Clinical providers diagnose BPD among sexual and gender minority (SGM) patients regardless of maladaptive personality domains that underlie the BPD phenotype. However, common forms of distress observed among SGM populations mirror BPD diagnostic criteria. It is possible that SGM individuals differ in clinical presentations than their cisgender heterosexual counterparts and this difference might be responsible for the increased BPD diagnosis rather than clinical bias.
Objective: To compare the diagnosis of BPD among a large sample of clinical providers based on SGM status using a vignette-based randomized experiment.
Method: 426 licensed clinical providers (clinical/counselling psychologists, psychiatrists, clinical social workers, and licensed mental health counsellors) were randomly assigned to receive one of three clinical vignettes describing a hypothetical case that highlights symptoms commonly endorsed among SGM individuals between Fall 2021 and Fall 2022. Vignettes differed in the SGM status of the presenting client (conditions: cisgender heterosexual man, cisgender gay man, transgender woman). Participants reported the primary and any comorbid diagnoses they believed fit the case, as well as their agreement that BPD was an appropriate diagnosis for their case.
Results: I will present the results from our preregistered study questions:
Results indicate that clinical providers assigned BPD to SGM vignettes more than in the cisgender heterosexual condition (OR=1.61, p=.04). This results, however, is driven providers’ increased diagnosis of BPD in the transgender (OR=1.97, p=0.01) rather than the sexual minority (OR=1.31, p=0.32) condition. Sub-sample and BPD criterion comparisons are currently underway and will be completed in time for the ISSPD 2023 conference.