Distinguishing and Addressing Gender Minority Stress and Borderline Personality Symptoms

Abstract

As transgender and gender-diverse people are gaining increased visibility in clinical settings, clinicians are requesting better guidance on providing affirming care to improve the mental health and well-being of these patients. In particular, more direction is needed on whether, when, and how to diagnose and treat borderline personality disorder among gender minorities, partially in response to beliefs among some mental health clinicians that a gender minority identity may be a manifestation of identity diffusion. In this Perspectives article, we argue that gender minority identity, even when fluid, is rarely a sign of identity diffusion. By taking a careful history of a patient’s gender identity development, the clinician can clarify and gain more conviction regarding the presence of a patient’s gender minority identity. Moreover, multiple stigma-related stressors experienced by gender minorities may produce symptoms and behaviors that can mimic or be consistent with certain diagnostic criteria for borderline personality disorder. We therefore conclude with recommendations for adopting a gender-affirming framework to treat borderline personality symptoms when present among gender minority patients, with implications for future research and practice.

Personality Disorders and Personality Profiles in a Sample of Transgender Individuals Requesting Gender-Affirming Treatments

“…This pattern is thought to lead to the emotional dysregulation at the core of borderline PD. The same considerations can be extended to transgender people [81] to explain the high prevalence of borderline PD and traits assessed in the current study, as well as previous ones [26]. It must be noted however that the current formulation of PDs criteria in DSM-5 does not allow to exclude gender minority stress-related symptoms that resemble the pathological traits of any PD diagnosis.…”

Characteristics of Transgender Individuals With Emergency Department Visits and Hospitalizations for Mental Health

“…The multifold increase in personality disorder diagnoses we found in the transgender samples in this study may be partially explained by the minority stress model (11,21). Symptoms and behaviors consistent with diagnostic criteria of borderline personality disorder may be better understood as reactions to stress and oppression experienced by members of minority groups (21,22). A society that subscribes to a rigid sex-gender binary viewpoint (23), where transgender individuals are regularly misgendered and face daily discrimination and marginalization, creates environments that can produce such symptoms and behaviors in response.…”

Intersections of occupational participation and borderline personality disorder: A grounded theory approach

“…However, informant reports did not differ between men and women, suggesting symptomology to be similar across gender despite differences in gender perspectives. With increasing visibility of transgender and gender-diverse people, more research is also needed on the prevalence and symptomology within this population, particularly because stigmarelated stressors experienced by gender minorities may contribute to behaviors or symptoms that could mirror BPD diagnostic criteria (Goldhammer et al, 2019).…”