The assumption that psychiatric diagnoses are neutral and universal has been increasingly questioned in recent years. Borderline Personality Disorder (BPD), in particular, serves as a striking example in this context. According to DSM-5 data, this diagnosis is three times more frequently assigned to women than to men. This disproportionate ratio raises the question of whether the diagnosis itself is fundamentally problematic.
In the Turkish context, this issue is particularly noteworthy. Interviews with female patients in psychiatric clinics reveal that many women diagnosed with BPD have actually experienced long-term intimate partner violence. For instance, a 32-year-old patient in Istanbul reported being labeled as “borderline” due to her intense emotional reactions to her husband’s physical abuse. This case clearly illustrates the gender biases embedded in diagnostic processes.
Historical Context: From Hysteria to Borderline
The history of psychiatry’s pathologization of female behavior is long-standing. In the 19th century, the diagnosis of “hysteria” encompassed a range of symptoms believed to result from repressed female sexuality. Today, similar symptoms are classified under different diagnostic labels.
An examination of the development of BPD in modern psychiatry reveals that its diagnostic criteria tend to pathologize women’s emotional expressions. For example, the criterion of “intense and unstable interpersonal relationships” often reflects insecure attachment styles common among women. This exemplifies psychiatry’s tendency to focus on individual pathology while neglecting social context.
Gender Biases in Clinical Practice
Gender biases observed in clinical settings are striking. Research shows that male and female patients presenting identical symptoms often receive different diagnoses. For instance, a man exhibiting angry outbursts may be diagnosed with “antisocial traits”, while a woman displaying similar behaviors is labeled “borderline”.
This phenomenon takes on a unique dimension in Turkey. In a cultural context where women’s emotional expression is already restricted, intense emotional reactions are more likely to be pathologized. For example, a woman who reacts strongly to her husband’s infidelity may be deemed “overly emotional”, while the man’s behavior is normalized as part of “masculine nature”.
The Link Between Trauma and BPD Diagnosis
A significant majority of women diagnosed with BPD report histories of childhood sexual, physical, or emotional abuse. Judith Herman’s work highlights the profound impact of such trauma on personality development. Yet, the psychiatric system continues to interpret these symptoms as individual pathology rather than adaptive responses.
In Turkey, this issue becomes even more complex. In a society where domestic violence is widespread, pathologizing women’s survival strategies leads to secondary victimization. For example, a woman who grew up with an abusive father and subsequently struggles with trust issues and fear of abandonment is exhibiting an understandable trauma response—not necessarily a personality disorder.
Feminist Therapeutic Approaches
Feminist therapy offers an alternative framework for women diagnosed with BPD. This approach is rooted in the understanding that women’s struggles stem not from individual pathology but from societal structures. Unlike traditional psychiatry, feminist therapists:
- Minimize the use of diagnostic labels,
- Situate the patient’s experiences within sociopolitical contexts,
- Center power dynamics in the therapeutic process.
In Turkey, feminist therapy is gaining traction. Therapists collaborating with women’s shelters have developed support programs for survivors of violence. Unlike conventional BPD treatments, these programs prioritize empowerment and helping women make sense of their experiences.
Conclusion and Recommendations
Addressing gender bias in psychiatric diagnoses requires a multifaceted approach. Key steps include:
- Integrating gender perspectives into psychiatric training curricula,
- Revising diagnostic criteria to account for cultural and gender factors,
- Prioritizing trauma-informed approaches in clinical practice,
- Developing policies to improve women’s access to mental health services.
Given Turkey’s unique sociocultural landscape, research in this area could significantly contribute to both national and international literature. A psychiatry that better understands and represents women’s experiences is crucial to the broader struggle for gender equality.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- Herman, J. (1992). Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror. Basic Books.
- Hacettepe University Institute of Population Studies. (2014). National Research on Domestic Violence Against Women in Turkey.
- Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.