It’s not my sense of self that’s unstable, it’s the world’s sense of me: the harms of the construct of ‘personality disorders’ towards transgender communities

Abstract

Research indicates transgender people are more likely to be diagnosed with a personality disorder than cisgender people. While this interrelationship is complex and multifaceted, this article discusses the disproportionate rates of personality disorder diagnosis in transgender people as rooted within social and historical contexts; suggesting transgender people are not more likely to have a personality disorder, rather they are more likely to be diagnosed with a personality disorder. Transgender identities have historically been framed as a manifestation of mental illness as opposed to an identity and inherent aspect of personhood. This is argued to confine understanding of transgender identities to the parameters of pathology, silencing and marginalising transgender communities. I suggest the disproportionate rate of diagnosis of personality disorders in transgender people is an extension of this historical pathologisation. Clinician bias may contribute to inappropriate diagnosis of personality disorders in transgender people due to personal values and unfamiliarity with transgender experiences. However, bias is also more deeply rooted within the construct of personality disorders itself, which appears to inherently pathologise deviation from rigid gender norms and expectations. This has implications for the ethical and ontological basis of the diagnostic construct.