A study carried out by Rodriguez-Seijasat (2013) at the University of Michigan suggests that medical professionals are more likely to diagnose LGBT people with BPD than they are to diagnose heterosexuals with the same disorder.
The study involved 36000 participants aged 18 to 90 years old.
Approximately 3 percent were LGBT and the other 97 percent were heterosexual.
The results of the study showed that LGBT individuals were approximately twice as likely to be diagnosed with BPD than their heterosexual counterparts.
According to Rodriguez-Seijasone, one reason why this overdiagnosis of BPD amongst the gay community exists may be that those making the diagnosis are liable to overlook the negative effects of the stress involved in being part of a sexual minority, and instead attribute these negative effects to a disordered personality or genetic factors associated with BPD.
For example, LGBT individuals may suffer confusion about their identities (a symptom of BPD) not because their personality is disordered but because they may feel particularly pressured, compared to the average person, to behave differently depending upon the social context in which they find themselves in (e. g. if they have a family who disapproves of homosexuality, gay people may feel that they need to behave in ways that conceal their true selves when in the company of these intolerant and prejudiced relations).
The study also found that those from the LGBT community had more impulsive sex than heterosexuals, had greater money management problems, and had a greater propensity to self-harm.
Again, though, overly attributing this behavior to a disordered personality or to genetic predisposing factors may serve, Rodriguez-Seijasone points out, only to re-stigmatize LGBT individuals.
Indeed, whilst these features of behavior may all be construed as symptoms of BPD, they are also explicable in terms of alternative cultural norms (in the case of impulsive sex), internalized feelings of worthlessness (in the case of money management problems/overspending which may arise as a desperate attempt to compensate for such feelings), and emotional distress linked to being part of a minority which still faces significant discrimination and prejudice (in the case of self-harm).
Rodriguez-Seijasone concludes that we need to be careful when diagnosing BPD in LGBT individuals and consider to what degree their symptoms are a result of the psychological pressures that being part of the LGBT community entails. In this way, he hopes, we can, by tailoring treatment for gay people presenting with emotional disturbances more appropriately, make such treatment more effective.
Reuter et al.(2015), in a study focusing on adolescents, also found that LGBT individuals were more likely to be diagnosed with BPD than their heterosexual peers and, additionally, bisexual adolescents were more likely to be diagnosed with BPD than homosexual adolescents. Reuter speculates that this might be the case as, as Ochs (2015) theorized, bisexuals may be subjected to dual marginalization whereby they are neither fully accepted by the heterosexual nor the homosexual communities.
Reuter also suggests that the minority stress model may be applicable to understanding LGBT mental health issues. This model theories that those from minority groups are brought into conflict with a wider society which can involve experiencing prejudice, discrimination, and rejection from family, peers, and society in general. Furthermore, LGBT individuals are more likely to be victims of physical and psychological violence as well as be liable to feelings of internalized homophobia and self-stigmatization. All this, unsurprisingly, can have serious effects on both physical and mental health.
Finally, Reuter also speculates that LGBT individuals are more likely to experience chronic invalidation during adolescence (and, indeed, sometimes throughout their entire lives) which (as highlighted by Linehan, 1993) may have a particularly devastating effect on mental health.
Whilst, then, a BPD diagnosis is more common within the LGBT community compared to the heterosexual community, Reuter warns against falling into the potential trap of inferring that being from a sexual minority is enough, on its own, to cause a person to develop BPD.
It seems reasonable to conclude that whilst LGBT may be more at risk of developing BPD-like symptoms as a result of traumatizing factors deriving from interpersonal and other issues such as those referred to above, it is important that any diagnosis reflects the role such traumatizing factors have played in the LGBT individual’s psychological difficulties when appropriate, one such more appropriate diagnosis may be, in some instances complex posttraumatic stress disorder.