University of Michigan, Ann Arbor, MI, USA.
Brown University, Providence, RI, USA.
Assessment. 2021 Jun;28(4):1097-1109. doi: 10.1177/1073191121991922. Epub 2021 Feb 15.
Sexual minority individuals are diagnosed with borderline personality disorder (BPD) at higher proportions than heterosexual individuals regardless of presenting psychopathology. It is unclear if such bias is reflective of diagnostician idiosyncrasies or population-based diagnostic/criterion bias. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were utilized to examine if differences in BPD endorsement were related to/independent of transdiagnostic factor differences between sexual minority and heterosexual individuals. BPD diagnosis/criterion endorsement was higher among sexual minority compared with heterosexual individuals (odds ratios = 1.47-3.82). Furthermore, when dysfunction/impairment associated with criterion endorsement was ignored, endorsement disparities were magnified. Diagnostic/criterion differences were mostly explained by transdiagnostic factor differences associated with sexual minority status, with some notable exceptions. These results suggest that the predilection toward BPD diagnosis among sexual minority individuals does not appear reflective of criterion-related bias. They further highlight the importance of understanding group-specific forms of psychiatric malaise and reinforce the importance of cultural humility for equitable assessment. These results further raise questions pertaining to the conceptualization and epistemology of BPD as it relates to sexual minority individuals.
性少数群体个体被诊断为边缘型人格障碍（BPD）的比例高于异性恋个体，无论其表现出何种精神病理学。目前尚不清楚这种偏见是反映了诊断者的特质还是基于人群的诊断/标准偏见。本研究利用国家酒精和相关条件流行病学调查-III 的数据，考察了 BPD 诊断的差异是否与性少数和异性恋个体之间的跨诊断因素差异有关/无关。与异性恋个体相比，性少数群体个体的 BPD 诊断/标准诊断率更高（优势比=1.47-3.82）。此外，当忽略与标准诊断相关的功能障碍/损伤时，诊断差异会被放大。诊断/标准差异主要由与性少数群体相关的跨诊断因素差异解释，也有一些显著的例外。这些结果表明，性少数群体中 BPD 诊断的倾向似乎并不反映与标准相关的偏见。它们进一步强调了理解特定于群体的精神不适形式的重要性，并强化了文化谦逊对于公平评估的重要性。这些结果进一步提出了与性少数群体相关的 BPD 的概念化和认识论相关的问题。
