No Man's Land: Gender Bias and Social Constructivism in the Diagnosis of Borderline Personality Disorder

Abstract

The literature on borderline personality disorder (BPD), including its epidemiology, biology, phenomenology, causes, correlates, consequences, costs, treatments, and outcomes is vast. Thousands of articles and books have been published. Because the true prevalence of BPD by sex (gender) in the general population is still unknown, the important question of why women, rather than men, are more frequently diagnosed with BPD remains largely unanswered-despite current evidence for the origin of personality disorder in genetics and neurobiology, and despite recent suggestions that biased sampling is the most likely explanation for gender bias in the diagnosis of BPD. This paper reviews selected literature on (a) the epidemiology of BPD, (b) gender bias in the diagnosis of BPD, and (c) the social construction of diagnosis, particularly the diagnostic entity labeled "Borderline Personality Disorder." It attempts a synthesis of diverse, multidisciplinary literature to address the question of why women outnumber men by a ratio of 3:1 in the diagnosis of BPD. It rests on assumptions that (a) to varying degrees sociocultural factors inevitably play a role in the expression of disease conditions, and that (b) personality disorders, including BPD, have cultural histories. It also rests on the belief, for which there is considerable scholarly support, that the phenomenon called BPD has multiple, complex, interactive, biological, psychological, and constructed sociocultural determinants. Nurses must understand the phenomenon at this level of complexity to provide appropriate care.

Publication trends in individual DSM personality disorders: 1971–2015

“…When Axis II conditions are difficult to differentiate, clinicians may also favour use of one diagnosis, inadvertently biasing publication rates. Biases in diagnosis of personality disorders such as borderline personality disorder have been documented previously (e.g., Bjorklund, 2006), which may further complicate interpretation of our findings. For example, overdiagnosis of borderline personality disorder, and underdiagnosis of Cluster C disorders may have inadvertently contributed to increased research output for borderline personality disorder, and more limited research output in the Cluster C conditions.…”

Maternal Transmission of Borderline Personality Disorder Symptoms in the Community-Based Greifswald Family Study

“…There is some evidence, however, linking paternal variables, for example, psychopathology, to offspring's BPD symptoms (Helgeland & Torgersen, 2004). In addition, the literature is inconsistent as to whether women are diagnosed as having BPD more frequently than men (Bjorklund, 2006) or whether prevalence may be equal among both sexes (Grant et al, 2008). Thus, the influence of BPD in fathers on offspring requires consideration in future research.…”

Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden

“…[50][51][52]) and as the MSI-BPD instrument has been used less often with male participants, we decided to use a lower cut-off of 5+ positive answers instead of 7+ suggested by Zanarini and colleagues [48] to reduce the risk of false negatives.…”