Introduction:

Connection between borderline personality and gender identity. Difficult subject especially if we begin to talk about surgery. Once again, the goal is not to stigmatize but to show that it is really important to search what really is  behind a behavior. You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering

Glossary

Gender identity disorder : Individuals with this mental disorder are uncomfortable with their apparent or assigned gender and demonstrate persistent identification with the opposite sex

Gender Dysphoria : if the person has persistent discomfort with gender role or identity

Transsexualism : Incidence: 1/30,000 males; 1/100,000 females. A gender identity disorder in which the person believes he is the victim of a biologic accident, cruelly imprisoned in a body incompatible with his subjective gender identity. The diagnosis is made only if the disturbance has been continuous for at least 2 years. Differential diagnosis, often difficult to make, must distinguish transsexuals from ... persons with primary borderline personality disorder (the merck manual)

* G De Cuypere, MD; C James, MD - Department of Psychiatry, University Hospital, Gent, Belgium
Gender identity disorder and psychiatric comorbidity: Clinical issues
120 patients seeking for sex reassignment surgery treatment (SRS) in out Gender-Identity Clinic have been assessed regarding their transsexual symptomatology as well as their psychopathology.
The comorbidity of psychosis or borderline personality disorder on the one hand and transsexualism on the other is common, causing a difficult decision-making process for the clinician.

* Marantz S, Coates S. - Clinical Services, Comprehensive Rehabilitation Consultants, New York City, NY.
1991 J Am Acad Child Adolesc Psychiatry - Mothers of boys with gender identity disorder: a comparison of matched controls.
This pilot study compared mothers of boys with gender identity disorder (GID) with mothers of normal boys to determine whether differences in psychopathology and child-rearing attitudes and practices could be identified. Results of the Diagnostic Interview for Borderlines revealed that mothers of boys with GID had more symptoms of depression and more often met the criteria for Borderline Personality Disorder than the controls. Fifty-three (53%) percent of the mothers of boys with GID compared with only 6% of controls met the diagnosis for Borderline Personality Disorder on the Diagnostic Interview for Borderlines or had symptoms of depression on the Beck Depression Inventory. Results suggested that mothers of probands had child-rearing attitudes and practices that encouraged symbiosis and discouraged the development of autonomy.

* Meyer JK.
1982 J Am Psychoanal Assoc  - The theory of gender identity disorders.
Experience with more than 500 patients over the last decade has led to the conclusion that the quest for sex reassignment is a symptomatic compromise formation serving defensive and expressive functions. The symptoms are the outgrowth of developmental trauma affecting body ego and archaic sense of self and caused by peculiar symbiotic and separation-individuation phase relationships. The child exists in the pathogenic (and reparative) maternal fantasy in order to repair her body image and to demonstrate the interconvertability of the sexes. Gender identity exists not as a primary phenomenon, but in a sense as a tertiary one. There is, no doubt, a tendency to gender-differentiate in a way concordant with biological endowment. Nevertheless, gender formation is seriously compromised by earlier psychological difficulty. Gender identity is a fundamental acquisition in the developing personality, but it is part of a hierarchical series beginning with archaic body ego, early body image, and primitive selfness, representing their extension into sexual and reproductive spheres. Gender identity consolidates during separation-individuation and gender pathology bears common features with other preoedipal syndromes

* Wise TN, Meyer JK.
1980 Arch Sex Behav
Gender dysphoria has been clinically associated with borderline personality disorder

Please read the data adoption and bpd

"A person with a gender identity disorder is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that he/she is, in fact, a member of the other sex who is trapped in the wrong body
- Boys with gender identity problems pretend not to have a penis; they want it removed, and they wish they had a vagina.
- Girls with gender identity disorder wish they could grow a penis, and do not look forward to growing breasts or menstruating. They would like to be a man when they grow up
Frequently, people with gender identity disorder complain that they were 'born the wrong sex.' They describe their sexual organs as 'ugly' and may refrain from touching their genitalia. Those with the disorder may show signs of trying to hide their secondary sex characteristics" (John L. Miller M.D.)

"The cause of gender identity disorder is unknown, but hormonal influences in the womb, genetics, and environmental factors (such as parenting) are suspected to be involved" (medline)

"In DSM-IIIR, gender identity questions were one of the bpd diagnostic criteria. Whether it is part of the illness or not is unclear, but there is a higher incidence of gender identity issues in BPD than we see in the general population" (mhsanctuary)

"There was a study approximately 10 years ago that showed 50% of transsexuals lost their desire to change sexes when treated with Tegretol. I don't have that reference any more.
While I doubt all transsexuals have the BPD, the association for most is very, very strong. Individuals with gender identity problems often also have the BPD" (doctor heller)

Here is our feeling

Caution, caution, caution
It seems that there is a close relationship between gender identity disorder and Bpd. That's mean that a lot of peoples with gender disorder have in fact a BPD disorder (but the opposite is NOT true, a few bpd peoples seems to have gender disorder)
Once again and for us, it is not a "surprise" when we know that almost all bpd peoples doesn't know who they really are. So for some of them, they even don't know if they are a male or a female...
.
When we say "caution", that's mean that it is criminal to let some people starting hormonal treatment and of course surgery, without testing first if this person has a Borderline disorder or not.
Can you imagine a person changing her sex to become himself / herself and then notice that the answers are still not there !
No, no, no.  We have no right is such case to make the wrong diagnosis.