GID vs. BPD
A Comparison Between Gender Identity Disorder a Borderline Personality Disorder

Have you ever heard of BPD (Borderline Personality Disorder)? I came across a website called Biological Unhappiness that discusses the topic in-depth. The word "dyphoria" is thrown around a lot on that site, and although I found no specific mention of GID or transgender issues in relation to it [with the exception of one letter to the doctor], I could see (given the broad nature of BPD "symptoms") how it would be easy for a therapist to make that leap.

I was also a bit taken aback by the emphasis the doctor who maintains the site places on pharmocological "fixes" for these problems (specifically his endorsement of Prozac for just about EVERYTHING and his claim that Prozac has FEWER side effects than St. John's Wort - a statement that contradicts the findings in a German medical study I've read). There was also mention of "brain differences" in BPD patients and an emphasis on BPD being a BIOLOGICAL disorder, not a personality trait - pretty much the same current thinking as GID. The assertion of it being a biological problem was cited as the basis for pharacological intervention.

The doctor even has similar "issues" with BPD classification in the DSM manual, as it "stigmatizes" people. Again, I was surprised that gender problems weren't lumped into it somewhere as well. Or perhaps that's because (as I'm sure many people treated for GID will attest) drugs don't "fix" GENDER dysphoria. I was curious, given the assertion that GID doesn't respond to anti-depressants and psychotropics, that drugs like Haladol and Prozac were recommended for the treatment of OTHER dysphorias (most notably the type that leads to self-mutilation behaviors).

Okay, so I'm not saying GID is a kind of BPD - given what I've read, it isn't. But I could see how a therapist familiar with the dysphorias of BPD might mistake GID for a form of BPD - especially because many of the peripheral/related psychological problems often associated iwth GID are also associated with BPD. I would assume this is exactly why a "gender specialist" should be consulted, as they would be less likely to misdiagnose GID as BPD.

I'd never heard of BPD before - although I'd heard of almost all the related terms like "Passive-Aggressive," "Bipolar," "Attention Deficit Disorder," "Obsessive Compulsive Disorder," virtually any substance abuse problem, and so on and so on. Virtually ANYTHING, it seems, can be related to it because the "Borderline" in the the term BPD refers to otherwise normal people who are likely to be pushed into a psychosis by some stress-induced "trigger" (they are on the "border" between normal and psychotic). It was actually termed as a kind of "epilepsy" in that a number of stimuli could make BPD people "snap" (such as sounds or light patterns) but "stressers" were more common triggers for the psychosis.

The general term of DYSPHORIA means the emotional problems of anxiety, rage, depression, or despair. Dysphorias can be caused by a lot of things, including a persistent gender identity disorder. According to the DSM-IV the symptoms for BPD are as follows:

Quote: --------------------------------------------------------------------------------

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1) frantic efforts to avoid real or imagined abandonment

2) a pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3) identity disturbance: markedly and persistent unstable self-image or sense of self

4) impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

5) recurrent suicidal behavior, gestures or threats, or self-mutilating behavior

6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

7) chronic feelings of emptiness

8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9) transient, stress related paranoia or severe dissociative symptoms

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As for when the BPD person slips into "psychosis," that means they no longer have a grasp on reality. According to what I have read, people in that state of mind often tell lies they firmly believe to be true (and may remember them as true even AFTER the pychotic episode has ended), and often acts "out of character."

Where I saw potential cross-over or misdiagnosis with GID were in people who recall childhood memories that are not true which lead them to believe they had a gender identity problem when younger. Or those that have episodic engagement in cross-gender activity (in some respects, public crossdressing could be considered "potentially self-damaging"). Attempted suicide and self-mutilation behaviors are also may be quite common among those with gender identity confusion, but often is not reported by GID patients because of fears that it will stand in the way of gender transition. Rocky (or empty) relationships are quite common, as is paranoia about being "found out." Fear of abandonment also figures prominently in the lives of most gender patients. And GID could very easily be described as a "markedly and persistent unstable self-image or sense of self."

So, then, why WOULDN'T Gender Identity Disorder be a result of BPD? Well, a pseudo-GID might be. Perhaps if the person believed they had told their parents they wanted to be a girl as a child, but actually had not. And if they sporadically crossdressed and behaved "out of character" (say, hyper-feminine), or TRULY felt they were another person during a psychotic episode. I'm sure it would take a well-trained and astute therapist to discern the difference. Also, as I mentioned before, GID does not respond to anti-psychotics and anti-depressants, strongly implying it is NOT a psychosis. The "dysphoria" does not go away when drugs are prescribed for GID, with the possible exception of HRT.

Interestingly enough, BPD is affected by hormones. BPD is an imbalance in the functioning and chemicals of the limbic system. In some people HRT might "correct" the chemistry. But this would likely only be true if the person's brain was physically in need of the hormones for proper functioning. That's where GID and BPD may have something in common, IF (and science has yet to prove this) IF Gender Identity Disorder is caused by a physical problem.

The CAUSE of GID is the wrong body for the self-image, the SYMPTOMS are the anxiety, rage, depression, or despair (i.e. "dysphoria"). Most of the related problems people with GID experience are caused by SOCIAL friction. If we were not taught to feel guilt and shame over cross-gender expression we would openly do so - and never suffer the psychological turmoil and fears brought on by social condemnation. (The DSM-IV manual actually contradicts itself to specifically classify GID as a "mental illness" instead of social nonconformity - because if it didn't it would not belong in the manual at all). Correcting the body to match the self-image has been shown an effective treatment for the symptoms of dysphoria. The psychological problems caused by social friction can only be treated by gaining acceptance within society (either by socializing in a subculture where such behavior is accepted or by assuming the opposite gender role and living in stealth).

The treatment for BPD is not aimed at "curing GID." The medical evidence shows that BPD is caused by a chemical imbalance in the limbic system. Psychopharmacology has proven an effective treatment in "correcting" the chemical imbalance, which, in turn, alters brain function and behavior - thus preventing over-reactions to stress that become psychotic. Essentially, the person experiences the same "coping mechanisms" as anyone else, but (due to chemical imbalances) they over-react or get stuck in a "behavioral loop." A person in a state of psychosis cannot judge what is real and what is imagined. I'm supposing it is possible such a person could believe they are the wrong gender while in such a state of mind. And in summary, yes, it is a case that nobody knows how to change the MIND of a person suffering with GID, but altering the BODY appears to work rather well. A person suffering from BPD might claim they have GID (and even firmly believe they do), but it would not be persistent and such beliefs, desires, and behaviors would dissapate under the application of psychopharmacology.

I felt it was important to at least LOOK at a "psychotic disorder" like BPD - especially because it shares some of the same elements as GID. And also because BPD is a concerned with behaviors caused by a biological disorder. Some people may be tempted to think that if psychopharmacology can successfully treat BPD, it may ALSO be able to "treat" another "behavior" problem supposedly caused by a biological disorder - GID.

Friends, family, and co-workers often assume anyone that comes out as transgender is "crazy" or "delusional." So, being familiar with how GID differs from a psychosis can be valuable ammunition against such assertions. To the outside observer, someone with GID may appear to have some kind of "borderline" condition - especially if they have periodically engaged in cross-gender activities in the past. To that outside observer it would seem that the crossgender desire comes and goes (I've actually seen that exact comment on a message board). It is assumed, then, that the dysphoria (anger, anxiety, etc.) ALSO comes and goes. Or for those that are very adept at hiding their feelings, the outside observer may never see ANY evidence the person is emotionally troubled.

The simple fact is that, with GID, the "dysphoria" is NOT episodic - it is persistent whether the individual expresses it or not, it is not "triggered" by any stimulus, and does not respond to anti-psychotic/anti-depressant medications.