Sunday, August 23, 2009

Sexism in the DSM's Borderline Personality diagnosis?

"People ask, 'how did you get in there?' What they really want to know is if they are likely to end up in there as well. I can't answer the real question. All I can tell them is, it's easy."
-----------Excerpt from Girl, Interrupted by Susanna Kaysen



I've been posting about mental illness lately so I thought I'd tackle this as well.

When I was in grad school I had a couple different assignments that involved writing about Borderline Personality Disorder (BPD). One involved writing a paper on BPD from two different theoretical perspectives, while also bringing in a cultural aspect and a neurological component. The second assignment for a separate class required that I review a list of text and deside to explore one of them. From the list I chose the memoir Girl, Interrupted. It was a book I had read years ago and the adapted film is one of my favorite movies.




Author Susanna Kaysen released her memoir Girl, Interrupted in 1993. The book is relatively short but packed with an incredible story of a young woman who spent over a year in a mental institution, battling BPD.




In the film we see Winona Ryder who actually looks strikingly like a young Kaysen.



We also see Angelina Jolie play Lisa Rowe. Yes, there really was a Lisa in the book.

So, what is BPD?
The term Borderline Personality Disorder was coined as clients do not fit precisely into the category of neurotic or psychotic but has features of both.

In the book and in the film Kaysen briefly brings up an issue of sexism that is attached to individuals with BPD. The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes persons with BPD as being impulsive usually at the beginning of early adulthood, having instability of interpersonal relationships, distorted self image, having intense fear of real or imagined abandonment and experiencing changes in cognition and behavior due to real or perceived abandonment. Depression often accompanies this disorder and it is important to rule out Major Depression before diagnosing a person as BPD.

I can tell you that there is a huge stigma that individuals with BPD face. In my experience many therapists do not look forward to working with such clients as they tend to be incredibly dramatic, manipulating and often leave the clinician feeling emotionally drained.


"And it is easy to slip into the parallel universe. There are so many of them. Worlds of the insane, the crinimal, the crippled, the dying, perhaps of the dead as well. These worlds exist alongside this world and resemble it, but are not in it."

------------------Excerpt from Girl, Interuppted by Susanna Kaysen


The most current information from the DSM-IV-TR states that that those with BPD “may gamble, spend money irresponsibly, binge eat, abuse substances, engage in unsafe sex, or drive recklessly”. However, the DSM III stated that three characteristics of BPD were shopping sprees, shoplifting and eating binges. The former list may have been specified to women in particular. Although the most current language appears to be gender neutral, BPD is often thought of as a female disorder. It is unclear as to whether BPD exists primarily in women or is simply diagnosed primarily in women.

The symptoms of BPD are split into gendered categories as well. Men who experience BPD are said to develop narcissistic personalities while women are said to have difficulty maintaining healthy relationships. Certainly both genders can develop such barriers.

Several studies have shown that clinicians are influenced by the gender of their patients and are more likely to diagnose men with antisocial personality disorders and borderline, dependent or histrionic personality disorders in women even if the symptoms are identical between the two.

Although some studies have found that women are more likely to have BPD,
it can be argued that sampling issues may contribute to inconsistencies in research as more women seek clinical assistance than do men.

"Another odd feature of the parallel universe is that although it is visible from this side, once you are in it you can easily see the world you came from. Sometimes the world you came from looks huge and menacing, quivering like a vast pile of jelly; at other times it is miniaturized and alluring, a-spin and shining in its orbit. Either way it can't be discounted. Every window on Alcatraz has a view of San Francisco."

-------------Excerpt from Girl, Interrupted by Susanna Kaysen


Many feminist psychologists believe that there is a history of sexism within the DSM's diagnosis of BPD. Additionally, there is often sexism in the way we look at the disorder and treat it. Again, as mentioned earlier it is often viewed as a female illness.

I'm glad to say that there are many of us who know better
.

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