Tuesday, August 20, 2013

Gender Identity and Sexual Orientation in Women with Borderline Personality Disorder: Part 2

… and now for the good stuff! Let’s see if we agree.

Gender Identity and Sexual Orientation in Women with Borderline Personality Disorder: Part 2

Devita Singh MA1, Shelley McMain PhD2, Kenneth J. Zucker PhD1,*
Article first published online: 3 NOV 2010
The Journal of Sexual Medicine
Volume 8, Issue 2, pages 447–454, February 2011


Table 2 shows descriptive data for the GIDYQ and the RCGI for the women with BPD in the current study (for comparative purposes, Table 2 also shows the mean GIDYQ scores of females with GID and a clinical control group of women from data reported on in Deogracias et al.  and Singh et al.  For the GIDYQ, we identified the percentage of BPD women who met the criterion for caseness as defined by Deogracias et al. and Singh et al., which would require a mean score of ≤3. None of the women with BPD met this criterion for caseness.

We next analyzed the GIDYQ and RCGI as a function of self-labeled sexual orientation. For this analysis, we excluded the six women who self-identified as either asexual or unlabeled. 67% of the BPD participants self-identified as heterosexual and 27% self-identified as either bisexual or lesbian. To compare the heterosexual women with the bisexual and lesbian women, we collapsed the latter two categories. A t-test showed that the self-identified bisexual/lesbian women reported significantly more gender dysphoria on the GIDYQ than did the heterosexual women, t(92) = 2.59, P = 0.011, d = 0.36. The self-identified bisexual/lesbian women also recalled significantly more cross-gender behavior in childhood on the RCGI than did the heterosexual women, t(92) = 2.95, P = 0.004,d = 0.28. For the continuous measure of sexual attraction (excluding five women who indicated that they were not attracted sexually to either men or women), the correlation with the GIDYQ was 0.35 (N = 95, P < 0.001) and the correlation with the RCGI was 0.58 (N = 95,P < 0.001). Across all 100 women, the correlation between the GIDYQ and the RCGI was significant, r(98) = 0.58, P < 0.001.

We next compared the data on women with BPD with the same data on the diagnostically heterogeneous clinical control women reported on by Singh et al.  (see Table 2). On the GIDYQ, a 2 (Group: BPD vs. Clinical Controls) × 2 (Sexual Orientation: heterosexual vs. bisexual/lesbian) analysis of variance revealed a significant main effect for sexual orientation, F(1, 183) = 22.18, P < 0.001, with the non-heterosexual women reporting significantly more gender dysphoria than the heterosexual women. On the RCGI, there was also only a significant main effect for sexual orientation, F(1, 145) = 14.93, P < 0.001, with the non-heterosexual women recalling significantly more cross-gender behavior than the heterosexual women.

In our series of carefully diagnosed women with BPD, we did not detect any strong evidence of marked gender identity confusion or gender dysphoria. Using a well-validated dimensional measure of gender dysphoria, none of the women met the criterion for “caseness,” as defined by a mean score of ≤3. The mean GIDYQ scores for the BPD women in this sample were, on average, comparable to the diagnostically heterogeneous clinical control group of women reported on by Singh et al.  (see Table 2). Thus, our data appear to be reasonably consistent with Wilkinson-Ryan and Westen's finding that clinician ratings of gender identity conflict ranked relatively low among an array of possible indicators of identity disturbance in BPD patients. Therefore, a cautious conclusion is that frank gender dysphoria is not a particularly salient aspect of identity issues that female patients referred for BPD wrestle with.

The results of the present study have some implications for theorizing about the relationship between GID and PDs. Over two decades ago, for example, Lothstein argued that female-to-male transsexualism was “primarily a disorder of the self-system . . . involving an early childhood developmental arrest . . . stemming primarily from borderline personality and narcissistic disorders” (p. 11). Although subsequent research on general patterns of associated psychopathology in adult females with GID suggests somewhat elevated rates compared with normative data, the evidence is far from convincing that there is a gross elevation in BPD. For example, Madeddu, Prunas, and Hartmann identified no case of BPD using the Structured Clinical Interview for DSM-IV (SCID) in a sample of 16 female-to-male transsexuals (see also Lobato et al. ). Although other studies have identified modest elevations of BPD traits among female-to-male transsexuals, there is little indication that the association is specific to GID because many of these studies failed to include clinical control comparison groups. In the present study, starting with a sample of BPD women, there was clearly no evidence at all for GID caseness.

I imagine there are quite a few other variables that they’re not taking into account when it comes to trauma and confusion in transsexual psychology, but yanno, try not to gloss over that too much. Egads.

In our sample of BPD women, 27% self-identified as either bisexual or lesbian, and this metric of sexual orientation correlated quite strongly with our self-reported continuous metric of sexual attraction. The percentage of women who self-identified as either bisexual or lesbian was virtually identical to the percentage reported on by Reich and Zanarini and similar to that of Schulte-Herbr├╝ggen et al.. Given that these percentages are quite elevated when compared with population base rates of a self-reported bisexual or lesbian sexual orientation, how might this finding be interpreted?

If the elevation is veridical, three explanations are plausible.  (1.)The first is that the unique stressors associated with a minority sexual orientation predispose a person to develop BPD.  (2.)The second is that a BPD is related to the development of a minority sexual orientation. Perhaps women with BPD experience a greater fluidity in their sexual interests, more so than unaffected women, and this leads them to explore sexual relations with both men and women and, for some, results in a greater percentage eventually adopting a minority sexual identity.  (3.)A third explanation is that both phenomena are related to a third factor or set of factors, which, at present, are unknown.

So either being Gay/Bi makes you more prone to BPD. (My opinion, probably because people would have experienced more abuse, ostracisim, prejudice, and social struggles in their life do the culture they live in).

Being Borderline makes you more likely to be sexually fluid and open to a more sexually open lifestyle.

            Or, they’re not sure yet. (Perhaps it’s just a coincidence.)

An alternative possibility to a veridical explanation pertains to some kind of referral artifact. It is conceivable, for example, that women with a minority sexual orientation and who have a BPD sought out services at our clinic because it has a reputation within the community as being sensitive to sexual minorities, which perhaps was also the case in Reich and Zanarini's U.S. hospital sample. If this conjecture is correct, then it would argue against any kind of genuine elevation of a minority sexual orientation among women with a BPD. One way to test this hypothesis would be to ascertain sexual orientation in a wider range of people with a BPD, including those identified by epidemiological methods, so that one does not have to rely on clinical samples per se.

In the present study, we found that the BPD women who self-identified as bisexual or lesbian reported significantly more concurrent gender dysphoria on the GIDYQ (but not at the level of “caseness”), and also recalled significantly more childhood cross-gender behavior on the RCGI than did the women who self-identified as heterosexual. It is well-established that childhood gender nonconformity is, on average, more common among bisexual and lesbian women than heterosexual women. Thus, these findings were quite consistent with a much broader literature that has documented an association between sex-typed behavior in childhood and later sexual orientation. There was, however, no indication that this pattern was unique to the women with BPD as we previously observed a similar relation in a diagnostically heterogeneous clinical population of women, none of whom were diagnosed with BPD.

So basically, women with BPD and bisexual/lesbian orientation acted pretty much the same way as their non-personality disordered counterparts when it came to gender dysphoria and childhood gender nonconformity, on average. Which to me, indicates that this, as states earlier, as little to do with personality disorder at all.

The relationship between gender role behavior in childhood and later sexual orientation in our sample of women with BPD carries some clinical implications. If it is indeed the case that a minority sexual orientation is elevated among women with BPD, then it would be important to also obtain in a developmental history information about gender development during childhood. It is well known that pervasive cross-gender behavior in childhood carries the risk of social stigma (e.g., within the peer group) and, when it is present, may function as a psychosocial stressor that could serve as a predisposing factor in the development of BPD.

Ah, however, but if a person is also lesbian/bisexual and predisposed to BPD, being lesbian/bisexual and having indicators of this in childhood by gender roles by exacerbate the problems because the stigmas that crossing these lines create is often difficult for children. And as we know, when a sensitive child prone to BPD is stressed, and constantly surrounded by a stressful environment, not accepted for who they are, pressured to be someone they’re not, this is going to wreak havoc on who they are, and create greater issues of identity down the line.

It can anyways. It’s going to depend on the person. I’ve always been comforted by the fact that I’m not heterosexual. Thought I know countless numbers of people that have not had this experience. Granted my heterosexual experiences have been much more traumatic than my homosexual ones, which perhaps, is what contributes to this. Even though these didn’t occur until years after I started dating both men and women. This is why, as with all things, it’s important to take individuals for who each person is and understand each person’s story and history. We all have our own. 

1 comment:

  1. Yeah I'm not at all surprised that non-heterosexuality is more common in BPD women. That's what I've come across myself...
    Because BPD is often caused in early infancy and childhood I doubt sexuality would cause BPD (it wouldn't be something others could be aware ofa at that age usually).. I think BPD causes a more fluid sexuality. That's just my opinion


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