Gender identity and sexual orientation in women with borderline personality disorder.
BACKGROUND
In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (DSM-IV-TR) (and earlier editions), a disturbance in "identity" is one of the defining features of borderline personality disorder (BPD). Gender identity, a person's sense of self as a male or a female, constitutes an important aspect of identity formation, but this construct has rarely been examined in patients with BPD.


OBJECTIVE
In the present study, the presence of gender identity disorder or confusion was examined in women diagnosed with BPD.


METHODS
We used a validated dimensional measure of gender dysphoria. Recalled gender identity and gender role behavior from childhood was also assessed with a validated dimensional measure, and current sexual orientation was assessed by two self-report measures.


METHODS
A consecutive series of 100 clinic-referred women (mean age, 34 years) with BPD participated in the study. The women were diagnosed with BPD using the International Personality Disorder Exam-BPD Section.


RESULTS
None of the women with BPD met the criterion for caseness on the dimensional measure of gender dysphoria. Women who self-reported either a bisexual or a homosexual sexual orientation had a significantly higher score on the dimensional measure of gender dysphoria than the women who self-reported a heterosexual sexual orientation, and they also recalled significantly more cross-gender behavior during childhood. Results were compared with a previous study on a diagnostically heterogeneous group of women with other clinical problems.


CONCLUSIONS
The importance of psychosexual assessment in the clinical evaluation of patients with BPD is discussed.
Gender Identity Service, Child, Youth, and Family Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Devita
D
Singh
Shelley
S
McMain
Kenneth J
KJ
Zucker
D000328:Adult; D001727:Bisexuality / Q000523:psychology; D001883:Borderline Personality Disorder / Q000523:psychology*; D005260:Female; D005783:Gender Identity; D018452:Homosexuality, Female / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012725:Sexual Behavior / Q000523:psychology*; D055815:Young Adult