Resolution, Not Conflict

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Gender Bias in Diagnosing Anger: Batterer or Borderline?

How much of a role does gender play in diagnostic labeling of people who rage? All are toxic in their impacts on those around them. Yet women tend to get labeled clinically as borderline while men get called abusive, sociopathic, or bipolar. By contrast, the terms "toxic" and "narcissistic" seem to be equal-opportunity diagnostic categories. Read More

I'm a firm believer in the

I'm a firm believer in the idea that culture deeply shapes the gender roles we take up as we grow older. A two year old can already have gendered toy preferences even though there's nothing biological about blue vs pink. If you start from a seed of overwhelming anger and add the very invasive way societal beliefs about gender shape our most fundamental behavior, I'm not surprised that there is a gender difference in the way that anger issue expresses itself.

Interesting article

Society does seem to equate violence with the masculine. Although emotionally unstable or hysterical with the feminine.

As for adhd yeah well, if boys are still brought up to explore, to play, to be adventurous and all that fun stuff no wonder. Imagine after all that being stuck in a classroom, needing to be still quiet and disciplined for hours on end!!!

Girls normally have been taught these skills from the beginning.

I'm probably assuredly out of date, but I guess some of these biases still factor heavily no???

Seems like calling this

Seems like calling this behavior "abusive" makes the most sense. Emotional, verbal, and physical abuse are all abuse, hurting another person. "Toxic" seems like a weird term to me, as I've known people I would consider toxic who weren't abusive per se... like someone who is constantly in a bad mood, constantly complains or has something negative to say. Never heard of toxic as being a clinical term. I've also known people who were narcissistic to a fault but not abusive. I would say my mother suffered from narcissism and she did have clinical depression, possibly just clinical depression that was so bad she couldn't see past the end of her own nose. If we had a problem or needed her help it was always "woe is me" never "how are you feeling?" not once that I remember. I've also heard of men who felt they were suffering from borderline personality disorder but couldn't get the diagnosis or the treatment. I think it does sort of make sense to have male and female clinical labels due to gendered behavior, as long as it's well recognized that the labels can also cross genders, if uncommonly.

Clarifying...

These comments are clarifying for me that labels that refer to specific behaviors, e.g., verbal abuse, are more helpful that those that claim to refer to a syndrome (e.g., borderline). There's too much variability in broader categories.

The description of narcissism in your mother is especially poignant: "If we had a problem or needed her help it was always "woe is me" never "how are you feeling?" not once that I remember."

Gender based descriptions

I think that the behavior descriptions have gender bias. But, to me, abuse is abuse -- whether physical or mental/emotional. Anger is anger no matter whether it is expressed physically or verbally/emotionally.

I also think that some diagnoses are seen as so "patient-damaging" that they are not used and instead the diagnosing professional might merge one type of disorder into another to avoid creating hopelessness for the patient.

The distinctions between "high functioning borderlines", "(low functioning) borderlines", "malignant narcissists" and "psychopaths" have been a topic discussion topic in another forum.

I think that these label are both with gender bias and with "hopelessness aversion".

Some people consider Jodi Arias (sp?) a borderline -- but she seemed to be more of a psychopath.

Can/should these behaviors be characterized as disorder by the degree of impulse control exercised rather than by gender or aversion to stigmatizing people with specific diagnoses?

Violence is really the outcome of the lack of impulse control. The type of violence is really a matter of "capacity and opportunity", it seems to me. Is self-directed physical violence/abuse really that much of a distinguishing factor when outward directed emotional/verbal violence/abuse is also present?

Males can be borderlines. And all of these Cluster Bs share so many characteristics. But more puzzling to me is whether low functioning borderlines and high functioning borderlines both are borderlines?

2011 study of borderline pd shows no difference in prevalence by gender

I came across this study that explains why, until recently, men evidencing the traits associated with bpd have been diagnosed as "antisocial pd", and concludes that there is no difference in prevalence by gender: men and women have borderline pd in virtually equal numbers.

Innov Clin Neurosci. May 2011; 8(5): 16–20.
PMCID: PMC3115767
Gender Patterns in Borderline Personality Disorder
Randy A. Sansone, MDcorresponding author and Lori A. Sansone, MD

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767/

Excerpted from the conclusion:

"...men with BPD are more likely to have treatment histories for substance abuse whereas women with BPD are likely to have utilized more pharmacotherapy and psychotherapy services. ...

Thus... women with BPD are more likely to be over-represented in mental health services and men with BPD are more likely to be over-represented in substance-abuse treatment programs and/or jails...

...this suggests a risk of sampling bias with regard to prevalence studies."

So it makes sense to me that borderline pd may need to be re-examined as a diagnosis and perhaps sub-categories added to account for the differences in presentation by gender.

Or perhaps, the whole concept of naming "sets" of behaviors needs to be discarded, and instead a "menu" of behaviors can be checked off instead so each patient has a unique, personalized diagnosis.

A great study and a reference that's very helpful

Very clarifying study.

I agree with your conclusion that a menu of specific psychological attributes may be more helpful than labeling sets of behaviors as if it were a single degree entity.

I'd at least like to limit the term bpd to emotional hyper-reactivity. Bpd can exist on its own, or can co-exist, or lead to, depression, psychopathic behavior;, narcissism, etc.

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Susan Heitler, Ph.D., is the author of many books, including From Conflict to Resolution and The Power of Two. She is a graduate of Harvard University and New York University.

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