Distinguishing and Addressing Gender Minority Stress and Borderline Personality Symptoms
Distinguishing and Addressing Gender Minority Stress and Borderline Personality Symptoms
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DOI：
10.1097/hrp.0000000000000234
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发表时间：
2019-09-01
影响因子：
3.8
通讯作者：
Keuroghlian, Alex S.
中科院分区：
文献类型：
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作者：
Goldhammer, Hilary;Crall, Cary;Keuroghlian, Alex S.
由于变性人和不同性别的人在临床环境中的可见度越来越高，临床医生要求在提供肯定护理以改善这些患者的心理健康和福祉方面提供更好的指导。特别是，在是否、何时以及如何诊断和治疗性别少数群体中的临界性人格障碍方面，需要更多的指导，部分是为了回应一些心理健康临床医生的信念，即少数性别认同可能是身份认同扩散的表现。在这篇观点文章中，我们认为，性别少数认同，即使是流动的，也很少是认同扩散的迹象。通过仔细研究患者性别认同发展的历史，临床医生可以澄清患者的性别少数认同的存在，并获得更多的确信。此外，性别少数群体经历的多种与污名相关的应激源可能会产生能够模仿或符合某些临界性人格障碍诊断标准的症状和行为。因此，我们建议采用性别肯定框架来治疗出现在性别少数群体患者中的边缘人格症状，这对未来的研究和实践具有启示意义。
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.