Grant: Doctoral Research Award: Canada Graduate Scholarships

Transgender or "trans" people (i.e., those with a different or more expansive gender than the one they were assigned at birth) are disproportionately diagnosed with borderline personality disorder (BPD) compared to non-transgender people. Identity disturbance is a diagnostic criterion of BPD in the Diagnostic and Statistical Manual of Mental Disorders-5-TR, and is characterized by a persistently unstable sense of self. Conflation between gender identity changes that are normal for trans individuals and the BPD symptom of identity disturbance may lead to overdiagnosis of BPD in trans groups. Such a conflation has significant implications; in Canada, trans people must be diagnosed with gender dysphoria before they can access government-funded gender-affirming surgeries, and assessing gender dysphoria involves ruling out other plausible diagnoses like BPD. Therefore, differentiating between gender identity changes as a harmful element of BPD and a normative trans experience is vital to avoid discriminating against trans experiences and potentially limiting access to needed gender-affirming care. Therefore, this study has three aims: (1) Conduct and qualitatively analyze interviews about gender identity changes in trans people with and without BPD, and identity disturbance in those with BPD. (2) Using the findings in aim 1, establish guidelines for trans-inclusive BPD assessments that aim to differentiate between identity disturbance and normal trans experiences. (3) Evaluate the extent to which the new guidelines change diagnostic outcomes on the identity disturbance criterion for trans people with and without BPD. This study will use a participatory action research design, whereby a group of trans people with BPD will advise on every aspect of the study. By describing trans people's experiences of gender identity changes and improving diagnostic precision and equity, this research could positively impact social, legal, and medical outcomes for trans people.