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THREAD: Gender, race and #BPD diagnosis
This has been on my mind a lot lately. The label of 'borderline personality disorder' is already one that comes with a lot of baggage, often negative connotations and negative bias from care providers and laypeople alike.
This has been on my mind a lot lately. The label of 'borderline personality disorder' is already one that comes with a lot of baggage, often negative connotations and negative bias from care providers and laypeople alike.
I think it's a diagnostic category that can be useful when it's shared in a neutral, non-judgemental way to help people understand themselves.
But it's also more complicated than that, because care providers often bring major bias to WHO we see as having #BPD in the first place.
But it's also more complicated than that, because care providers often bring major bias to WHO we see as having #BPD in the first place.
I'm speaking mostly from my own anecdotal observation, but this is documented in the literature as well. For example, #BPD is predominantly diagnosed in women, and men exhibiting many of the same features are more often given a label of antisocial personality disorder.
"BPD in men may not be as rare as generally viewed, and which may reflect BPD being commonly viewed as weighted to women and being misdiagnosed as an antisocial personality disorder (ASPD) in men."
- https://www.ncbi.nlm.nih.gov/pubmed/28768209 (2017)
- https://www.ncbi.nlm.nih.gov/pubmed/28768209 (2017)
Why? The same core features of affective instability/dysregulation, intense anger, and difficulty with interpersonal relationships manifest differently. By and large, women tend to present with more INternalizing symptoms (depression, self harm) and men with more EXternalizing
(physical aggression, yelling, more frequent difficulty with substance use). The latter is more likely to be characterized as harmful to others, violent, and 'antisocial'.
This is especially an issue among racialized men. I've seen this play out multiple times: Black men with
This is especially an issue among racialized men. I've seen this play out multiple times: Black men with
difficulty regulating emotions who have outbursts of anger and frustration are so quickly labeled 'antisocial', and treated only with basic strategies aimed at containing behaviour seen as purposeful and malicious.
Black and Indigenous men are already hugely overrepresented in
Black and Indigenous men are already hugely overrepresented in
forensic psych and prison populations. Part of that is the bias of attributing violent, antisocial/malicious intent to behaviour that in others may be treated with more patience and understood as emotional dysregulation rooted in trauma.
Labels also help determine resources.
Labels also help determine resources.
Someone with a #BPD label will have access to more and different resources, including things like referral to specialized therapy, than someone with an #ASPD label.
People's paths get pre-determined so early based on how care providers interpret their behaviour.
People's paths get pre-determined so early based on how care providers interpret their behaviour.
tl;dr let's really make our 'trauma informed' practice into reality. We need to push beyond the bias that says externalizing behaviour, especially among racialized men, means antisocial traits.
