Is There a Bias in the Diagnosis of Borderline Personality Disorder Among Lesbian, Gay, and Bisexual Patients?

Abstract

High prevalence of borderline personality disorder (BPD) diagnosis is observed among sexual minority samples. It is unclear if sexual minority individuals are systematically diagnosed with BPD at higher rates than heterosexual individuals, and if potential diagnostic disparity can be explained by differences in maladaptive personality domains. Utilizing data from partial hospital patients ( N = 1,099) the current study explored (a) differences in the frequency of diagnosis of BPD based on sexual orientation, (b) whether disparities explained differences in psychopathology across groups, and (c) the congruence between traditional methods of BPD diagnosis (i.e., clinical assessment) versus diagnosis based on elevations in self-reported maladaptive personality domains consistent with the alternative model for personality disorders. Sexual minority individuals were more likely to be diagnosed with BPD than heterosexual individuals (odds ratio [ OR] = 2.43, p < .001), even after controlling for differences in clinical correlates of BPD diagnosis (age, gender, comorbid posttraumatic stress disorder, maladaptive personality domains; OR = 1.59, p < .05). Diagnostic disparity was highest for bisexual compared with heterosexual patients. These results suggest that clinicians may be predisposed to provide a BPD diagnosis to sexual minority patients that is independent of presenting psychopathology and bear important implications for future research aimed at discerning whether such predisposition is due to measure or clinician bias.

A Population-Based Examination of Criterion-Level Disparities in the Diagnosis of Borderline Personality Disorder Among Sexual Minority Adults

“…Despite high prevalence of BPD diagnosis among sexual minority psychiatric samples (Grant et al, 2011;Reuter et al, 2016), and evidence demonstrating provider bias in the provision of the BPD diagnosis based on sexual minority status (Eubanks-Carter & Goldfried, 2006;Rodriguez-Seijas et al, 2020), these results suggest that the majority of BPD criteria do not demonstrate bias at the population level. That is, higher criterion endorsement reflects elevations in transdiagnostic psychopathology experienced by sexual minority individuals rather than item-specific issues independent of psychopathology.…”

“…In another study of actual clinical diagnostic patterns, sexual minority patients in a partial hospital setting were more likely to be assigned a BPD diagnosis than heterosexual patients. Importantly, this diagnostic disparity persisted even after transdiagnostic dimensions of personality pathology were controlled (Rodriguez-Seijas et al, 2020). Together, this emerging literature suggests that providers are more likely to assign a diagnosis of BPD to sexual minority individuals than heterosexual individuals, regardless of underlying psychopathology or clinical presentation .…”

“…Empirical evidence routinely documents elevated prevalence of psychosocial dysfunction among sexual minority (i.e., lesbian, gay, and bisexual) individuals compared with heterosexual persons (Rodriguez-Seijas et al, 2019), and high prevalence of BPD diagnosis within sexual minority samples (Grant et al, 2011; Reuter, Sharp, Kalpakci, et al, 2016). Health care providers demonstrate bias in the diagnosis of BPD; they are more likely to diagnose BPD among sexual minority compared with heterosexual persons regardless of presenting psychopathology (Eubanks-Carter & Goldfried, 2006; Rodriguez-Seijas et al, 2020). It remains unclear, however, the extent to which disparities might reflect bias related to any specific diagnostic criterion utilized for the adjudication of the diagnosis.…”

Making Meaning of Religious Values in Preventing a Fatal Suicide Act of a Bisexual Youth with Borderline Personality Disorder: A Qualitative Study

“…Previous studies also revealed that individuals with BPD tend to exhibit homosexual or bisexual orientations (Reich & Zanarini, 2008). Surprisingly, Rodriguez-Seijas et al (2020) found the clinicians bias in the diagnosis of individuals from sexual minority groups, especially bisexual, who were more likely to diagnose BPD. The findings make clear the need to understand individuals from sexual minority groups, whether they actually experience psychopathology such as BPD, or whether their psychopathological symptoms are influenced by their sexual orientation, which is often linked to rejection of a more heterosexual society.…”

Sexual Minority Mental Health

“…Related to appreciating the role context plays in intervention, understanding the social and structural context is also important for assessment and measurement purposes. For instance, emerging research suggests that clinical providers are more inclined to provide diagnoses of more severe forms of psychopathology (e.g., borderline personality disorder) among sexual minorities than heterosexual persons (Eubanks-Carter and Goldfried, 2006;Rodriguez-Seijas, Morgan and Zimmerman, 2021b). Relatedly, research using populationbased data further shows that sexual minority persons are more likely to endorse several criteria of severe psychiatric disorders if one does not account for associated distress or impairment related to those criteria.…”