Among my many diagnoses, I have what is known in the UK as Emotionally Unstable Personality Disorder (Of The Borderline Type), known elsewhere as Borderline Personality Disorder. BPD is described by Wikipedia as “a prolonged disturbance of personality function … characterized by depth and variability of moods.” It manifests in many ways, including rapid cycling mood swings, ‘self-destructive behaviour’, black and white thinking, disassociation and extreme fear of abandonment.
BPD is a serious mental illness and is difficult to diagnose. Unfortunately it is also well-known as being used by psychiatrists and mental health professionals as a way of labelling ‘difficult’ or ‘problem’ patients – I know at least one woman who was threatened with a diagnosis of BPD by a mental health professional because she wouldn’t do as she was told.
Three-quarters of patients diagnosed with BPD are female. I’ve spent some time since my diagnosis wondering why that is, when one would expect the split to be roughly 50/50.
My first thought is that the diagnostic criteria cover much of what is considered to be “stereotypically feminine” behaviour, but to a more extreme level. For example, one of the diagnostic criteria, “Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).” – well, women are supposed to be overly emotional people anyway, right? Another of the criteria is “Frantic efforts to avoid real or imagined abandonment.” We’ve all heard the stereotyped stories of bunny boilers, of women who get pregnant to ‘trap their man’, of women who are controlling and possessive and who are terrified of being alone. Women are supposed to be flighty, unable to control their emotions, and to have trouble navigating their interpersonal relationships.
The second thing I’ve been thinking about is that it’s possible that women get the diagnosis of BPD because some of the diagnostic criteria include things which are considered ‘normal’ for men, but ‘abnormal’ for women. For example, if a woman behaves in an ‘unfeminine’ way, say by expressing extreme anger (another of the diagnostic criteria is “Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)”), the label of BPD is slapped on her by the psychiatrist. “Frequent displays of temper, constant anger [and] recurrent physical fights” are not seen as disordered behaviour in men, they are seen as fairly normal. But it seems that when a woman displays those tendencies she is not normal, she is personality disordered.
Another of the criteria is “Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).” Again, some of these things seen as “potentially self-damaging” (I’m looking at ‘promiscuous sex’ and ‘reckless driving’ in particular) are seen as normal behaviours for men, but in women are considered undesirable enough to be included in the criteria for diagnosing a serious mental illness.
And lastly, I’ve been wondering whether Borderline Personality Disorder is a mental illness/personality disorder at all. Considering so many more women are diagnosed with it than men, and considering it’s thought to develop in early childhood rather than being an innate mental illness, could there be something about being raised female which increases women’s propensity towards BPD-type thinking? Could that ‘inappropriate anger’ be not a disordered way of thinking, but valid female rage against a world which devalues women and things which are thought of as ‘traditionally feminine’?
As I said at the beginning of this post, I have a diagnosis of Borderline Personality Disorder and I believe this to be accurate because my life is severely impacted by my symptoms. But I often wonder if, in a world where men and women were seen as equal, where women were valued and seen as being as worthy as men, whether this diagnosis would exist at all. Or, in an ideal world where women were not seen as ‘other’ and our natural behaviours were not seen as ‘deviant’, whether the world would be more shaped for women (and men) displaying Borderline type symptoms and thus our lives would not be so devastatingly impacted by it. One thing I do know is that as a diagnosis in the current climate, it is extremely stigmatising and for many women it seems to do more harm than good.
Cross-posted to The F Word.
I am pretty convinced that borderline IS a mental disorder – but it’s not unlikely that it’s being misused A LOT.
I’ve actually read a biography by a woman diagnosed with borderline disorder. The wikipedia description: “a prolonged disturbance of personality function … characterized by depth and variability of moods.” plus “black and white thinking” described her very well.
But those other characteristics that would be, like you said, considered ‘normal’ for men, weren’t mentioned in the book.
It’s as if one borderline is two things: either a mental disorder, or a misused diagnosis for females not acting “feminine enough”.
By: Eli on Friday 11th June 2010
at 7:57pm
“I am pretty convinced that borderline IS a mental disorder – but it’s not unlikely that it’s being misused A LOT.”
I’d agree with this. Also, I can’t remember where I read it, but I will try and find the link, that a lot of womyn who are diagnosed with BPD are actually more likely suffering from Acute Post Traumatic.
By: berryblade on Wednesday 16th June 2010
at 9:07am
I’m going to link this post for the next Bristol Feminist Network book group on Women and Mental Health. If you have any further suggestions for online reading on this topic, I’d be very interested.
Thanks
Annifa
xx
By: annifa on Saturday 3rd July 2010
at 12:07am
Please look into Relational-Cultural Therapy, which takes a very different approach to BPD. It’s harder to find their research online, but you can start here: http://www3.interscience.wiley.com/journal/72511959/abstract or wherever you have access to scholarly articles. They have done a lot of thinking about how disconnecting and degrading the diagnosis has become.
They take the view about BPD being PTSD as well.
By: Amy on Saturday 10th July 2010
at 5:58pm
I am also diagnosed Borderline. It is definitely real in my case. I enjoyed your piece and found it thought provoking.
By: Faith Void on Thursday 15th July 2010
at 2:34pm
ive got to admit in reading about borderline personality i read more about woman having BPD than men but there wa that big article about darth vader having borderline personality disorder i have bpd and im a bloke maybes im the odd one out get in i love been diffrent
By: kevin blumer on Tuesday 23rd November 2010
at 8:15pm
It’s certainly valid for you to question BPD in terms of gender bias. But I’m sure a female specialist would give you the same evaluation. Like all stats, I think the numbers are always questionable. If there are more female borderlines, I think it has more to do with the greater likelihood of sexual trauma. For better or worse, women tend to be the more emotional of the sexes and this too would have an effect on borderline symptoms. But it makes me uneasy that someone might dismiss their diagnosis because they think they are being unfairly judged based on their sex. It is a particular concern with borderlines as they are prone to self-victimization (“The world is out to get me”). Denial is also a major component to the disorder.
By: savorydish on Friday 28th January 2011
at 1:56am
> For better or worse, women tend to be the more emotional of the sexes
1) women aren’t more or less “emotional” than anyone else.
2) woman isn’t a “sex,” it’s a gender.
By: twiggy on Wednesday 25th May 2011
at 5:49pm
Technically, “woman” is a word used to denote “adult female human” and could therefore be construed to be a sex as well as a gender.
By: Anji on Wednesday 25th May 2011
at 6:27pm
Technically, you’re being “transphobic” and you should “shut up and sit down”
fucking cis people.
By: twiggy on Thursday 26th May 2011
at 1:31am
That’s interesting! It made me think. Thank you.
By: J.B. on Thursday 26th May 2011
at 7:56pm
BPD is a serious mental illness and is difficult to diagnose. Unfortunately it is also well-known as being used by psychiatrists and mental health professionals as a way of labelling ‘difficult’ or ‘problem’ patients – I know at least one woman who was threatened with a diagnosis of BPD by a mental health professional because she wouldn’t do as she was told.
No, you are quibbling with words simply to argue. Perhaps you are also ODD (Oppositional Defiant Disordered). Them term mental illness exists because only doctors are authorized to dispense medications. You cannot get a prescription from a friend or psychologist using CBT (challenging your viewpoint with rational facts).
Your argument is flawed. Take the first part of the definition, I will use the OLD expanded version: Borderline Psychotic Personality (Disorder).
Borderline – A place between dull rational emotionless behavior & another state of thinking.
Psychotic – Irrational beliefs which are not based in objective fact. In the case here, a woman not differentiating between the outside world & her feelings. Anyone’s feelings being nothing more than the toilet-swirl-of-the-cranium.
Personality – An external assessment of someones demeanor.
So yes, there are many people who operate with a personality & viewpoint which teeters on insane. Men & women all over the place. This judgement is made based on a reference to “normal” which is a mathematical term denoting the top of the bell curve. Where most or the majority of people operate from.
Disorder is a classification given when someones behavior is causing either them or the people around them sufficient difficulty in life to warrant the distinction. They are so far off the mathematically typical behavior of the group & that difference is harmful to themselves or others.
So putting it all together.. Borderline Psychotic Personality Disordered & relating this to feminism…
By definition, they are:
- problem patients
- will not take advice
- is disruptive to her family, friends, coworkers
- operates from a bizarre idea that her thoughts & feelings dictate the state of objective reality (the outside world). That is not how it works.
- rationalized her own paranoia into non-existent groups (“the patriarchy” – we live in a patriarchal world, there is no secret society)
- operates from a victim mentality
Again, if someone’s own personal belief system & external operations are such that they are at the extreme of the bell curve AND that difference is harmful to herself & others THEN they are “disordered”.
If they realize this & want to have a better existence, they change. Either with CBT (challenging their self-centered viewpoints) or via medication. If they do not see any reason to change then their disruptive behavior is shunned by the majority.
You also have stated some very typical & poor assertions that are incorrect. Women are not “supposed” to be more emotional. They simply are, much of it driven by biologically based hormonal fluctuations. If those pace her to the extreme statistical position on a bell curve (say the 110 percentile) then they do require some form of intervention.
PMDD is the same as PMS. But doctors must only prescribe helpful medications for a diagnosed condition. The condition was invented to allow for dispensing Prozak as Serafem. That is political, the help to the patient & the people encountering their disruption is not.
I hope this helps you understand. I am typical (as a human) in that I do not want to spend much of my time arguing with anyone of any gender. That activity is disruptive to my own responsibilities.. to my self, my children, my ex-wife, my employer, & my Queen & country (Canadian here).
You can try to change reality to match your self centered existence all you want. Do not be put off by the fact that no one else has to comply with your own interpretation of existence. So be a good little girl & take your pills please.
By: roberttoronto on Thursday 14th July 2011
at 5:16pm
“You can try to change reality to match your self centered existence all you want. Do not be put off by the fact that no one else has to comply with your own interpretation of existence.”
Irony, anyone?
By: mr on Friday 19th August 2011
at 5:22pm
I have borderline too. Problem is in the uk there isn’t much help because there’s not much they can do unless you want to change and take more pain. In life its a massive disability and stops me doing loads of things i have came out my shell a little bit now and tryed going out meeting people to help my self a little. My biggest wish is that the NHS over here will take it more serious and put more support out there.
By: kbos2hm on Thursday 24th November 2011
at 5:42pm