Misdiagnosis of Borderline Personality Disorder in Transgender and Gender Nonbinary Populations

BackgroundTransgender and nonbinary (TNB) individuals have faced problems with clinical bias in the mental health world. TNB individuals appear to be assigned pathologizing diagnoses like personality disorders at disproportionate rates from their cisgender counterparts, which can result from transphobia and lack of trans-affirmative training.AimsThe following study aims to examine potential diagnostic bias and factors which may lead to the misdiagnosis of BPD in TNB populations.MethodsThis study included a clinical vignette of an adolescent client presenting to the emergency room with several symptoms which met criteria for gender dysphoria. This vignette was presented via email to currently practicing mental health clinicians (N = 178) who were then asked to select a diagnosis from a list provided and report the degree to which each symptom or diagnostic feature impacted their diagnostic decision-making. In addition, practitioners provided demographic information as well as their level of training working with TNB clients, their level of comfort working with TNB clients, and their perceived personal knowledge or competence in TNB-affirmative care. Practitioners also completed a measure to assess levels of endorsement of transphobic attitudes or beliefs.ResultsFindings indicated that borderline personality disorder was the third most selected diagnosis (n = 12), with gender dysphoria (n = 82) and major depressive disorder (n = 75) being the two most assigned diagnoses. Additionally, findings suggested personal knowledge of trans affirmative care, rather than formal training, was more likely to predict diagnostic outcomes in this case. Specifically, individuals who diagnosed gender dysphoria had higher transphobia scores compared to those who chose another diagnosis.DiscussionClinical implications and suggestions for future research are discussed.