Gender Bias in Borderline Personality Disorder
Gender Bias in Borderline Personality Disorder
Borderline personality disorder (BPD) is a mental health condition which is characterised by symptoms such as persistent patterns of emotional instability, negative self-perception, challenges with interpersonal relationships, and impulsiveness (American Psychiatric Association, 2022). These symptoms can be evident in early adulthood and are significantly correlated with high suicide rates. The prevalence rates of BPD in the general population are between 0.7% and 2.7% (Chapman et al., 2024). Many questions persist about the development and aetiology of BPD, as gender maintains an essential influence in BPD diagnoses. Research has found that the prevalence rates between genders show that females have higher rates of being diagnosed with BPD than males. Studies have suggested that women are more likely to be diagnosed with BPD due to biological traits such as individuals' emotions and hormones (Skodol & Bender, 2003). Although recently, epidemiologic studies have found that gender biases may be evident regarding the prevalence rates of BPD diagnoses between males and females (Bozzatello et al., 2024). Moreover, research findings have indicated that differences in the prevalence of BPD in gender may be linked to the emotions expressed by females and males rather than biological factors (Ussher, 2013). These studies highlight the considerable impact that gender biases exert on the diagnosis of BPD. Consequently, it is crucial to investigate whether biases associated with BPD are affecting the precision of gender prevalence in BPD diagnoses. These studies highlight the considerable impact that gender biases exert on the diagnosis of BPD. Consequently, it is crucial to investigate whether biases associated with BPD are affecting the precision of gender prevalence in BPD diagnoses. This essay aims to analyse the extent to which gender biases play a role in the prevalence rates of BPD and the validity of diagnoses between males and females. This will be achieved through the consideration of different research studies and scholars on gender biases, stereotypes and differences in reporting rates between both males and females. The thesis of this essay is that although the DSM-5-TR criteria for BPD provides a valid foundation for diagnosis, it is essential to see if these symptoms are influenced by gender biases and how this may affect prevalence rates of BPD between genders.
Based on analysing case study A and the DSM-5-TR criteria for BPD, the most relevant diagnosis for Jane, who is a 35-year-old female, is BPD. Janet shows how multiple symptoms based on the criteria of the DSM-5-TR for BPD. Janet, for example, shows persistent emotional instability and interpersonal connections, as well as negative self-perceptions (American Psychiatric Association, 2022). Janet's two divorces and idealisations and devaluation of her partners highlight her instability in relationships. She also displays instability in her identity as she is experiencing negative self-perceptions regarding her true self and contemplations of adherence to traditional gender stereotypes. Janet additionally conveys persistent feelings of solid anger and inability to control these emotions in her professional environment, showing her instability of emotions is a characteristic of BPD. Janet also indulges in impulsive behaviours such as excessive alcohol use and expenditure, as well as causal sex connections supporting a BPD diagnosis. Furthermore, despite Janet's successful career, she still claims to experience intense emotions of worthlessness and emptiness. Janet has met multiple critical criteria for BPD following the DSM-5-TR. As mentioned, although the DSM-5-TR provides a valid criterion for Janet's diagnosis, Gender biases may be evident.
Social gender biases are the first point to consider in the higher prevalence of BPD diagnosis in females. Social gender bias consists of the diverse expectations in society that are placed on both women and men; these expectations can be negative, neutral, or positive and can determine how females' and males' emotional and behavioural traits are understood (Ruiz-Cantero et al., 2007). For example, social gender biases are shown as research states that characteristics commonly associated with BPD, such as impulsiveness and emotional instability, are seen as 'feminine' traits in our society (Ussher, 2013). This stereotype of 'feminine' traits has been highlighted by research to account for the overdiagnosis of BPD in women, as traits like neuroticism and impulsivity may be pathologised more readily in women than in men (Skodol et al., 2013). However, there have been multiple research studies that counter this argument, stating that biological differences between genders may also explain the discrepancy between gender prevalence in BPD. Sansone and Sansone (2011) emphasise that genetics and hormones may contribute to females' higher likelihood of being diagnosed with BPD, as females are perceived to be biologically more prone to traits such as impulsiveness and neuroticism. Further research also proposes that certain BPD traits and symptoms, such as emotional instability, are due to females' biological nature (Skodol and Bender.,2003). It is essential to consider that biological differences play a role in the difference in the prevalence of BPD diagnosis between genders. However, gender biases remain a critical factor in BPD diagnoses.
Furthermore, the following point elaborates on gender biases regarding emotions, precisely the expression of anger in women. Emotional instability and expressions of anger in femalesare sometimes misunderstood due to cultural standards that portray women as nurturing, emotionally restrained, passive, and empathic, particularly in public and professional settings (Deng et al., 2016). Following Janet's case study, her recurrent displays of anger, sarcasm and frustration in the workplace have resulted in her being labelled and seen as the 'difficult woman'. This label of the 'difficult women' highlights the gender stereotype women counter when expressing emotions such as anger due to traditional gender roles. Research states that men who express similar emotions in professional environments are more likely seen as authoritative or assertive rather than 'difficult' (Chaplin, 2015). In response to Janet's anger, which is due to her perceived exclusion in the male-dominated work environment, is supported by research as it has been stated that women who do not conform to society's gender norms and ideals of feminity and display emotions such as anger are usually viewed as 'out of order' (Oredsson, 2023). The perception of women as being 'out of order' highlights a gender bias in the diagnosis of BPD, as women's expressions of anger may be interpreted as signs of emotional instability, aligning with the criteria for BPD in the DSM-5TR. Studies indicate that societal stereotypes may result in the incorrect understanding of emotional expressions. However, biological factors such as hormone functions or cognitive traits likely contribute to why some behaviours are more commonly associated with BPD among females. According to Wang et al. (2019), BPD symptoms cannot be explained by gender biases due to the differences in neural functioning and behaviours between females and males. This study also investigated male and female brain activity in the prefrontal cortex and discovered that males and females have diverse cognitive functions and found that females show significantly higher levels of empathy than males (Wang et al., 2019).
Furthermore, another factor that may contribute to gender biases in BPD is the difference in help-seeking behaviours between women and men. According to research findings, men and women approach mental health support and services in quite different ways. These findings emphasise a clear gender bias in BPD as they found that females are significantly more likely to receive mental health assistance while males were found to have high rates of reluctance when it came to seeking Mental health assistance (Gney et al., 2024). This study is supported by further research, as another study found that females have higher rates of being likely to report they are experiencing BPD symptoms and seek help compared to men (Hall & Riedford, 2017). The study also highlights that women are more inclined to seek treatment for BPD despite neurobiological differences than males, as men are unaware they have symptoms of BPD, affecting their ability to receive professional assistance (Hall & Riedford, 2017.) Moreover, research states that despite gender differences in neural and cognitive functioning, males are more likely to express BPD-related symptoms and behaviours such as anger and frustration (Johnson et al.,.2003). However, due to societal gender biases, men are conditioned to assume and view feelings of anger and impulsive behaviours as 'normal', which may lead to a lower rate of seeking mental health services (Bozzatello et al., 2024). These research findings are crucial in understanding that seeking professional treatment and services may contribute to more women being diagnosed with BPD than men, highlighting a clear gender bias as there may be more males who have undiagnosed BPD.
In conclusion, while Janet's behaviours, such as emotional instability, impulsivity and interpersonal difficulties, are supported by DSM-5-TRcrtiera for BPD, the role of gender bias must be carefully considered. The key points, such as social gender bias and stereotypes related to feminity, as well as rates of reporting between genders, can contribute significantly to the differences between BPD diagnoses between males and females. Consequently, this essay only examined the gender differences in BPD. However, it did not counter any racial or ethnic biases, which may also be present in BPD, affecting the validity of this essay's findings. Therefore, future research should focus on racial and ethnic biases as well as gender, as different ethnicities have diverse cultural gender roles and stereotypes for men and women, which can improve future studies' validity and accuracy regarding the prevalence of BPD.
References
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