive from healthcare providers. One camp argues that it would be better to diagnose these women with post-traumatic stress disorder, as this would acknowledge the impact of abuse on their behavior. Critics of the PTSD diagnosis argue that it medicalizes abuse rather than addressing the root causes in society. Regardless, a diagnosis of PTSD does not encompass all aspects of the disorder.
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Notes
Treating "sex with multiple partners" as a symptom of mental illness is controversial, and doing so might lead to a greater percentage of women receiving a diagnosis of BPD, since having sex with multiple partners contradicts the traditional female gender role. (Simmons, D (1992) Gender issues and borderline personality disorder: Why do females dominate the diagnosis? Archives of Psychiatric Nursing, 6(4), 219–223)
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) occurs in 3-8 percent of women. Symptoms begin 5–11 days before a woman's period and cease a few days after it begins. Symptoms include: marked mood swings, irritability, depressed mood, feeling hopeless or suicidal, a subjective sense of being overwhelmed or out of control, anxiety, binge eating, difficulty concentrating, and substantial impairment of interpersonal relationships. PMDD typically begins in patients' early twenties, but many women wait until their early 30's to seek treatment. The timing and duration of symptoms is a major distinguishing characteristic between BPD and PMDD, as the symptoms of PMDD only take place during the luteal phase of a woman's menstrual cycle, whereas BPD symptoms occur persistently at all stages of the menstrual cycle. In addition, the symptoms of PMDD do not include impulsivity.
Estrogen
Individual differences in women’s estrogen cycles may be related to the expression of BPD symptoms in female patients. A 2003 study found that women’s BPD symptoms were predicted by changes in estrogen levels throughout their menstrual cycles, an effect that remained significant when the results were controlled for a general increase in negative affect.
When women who were already experiencing high levels of BPD symptoms began using estrogen-based oral contraceptives, their BPD symptoms worsened significantly.
Epidemiology
The prevalence of BPD was initially estimated to be 1 to 2 percent of the general population and to occur three times more often in women than in men. However, the lifetime prevalence of BPD in a 2008 study was found to be 5.9% of the general population, occurring in 5.6% of men and 6.2% of women. The difference in rates between men and women in this study was not found to be statistically significant.
Literature
The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism, and Online Dating is a memoir by Kiera Van Gelder.
Girl, Interrupted is a memoir by American author Susanna Kaysen, relating her experiences as a young woman in a psychiatric hospital in the 1960s after being diagnosed with borderline personality disorder.
Out of Here: My Recovery from Borderline Personality Disorder is a memoir by author Rachel Reiland, relating her treatment and recovery from borderline personality disorder.
See also
