Women ‘out of order’: inappropriate anger and gender bias in the diagnosis of borderline personality disorder

Abstract

I argue that the inappropriate anger criterion for borderline personality disorder (BPD) is likely to contribute to gender bias in the diagnostic process. In its current form, the inappropriate anger criterion is vaguely formulated, providing close to no guidance on to how to distinguish inappropriate from appropriate anger. Further, recent work in moral psychology highlights that the inappropriate anger criterion can be understood and applied in wide range of ways, none of which are required nor excluded by criterion. Moreover, research on public administration and management gives us reason to suspect that the criterion’s ambiguity coupled with the working conditions characteristic of healthcare settings is likely to increase the risk that clinicians will rely on stereotypes in their assessments of the appropriateness of anger. Specifically, various empirical studies point to the existence and widespread influence of gender stereotypes whereby anger is associated with men. Women who display anger are seen as underconforming to prescribed gender roles and, therefore, abnormal. Thus, we have good reason to think that women’s anger will more often be thought inappropriate than men’s, in general and in psychiatry.