I have been doing a lot of research on borderline personality disorder lately, because I got diagnosed with it. It led to me noticing a fairly interesting dichotomy.
Most personality disorders are diagnosed at a fairly similar rate in men and in women. The exceptions are Antisocial Personality Disorder, mostly diagnosed in men, and Borderline Personality Disorder, mostly diagnosed in women.
The DSM diagnosis for Antisocial Personality Disorder includes criminal behavior, deception, impulsiveness/failure to plan ahead, irritability and aggressiveness shown through physical violence and assaults, reckless disregard for the safety of oneself and others, irresponsibility (refusal to work and honor financial obligations) and lack of remorse (rationalizing hurting/mistreating/stealing from other people). The DSM diagnosis of Borderline Personality Disorder includes frantic attempts to avoid abandonment, unstable and intense interpersonal relationships involving extremes of idealization and hatred, persistently unstable self-image and sense of self, self-damaging impulsiveness, suicidal and self-injuring behavior, extreme mood swings, chronic emptiness, inappropriate anger, and stress-related paranoid ideation, delusions or dissociative symptoms.
Anyone else notice something odd? They basically boil down to “extremely dysfunctional hyper-masculinity” and “extremely dysfunctional hyper-femininity.”
I mean, think about it. Recklessness and violence? Associated with masculinity, key symptoms of Antisocial Personality Disorder. Emotional highs and lows and caring about relationships very intensely? Associated with femininity, key symptoms of Borderline Personality Disorder.
This isn’t really a full-formed thought, just a weird thing I noticed. I know there’s been some feminist critique of BPD– most notably, the way it occasionally is treated as being Bitchy Female Patient Disorder– but I don’t know if there’s been similar work done on Antisocial Personality Disorder. I wonder if this is biological or a reflection of gender norms/socialization or just a product of me spending too much time reading about personality disorders.
I once dated a guy who met every behavioral criteria on both the antisocial and borderline lists. Starting to wonder if most people who meet the criteria on one list meet those on the other, but doctors look more for criminal type stuff in men and more for relationship type stuff in women. Especially if we’re talking about domestic violence. I mean, if you alternate between idealizing and hating your partner and physically lash out when you’re in hate mode, is that antisocial or borderline? Also, impulsiveness shows up on both lists. So does anger/aggressiveness: antisocial if it leads to… Read more »
To describe the ‘symptoms’ of Antisocial Personality Disoder as “recklessness and violence” but the ‘symptoms’ of BPD as “emotional highs and lows and caring about relationships very intensely” struck me as an odd formulation. It seems to confirm the pathological nature of the behavior in APD while minimizing the pathological behaviors associated with BPD. It would give a different impression to describe APD symptoms as ‘intense frustration and focus on the now’ and BPD as ‘cutting and paranoid obsession’.
I once read a book that presented the idea of these being extremes of the masculine and feminine brains. The title eludes me at the moment. Here is the theory though: http://en.wikipedia.org/wiki/Empathizing%E2%80%93systemizing_theory
BPD and APD are very complex conditions and there is a wide variety of opinion in the medical community on diagnosis and treatment, or if they even exist. Ozy I think you’re right to question both what it means medically and how that relates to the cultural forces around it. IMHO the more information the better. If BPD is a correct assessment for your situation, it will have unique effects based on your chemical makeup, upbringing and current environment and ultimately it’s really up to you to make the best of it. I do think there is something to be… Read more »
@PhineasRex, spot on. But it’s also worth mentioning that the root cause for some disorders are linked inextricably to biology, so the problem may not be sexism within psychiatry as much as differences in biological sex.
Ozy, this really isn’t something you can usefully comment on without extensive training. I do not want to tell you what you can and cannot do but I am warning you that your post sounds just like everybody else who has just been diagnosed with a personality disorder. This is pretty common; somebody gets diagnosed with a personality disorder, does some light research, and then goes and tells people how much bunk personality disorders (or just the one they were diagnosed with) are. There is an issue of sexism in psychological diagnosis (there have been some good studies examining this)… Read more »
“This is pretty common; somebody gets diagnosed with a personality disorder, does some light research, and then goes and tells people how much bunk personality disorders (or just the one they were diagnosed with) are”
Ding ding ding!
…Did I at any point say that my disorder was bunk? I said it was interestingly gendered. As shocking as it may seem, something may be interestingly gendered and still real.
Christ. I am here inside my brain, I *know there’s something wrong here.* I’m a mass of dysfunctional patterns and suicidal urges held together by duct tape and sheer bloodymindedness.
I love you anyway. Or at least internet-love you.
In defense of Ozy, the way that I read the article was not as “the disorders are bunk due to gender” but more like “it would appear as though diagnoses of these disorders follow gender lines. It appears as though the disorders themselves describe a stereotypical hyper “masculine” and hyper “feminine” set of behaviors.” It is possible that Ozy has stumbled into something interesting. We know that society has some affect on how psychological disorders represent, and if these disorders are related to extreme version of society’s views on gender that might be revealing about underlying causes or shed light… Read more »
Carol Tavris did an excellent job documenting this in her book ‘The Mismeasure of Woman.’ She basically argued that we punish men and women for doing exactly what society demands from them and also noted that even when men and women behave the same way we’ll label it differently so that it gels with what is already decided.
This would line up with the whole “this is your gender role. you must read and act from this script and this script only. and when you do we will punish you for it. and if you don’t we will punish you for it.” bit that’s been going on for ages.
I know we’ve had talks about the gendered nature of depression on this blog before, and honestly, I would not be surprised to learn that some personality disorders are expressed in gendered ways.
Anyway, that is a tough diagnosis, there’s just so much societal baggage surrounding it and I’m sure the symptoms are no fun. I hope you are getting good care – my bf is a psych student and he says that DBT has shown some great results in the past decade or so. Hopefully you can find something that will work for you. <3
I think my thoughts about personality disorders are too inchoate right now to be worth anyone’s time to read. I just wanted to say that I’m sorry you’re suffering from enough of the symptoms you listed to be diagnosable with BPD. I know personality disorders aren’t the kind of thing you just get over, and it would be a little insulting to say “feel better soon,” but I really hope you’re able to find peace and fulfillment, if that’s what you want.
The diagnostic list may say different things, but I’ve met both APD and BPD sufferers. They’re exactly the same. I think it’s the same root dysfunction, we just keep giving it different names for men and women due to sexist history and the inherent difficulty to falsify theories in the social sciences. Depression also often manifests differently in men and women, but we don’t give two names for it.
I’ll defer to the opinion of any actual psychiatrists here, though.
It might be helpful to read the work of Simon Baron-Cohen (yes, he’s related) who specializes in the differences between ASPD, BPD, and ASD.
…or to do a broader literature search. Baron-Cohen’s work is interesting but controversial, and I would say a lot of his hypotheses are still in their infancy as far as testing goes.
In the borderline spectrum is also the extreme polarization, either someone is a saint or a demon. This often leads to what is called splitting. I think that is orthogonal to concepts of gender roles.
The borderline people I have known were usually victims of childhood abandonment themselves, hence their crippling and entirely irrational fear of it in later personal relationships. At a guess I might say that BPD and APD are flip sides of the same coin, with the same causes, that manifest differently due to genetic and environmental reasons, but I have no idea if this is correct. The only borderline people I have known have been women, but this is over a trivially small sample size, so that observation is hardly worth much. These personality disorder conditions are supposed to get better… Read more »
For anyone who hasn’t read The Hitchhiker’s Guide to the Galaxy, “taking the Ravenous BugBlatter Beast of Traal approach” to a borderline person means running away. Terribly fast. At all events do not get into a relationship with them unless you have the mental resilience sufficient to take a good waterboarding combined with the patience of a heron. I tried, for almost 2 years, and it nearly drove me to suicidal breakdown. Not that I realised at the time that this was what I was dealing with, but in hindsight it became as clear as day. The problem is that… Read more »
Yo, ACS, read the OP. OZY is now amongst those with a BPD diagnosis. It’s not “they don’t make it easy.” It’s “you don’t make it easy.”
I know empathy can be hard, especially when we’re talking about a category of people defined by personality traits that have hurt you in the past. But maybe remembering that you’re on a site, responding to a post, written by someone with a BPD diagnosis can help.
…I am so very, very pleased to discover that I am incapable of an honest relationship and that I view everyone on the planet as pixels on the computer screen for me to manipulate.
God, I know relationships with a borderline person can be *wretched.* I can observe my own behavior enough to figure that out. But can you steer away from the ableism?
What on earth are you on about here? Doesn’t it occur to you that as you impugn the way people living with BPD objectify others, you are referring to BPD sufferers again and again as some faraway “they” – on a blog where Ozy regularly engages with the comments? A bit ironic perhaps. Think twice about what it means to tell a newly diagnosed person that you advocate running the fuck away from people like her.
I can see how experiencing terrifying powerlessness and not being cared about in childhood could produce either antisocial or borderline personality disorders. Either way, the person doesn’t trust the people with whom they’re supposed to be bonded. The borderline person would like to trust the people they love, I think; the antisocial person has written that off as ridiculous and just wants power. I started out with borderline traits and got more antisocial as I got older, which I’m not sure is an improvement. I can feel empathy – and I suspect plenty of antisocial people can, hence sadism, only… Read more »
I think sometimes it is a little too neat to categorize people into certain Personality Disorders….frankly, I think my karate sensei is both: Antisocial and Borderline (with a good helping of Narcissistic) Personality Disorders!
Take a look at compensatory narcissism. It isn’t an official subset of NPD, but it would probably explain what you’re describing.
Personality disorders do tend to be quite narrowly defined. By necessity, since they describe deviant behavior and one can’t simply declare a new personality disorder to fit everyone with a new set of deviant behaviors. That said, the ones we have tend to do just fine, and drive-by diagnoses by random people in our lives will produce quite strange results. I myself am bipolar, but often my depressed periods express with a flat affect/ no emotional expression. Someone who knew me might look at these and, without input from me, incorrectly guess my symptoms but diagnosis that criteria correctly within… Read more »
A similar observation: anxious-preoccupied vs dismissive-avoidant attachment in the adult extension of attachment theory, Attachment_in_adults on wikipedia. Same dichotomy. Interestingly I am nominally male and identify with the former.
I don’t know about borderline, but Antisocial personality is biological. A person suffering from the disorder is usually biologically incapable of empathy.
Brian, I think you’re getting more at sociopathy/psychopathy (usage of both terms can be problematic as “sociopathy” and “psychopathy” aren’t clinical terms and usually refer colloquially to a pattern of behavior typical of a person diagnosed with Antisocial Personality Disorder, so vernacular usage further confuses the issue). Antisocial Personality Disorder is just that: a personality disorder. Personality disorders are defined as a set of dysfunctional behaviors caused by experiences that do not conform to typical societal expectations. Personality disorders are thus caused by traumatic or abnormal socialization and are defined culturally by what a society largely delineates as “unacceptable behavior”;… Read more »
All mental disorders and conditions are correlated with changes in the brain, but to say they are brain-bound — that biology has decided the behavior — is not something that has been conclusively determined in the majority of cases. Is it that the biology caused the behavior or that the behavior rewired the brain (as all thinking does, all the time)? Or were the two in an endless feedback loop that finally differentiated significantly enough to be diagnosable? The DSM is forever in flux, combining and separating disorders, eliminating them, attempting to reflect our most recent information, constantly razing over… Read more »