The Role of Social Inequality in the “Feminization” of Borderline Personality Disorder

Author

Jane Goldie Ekhtman, CUNY City CollegeFollow

Date of Award

2025

Document Type

Thesis

Department

Psychology

First Advisor

Waleed Sami

Second Advisor

Elliot Jurist

Third Advisor

Brett Silverstein

Keywords

social inequality, BPD, gender, therapy outcomes, SES, class

Abstract

Borderline personality disorder (BPD) is a severe and prevalent mental illness that is three times more likely to be diagnosed in women than men. BPD research has attempted to explain this gender disparity, with clinician gender bias emerging as a possible factor. Yet, no research to date has examined the role of social status in the overdiagnosis of women with BPD. There is merit in examining BPD through a class lens as low SES is a risk factor for BPD, poverty and income inequality disproportionately affect women, and low status is associated with stereotypical traits of femininity. Additionally, mental health providers (MHP) and trainees exhibit both gender and class bias in therapy. Thus, this study sought to investigate the role of a client’s social status in the likelihood of MHP to attribute female gender to the BPD diagnosis. In a between-subjects design, N=153 MHP and clinical trainees viewed a vignette of a client with BPD and either low or high social status. Participants were then asked the most likely gender of the client. A chi-square showed the association between client SES and assigned gender was significant, X² (1, N=153) = 31.898, p <.001, V=0.457. Participants were 7.78 times more likely to assume the client with BPD was female when the client had low social status than when the client had high social status. MHP with a completed clinical degree (OR: 15.63) were more likely to exhibit this bias than trainees (OR: 4.72). This study provides novel evidence that MHP 1) hold gendered bias of social class; and 2) this may play a role in the diagnosis of women with BPD. Investigating the “feminization” of BPD through an intersectional approach has important implications for improving the clinical practice of feminist psychotherapists and dismantling co-occurring systems of inequality within the clinical dyad.

Recommended Citation

Ekhtman, Jane Goldie, "The Role of Social Inequality in the “Feminization” of Borderline Personality Disorder" (2025). CUNY Academic Works.
https://academicworks.cuny.edu/cc_etds_theses/1190