From the National LGBT Health Education Center, Fenway Institute, Fenway Health, Boston, MA (Ms. Goldhammer and Dr. Keuroghlian); Harvard Medical School (Drs. Crall and Keuroghlian); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Crall and Keuroghlian).
Harv Rev Psychiatry. 2019 Sep/Oct;27(5):317-325. doi: 10.1097/HRP.0000000000000234.
As transgender and gender-diverse people are gaining increased visibility in clinical settings, clinicians are requesting better guidance on providing affirming care to improve the mental health and well-being of these patients. In particular, more direction is needed on whether, when, and how to diagnose and treat borderline personality disorder among gender minorities, partially in response to beliefs among some mental health clinicians that a gender minority identity may be a manifestation of identity diffusion. In this Perspectives article, we argue that gender minority identity, even when fluid, is rarely a sign of identity diffusion. By taking a careful history of a patient's gender identity development, the clinician can clarify and gain more conviction regarding the presence of a patient's gender minority identity. Moreover, multiple stigma-related stressors experienced by gender minorities may produce symptoms and behaviors that can mimic or be consistent with certain diagnostic criteria for borderline personality disorder. We therefore conclude with recommendations for adopting a gender-affirming framework to treat borderline personality symptoms when present among gender minority patients, with implications for future research and practice.
随着跨性别和性别多样化人群在临床环境中越来越受到关注，临床医生们要求提供更具支持性的护理指导，以改善这些患者的心理健康和幸福感。特别是，人们需要更多的指导，包括是否、何时以及如何诊断和治疗性别少数群体中的边缘型人格障碍，部分原因是一些心理健康临床医生认为，性别少数群体的身份可能是身份扩散的表现。在这篇观点文章中，我们认为，即使性别认同是流动的，也很少是身份扩散的迹象。通过仔细了解患者的性别认同发展过程，临床医生可以澄清并更加确信患者的性别少数群体身份的存在。此外，性别少数群体经历的多种与耻辱相关的压力源可能会产生类似于或符合边缘型人格障碍某些诊断标准的症状和行为。因此，我们最后提出了在存在性别少数群体患者时采用性别肯定框架来治疗边缘型人格障碍症状的建议，这对未来的研究和实践具有重要意义。
