NOT FOR PUBLICATION
Borderline Personality Disorder:
Patriarchal Boundaries of Sanity, Self, and Sex
by James I. Higginbotham
--bor'der·line n. 1. A line that establishes or marks a border. 2. An indefinite area intermediate between two
qualities or conditions. --bor'der·line adj. 1.a. Verging on a given quality or condition. b. Of a questionable nature
or quality; dubious. 2.a. Psychology. Relating to any phenomenon that is intermediate between two groups and not
clearly categorized in either group. b. Relating to a condition characterized by a pattern of instability in mood,
interpersonal relations, and self-image and manifested by self-destructive, manipulative, and inconsistent behavior.
(American Heritage Dictionary)
INTRODUCTION
The term “borderline” is a metaphor for a perceived boundary between two concepts. In
the psychiatric world, borderline refers to a personality type who exists in the “no man’s land”
between sane and insane. I use sexist language intentionally, because this diagnosis is
overwhelmingly applied to women; officially (APA, 1994), ¾ of those diagnosed as borderline
are female. In my own professional experience, the ratio is greater than 5 to 1, even though
studies (e.g., Trull, 1990) suggest that these borderline characteristics are more numerous among
non-clinical men than similar women. Such disparity suggests that this “mental disorder” is a
focal point for hidden assumptions and contradictions within psychiatric thought. The best
method of interpreting this fabled persona is through an examination of the discourse that
inscribes her in this militarized zone with a number, 301.83, and a designation, Borderline
Personality Disorder.
A review of the authoritative “speech acts” of the psychiatric community is an appropriate
starting point for a public debate (Benhabib, 1992). Since no voice should be privileged as a
given, then the official rhetoric of the psychiatric system should be scrutinized for its
metaphysical and ethical assumptions (Browning, 1987). This analysis of the diagnostic criteria
of BPD requires a hermeneutic of suspicion regarding the discourse of psychiatry, specifically the
Diagnostic and Statistical Manual of Mental Disorders (DSMTM). The question is whether Axis
by
II1 of the DSM, which classifies disorders of personality, is largely speculative and ultimately
political in nature. I believe these diagnostic categories not only reflect a patriarchal social order,
they’ve often been used as instruments of hegemony and have little therapeutic value. As a
pastoral counselor I’m also troubled that the worldview reflected in personality disorders is
incompatible with Judeo-Christian thought. Belief in a Creator implies the value of all persons
and a desire to understand the other, but a psychiatric diagnosis of borderline seems much less an
attempt to appreciate a person’s character, than to pigeonhole. Given this concern to protect the
integrity and individuality of persons who have been given this label, I will not use “borderline”
as a pronoun, and not present any case studies.
It is my thesis that the issue of BPD embodies central questions of sanity, gender, and
self, and their relation to Western society. In literature, the metaphor of a border often references
an entire culture, which is feared and demonized, like the U.S. obsession with the Mexican
border (Wirth-Cauchon, 1993). I propose to show that this diagnosis is indicative of patriarchal
circumscription of the boundaries of gender and madness and, more directly, the cultural borders
that the psychological world is designated to legislate. In other words, psychiatry helps define the
border of normality, and thus indirectly shapes norms of gender and morality. In the process of
drawing these lines, women are accused of crossing boundaries like inappropriate anger, sexual
promiscuity, and uncomfortable relating, and these are interpreted as signs of mental pathology.
So the thrust of this paper is that, like all disputed boundaries, borderline is a site of controversy,
not just about gender and madness, but also the limits of psychiatry.
1 The DSM is a multiaxial diagnostic tool. PD’s are identified on Axis II, but the more familiar clinical conditions such as
affective, anxiety, substance abuse, and adjustment disorders are classified as Axis I disorders.
2
AT THE BOUNDARIES OF ONE SELF
The first three criteria of BPD (see Appendix) raise the critical questions of what is a self
and what is an appropriate relation between self and others. The terminology includes a mixture
of psychodynamic or post-Freudian language (“idealization,” “devaluation,” “self-image”),
traditional medical-ese descriptors (“intense,” “markedly,” “persistently,” “extremes”), and
ambiguous concepts and adjectives (“frantic efforts,” “abandonment,” “unstable,” “identity
disturbance”) that invite conflicting interpretations, if not a projection of the clinician’s fantasies
and expression of entrenched prejudice.
Inconsistency in vocabulary and theoretical orientation is a core problem regarding the
normative character of the DSM. For example, many of the ethical assumptions ensconced in
Freudian theories are present. Medical language partially masks the values evident in these three
criteria; first, a person should have composure, even in the face of a crisis like abandonment;
second, a unified, stable self-image is normative; and third, a consistent view of others, based on
non-emotive (rational) processes, is ideal. These may well be fairly-well accepted mores in our
culture, but given the prescriptive character of the DSM, such norms must be adduced up front.
The concept of an independent, static, and unified self is a standard against which patients
are measured in this discourse. However, evolutionary and social psychologists, feminists, and
others have asserted that persons may be better understood through the affiliations in which they
have been involved, than by the traditional view of autonomy and differentiation. Let me offer a
couple of examples of these theories.
Feminist theologian Catherine Keller (1986) has cogently argued that a young child is
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inherently relational and that patriarchal societal forces encourage the belief that separate identity
is a primary goal of human development. Keller and other process-thinkers also advance the
primacy of relatedness one step further, proposing a notion of self that is constantly changing, in
flux with the experiences and people to whom one relates. In this theory, autonomy is not
fundamental, because one is connected with everything over against which one might identify
oneself. Human identity is process-oriented and fluid, not singular and fixed.
Another argument against the model of self that is normative in the DSM arises from
renowned psychologist Nancy Chodorow’s (1989) critique of the Freudian view of human
development. Chodorow demonstrates that women’s ego boundaries are more permeable due to
the primary care and socialization of girls by women. Thus, the cognitive style implied in the
diagnostic language might also be due to culturally constructed gender incongruities.
Psychologist Dana Becker (1997) applies a similar analysis to the borderline
classification that is more disturbing. Becker contends that like Snow White, women are
socialized through mirrored appraisals of others to have identities that appear fractured.
Tragically, girls’ identities often shatter under the pressures of adolescence into the condition that
receives the borderline label. Becker (p. 108) provides a compelling argument that the twin
phenomena of “female sexualization and devaluation” are dominant forces creating a culture of
invalidation: “Invalidating environments can engender the development of a false self because, in
these environments, an individual is encouraged to bring into play only those aspects of her inner
experience that fit the inner experience of another.”
These first three criteria of BPD give testimony to male definitions of the normative self.
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There is evidence that what is pathologized in the DSM is at least typical of women’s
socialization, if not potentially more true of human relations in general. The view of a healthy
person as autonomous, always rational, and having very firmly-defined relations with others has
been challenged on many sides as at least being untrue of women. Some argue that relationality is
feared by men because it diminishes the power of masculinity; is this why the porous boundaries
of BPD is pathologized? I am not suggesting that there should be no limits to the fluidity of self
and relations; people need boundaries to develop and function. Clearly, though, a person with a
rigid view of self and others will function much better in this patriarchally-defined society than
those on the other end of the spectrum who are probably more commonly termed mentally ill.
THE LINE BETWEEN HATE AND FEAR
The 4th, 6th and 8th criteria of BPD point to the misogynistic nature of this diagnosis.
When these criteria are added together, they create a caricature of a “bitch,” that dangerous,
unpredictable woman whom men fear and must control. A milder version these “symptoms” can
be seen in the proposed Premenstrual Dysphoric Disorder (DSM-IV, p. 715ff), an exclusively
female and highly criticized diagnosis. Criticism regarding the comparison of PMS and
uncontrollable women is so obvious that I only note the persistent history of these oppressive
concepts (e.g., Chesler, 1972; Noddings, 1989; and Ussher, 1992).
Evidence of sexism is unmistakable in the language here. The proposed PMS disorder is
the only other adult diagnosis in which inappropriate anger is a criterion. For example,
Antisocial PD (largely attributed to men) uses the words irritability and aggressiveness as
standards, but only if enacted through assault. Only oppositional defiant children are also
5
described as have difficulty controlling their anger. When insolent kids and women are the only
ones pathologized for throwing temper tantrums as opposed to violent behavior, then the
discourse is suspect.
The acclaimed movie, Girl, Interrupted is a dramatic first-person portrayal of being
labeled borderline. Diagnosed as an adolescent, Susanna Kaysen was shuffled in and out of
treatment facilities for a decade, often against her will. Her profound cynicism is understandable
when one examines the symptomatic language under which Kaysen (1993, p.148) was diagnosed
the 1960's. Earlier versions of the DSM included “shopping sprees,” “casual sex,” and
“promiscuity” as symptomatic. Kaysen (p. 158) wonders how many girls a 17-year-old boy
“would have to screw” to be judged promiscuous, as she was for sleeping with her one boyfriend
and getting caught for the lack of a private location. Kaysen’s (p. 156) cry “What would have
been an appropriate level of intensity for my anger at feeling shut out of life?” joins a chorus of
voices which echo against unmoved patriarchy and the mental health profession.
These are not questions of whining shrews; there is much evidence of a misogynistic
mental health culture. For example, psychiatrist Gerald Schoenewolf’s 1991 book, The Art of
Hating argues that destructive hate is the chief problem of human existence. Schoenewolf
identifies cultural depictions for several types of hate. For the Borderline type, he provides a list
of seven female examples especially the famous movie Fatal Attraction [also Zola’s Nana,
Souther’s Candy, Carmen, Salome, and the female stars in Blue Angel, Pretty Poison], and only
one male possibility, Dr. Jekyll and Mr. Hyde, is really drug-induced. I emphasize Fatal
Attraction, since it is often mentioned as prototypical of BPD, and suggests the image of a
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powerful and destructive female figure whose violent rage victimizes men. Schoenewolf (p. 48)
unknowingly supports this stereotype in his clinical description: “Borderlines are extremely
touchy individuals and it is hard to know quite what is going to set them off or how to relate to
them.”
A critical question arises: how much of this “dangerous anger” is in the perception of the
clinician? In psychiatric thought, rage is a sign of a breakdown in ego control that connotes an
unstable person. Yet, perceived resistance in the clinical relationship often is equated with such
out-of-control anger, too. Critics (Wirth-Cauchon and Greenspan, 1983) claim that since
resistance is a potential threat to the therapist’s authority, it makes clinicians feel helpless and
want to flee from the patient. Thus, women are accused of resistance and inappropriate anger,
because of a threat to the power of the counselor. This was Susanna Kaysen’s experience when
she reflected on her treatment by numerous male psychiatrists. Feminists (Greenspan) have long
critiqued traditional psychology, asserting that actions by many women considered resistant are,
instead, refusals to participate in the power dynamics of the therapeutic relationship or a rejection
of patriarchal domination, which they have experienced all too often.
Unfortunately, when anger is pathologized appropriate cries of injustice may not be
heard. Anger becomes outside the bounds of women’s discourse, and silences them in one more
manner. Therefore, anger is kept from being the empowering emotion that it can be, especially
for those who have undergone oppression (cf., Saussy & Clarke, 1996 and Greider, 1996). In my
work with numerous women who might fit the description of this disorder, anger often has been
experienced as an emotion in which they felt the most alive, filling an emptiness that seemed
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present, and thus therapeutic.
BORDERING ON ILLNESSES
The fifth, sixth, and seventh criteria of BPD surface diagnostic questions. Perhaps many
who are diagnosed with this PD actually should be understood as coping with a mental health
concern like depression, which would connote less shame and open up other possibilities for
treatment. The ninth symptom, dissociation, adds the category of Posttraumatic Stress Disorder
(PTSD) as a potential reason why so many women receive this designation.
Although confusion between categories is a problem throughout the DSM, there are
indications that BPD is less tenable than most diagnoses. Evidence of heterogeneity can be found
in the history of this classification. I contend that since “borderline” serves as a metaphor for the
boundary between two enigmatic concepts – sanity and madness – the term has become a
collection of disparate formulations brought together into an artificial unity in the DSM. At the
turn of this century, use of the term “borderline” usually referred to symptoms that would be
classified as Manic-Depressive today. In classical psychoanalytic thought, it was conceived as the
territory between neurosis and psychosis, and in neo-Freudian theories, related to conception of
the self and the not-self.
One chronicle of this history (Wirth-Cauchon) documents that analytic, neo-Freudian, and
other uses of the borderline term were merged into a single character type through the political
process of the DSM. I would even argue that the inclusion of several PD’s – borderline,
narcissistic, and histrionic – was, at least, partially a trade off for the elimination of the neurosis
concept. Supporting these hypotheses is a recent, curiously honest revelation by Theodore Millon
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(1996), the leading figure in the DSM’s work on PD’s. Millon’s final memo as the senior author
of the DSM-III committee, which included the BPD diagnosis for the first time, argued for
almost any other term than “borderline” as the nomenclature for this population. He (p. 659) said
“borderline” designates a “level of severity” more than a description of a disorder. Millon’s
memo nearly admits that “borderline” is what I would call a wastebasket of ideas organized
around a term. Notably, when first introduced, BPD became (and still is) the most commonly
diagnosed personality disorder. Thus, in a nearly arbitrary manner, the discourse of borderline
has evolved from a non-category – a territory between disorders – to a popular discrete entity.
One possible genesis for some features of BPD is trauma. It has been observed that in a
large percentage of cases the symptomology and experiences of persons identified as BPD
coincide with the recovery from early trauma and should warrant a diagnosis of PTSD (Becker
and Brown & Ballou, 1992). Research has found that the PTSD label is often not applied, even
when it is more appropriate than BPD. In a study involving hundreds of clinicians, Dana Becker
found that if a patient is identified as a woman, male clinicians are significantly more like to
diagnose BPD than PTSD when given a hypothetical case containing equal symptoms of each.
Becker does not comment on the particularly dubious nature of this taxonomic issue: a PD is not
to be diagnosed if an Axis I disorder like PTSD could better account for the symptoms.
Similarly, a significant amount of comorbidity or clinical overlap between depression and
BPD has been observed. Studies have raised the possibility that this collection of symptoms is a
type of depression that primarily impacts women with certain predispositions. Compounding this
connection is a recent national report on women’s depression (McGrath, et al., 1990) which notes
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that possibly a majority of women who suffer from major depression have been victims of sexual
assault or other severe trauma at some point in their lives. So there is both empirical and
theoretical basis for an argument that in many cases BPD should be understood as depression,
possibly involving distortions in self-image due to the social construction of gender identity.
Threatening the diagnosis in a very different manner, BPD is hypothesized to be delayed
development. One of the most comprehensive studies of hospitalized patients with a BPD
diagnosis (Stone, 1990) concludes that two-thirds will “get better” regardless of treatment after
the age of 30. If improvement occurs simply with maturity, then is the discourse of BPD a
judgment of deviance given women by a patriarchal society that resists assertiveness and
encourages passivity in young women?
Such questions raise serious concern regarding the usefulness of BPD. Heterogeneity and
comorbidity are problems for every diagnostic category, but there is strong evidence that PD’s in
general and BPD in particular are more prone to these difficulties.
WHAT’S IN A NAME?
Having examined the vocabulary of the DSM, I briefly want to turn to social and
historical factors that have shaped the discourse. Many (Becker, Brown & Ballou, Chesler,
Ehrenreich & English, Greenspan, and Ussher) have argued that women’s high rate of mental
illness is a product of their male-defined roles as second class citizens and their mistreatment or
stereotyping by a male-dominated and possibly misogynistic psychiatric profession. Certainly
increased exposure to stressful life events – such as mothering, greater poverty, and a host of
subtle and overt oppressions – is likely to be a factor. However, I am also asserting that normality
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has been defined such that women’s ways of acting, thinking, and especially relating are
considered closer to the line of what is madness than the “normal” male ethos.
Both gender and sanity are largely social constructions designed to order culture and
control forces that are constitutive to existence, but are not fully understandable. The phrase “a
normal person” seems self-evident, but everyone is blind to their quirks, and normal is
exceedingly difficult to define. Moreover, these issues are historically formed, and have changed
dramatically (cf., Scheff, 1984 and Ussher). Legal and medical definitions are now at the
forefront, and religious language has faded into etymology. Women are no longer called witches
or demon-possessed, they are marginalized with labels that have technical sounding
symptomology and fancy hypotheses about etiology.
Given such a history, we must consider the claims of the infamous psychiatrist, Thomas
Szasz (1961, p.292; italics orig.), who criticizes the mental health profession as an insidious
language-based game, in which “the psychiatrist as manipulator of human material punishes,
coerces, or otherwise influences people to induce them to play, or cease to play, certain games.”
If the game is about gender, then perhaps such criticism is warranted with regard to BPD.
Other scholars wonder if some behavior described within the BPD can be viewed as
appropriate adaptation to women’s marginalization. Psychoanalyst Andrew Samuels (1988)
observes that many women suffer tremendously from a circumscribed interpretation of what it
means to be female. Women are encouraged to be non-aggressive, selfless creatures who relate to
everyone, but receive little affirmation in return. Samuels asserts, “Borderline-personality
disorder may be regarded as a kind of protest of this requirement.” There is evidence of such
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adaptation in research (Chin 1994) that shows how well-functioning women who are defined by
more than one culture alter their behaviors according to the different value settings. For example,
an Asian-American woman might be deferent with an authority figure like her husband, while
confrontative and challenging at Euro-dominated workplace. Such behavior can be easily
pathologized as splitting, but it is clearly adaptive for such multiply-defined women.
Much of this involves labels (cf., Scheff), a necessary, but potentially destructive force
within any discourse. Society labels certain qualities as female, others as abnormal, and some are
called self-destructive. The pernicious thing about labels is the manner in which they tend to
coalesce into a larger stereotype. So, like histrionic, and dependent “characters,” there is a
borderline persona, born largely out of psychodynamic writings. In the clinic, the diagnosis of
"borderline" often creates reactions similar to a contagious disease: “I don’t want to have
anything to do with that client.” Even well-meaning pastoral counselors (e.g., Martin, 1995)
pigeonhole BPD’s as manipulative and dangerous. When a name creates the unintentional
appraisal of a therapeutic pariah, the discourse is suspect.
Nevertheless, the nature of sanity and normality is critical to human existence, and needs
to be defined. Care must be used, especially since mental illness is not a bodily disease in which
an organ ceases to function, rather socially aberrant behaviors which often have unknown
etiology. Such concern is particularly relevant to the label of a PD, which is designed to identify
maladaptive characterological styles of behavior. Unfortunately, this is essentially the immorality
of an individual according to a social definition of what is good for a person and society.
At this point, I feel trapped between different discourses and ways of making sense of
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human nature. As a counselor I have seen patterns of behavior that seem consistent, which appear
to contribute to the painful stories I hear. I identify similarities that fit the PD categories I am
calling into question. I am not sure how much of what I am seeing is due to my socialization,
since I can’t step outside my social identity as a clinician. My suspicious side questions the
legitimacy of these DSM categories, because they appear arbitrary. My religious convictions
include a basic belief in the goodness of all persons, implying that since humans do not randomly
organize their experience, there must be some positive meaning to these patterns, not just
maladaptability. Capping my confusion is the realization that mental illness is, at best, a fuzzy
concept involving social judgment and limited empirical evidence (cf., Lilienfeld & Marino,
1995).
I have to agree with psychiatrist Andrew Samuels (p. 182), “The borderline speaks to us
so deeply because in it we test the limits of sanity and madness.” Borders are critical to discourse
about human nature and relations. But are there ever clear boundaries in human psychology, or
only border areas? So maybe BPD exists as a protection for those of us within mental health,
from forces of the mind that we know to be uncontrollable, but don’t want to face within
ourselves.
Surprisingly, support for this possibility is in the DSM-IV (p. 651) itself, in its description
of BPD’s most dramatic symptom, self-mutilation, as “expiating the individual’s sense of evil.”
Here the DSM directly raises the ugly head of immorality, of course attributing it to the
borderline’s sense of self. In the end, this discussion is really about the nature of evil. Throughout
Western history, women in general, and types of women in particular, have been placed in a
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position of blame or marginalized as crazy or evil to protect the dominant viewpoint. If only
certain people are on the border of madness and evil, then those who make the rules have less
reason to consider their own insanity or the immorality of their rules. Maybe it is not so cynical
to believe, then, that the game of life can be understood as an attempt to write the instructions so
as to define the dominant group as the “good winners,” without letting the “losers” know that the
game was rigged.
Thus, I have examined the rules of diagnosis. Within them are suggestions of arbitrariness
and oppression, as well as ambiguity. If, as research indicates, that among those most cruelly
oppressed for decades, some tendencies to what is called pathology becomes ingrained at the
genetic level then changes to society are more profoundly needed to try to reverse the effects of
centuries of misogyny and other forms of subjugation. Otherwise, persons like those labeled as
having personality disorders become the scapegoat for social evil. Blaming the victim is an age-
old tradition among dominant powers, which will continue until there is greater appreciation for
the interconnection of personal and social difficulties, and a resulting change in the labels which
are used for those who suffer the most.
If all that I have implied is true, then all of us have a little “borderline” within us. To
believe otherwise, I think, only encourages oppression. We must either join those who have been
relegated to the borders of our culture or eliminate the boundaries entirely. Inclusion of the
“marginalized” voices into the discourse is necessary. Therefore, this paper has been a
preliminary attempt to examine the language and method by which certain persons are
marginalized and oppressed, and, in a sense, cross the boundaries which supposedly separate.
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This is a small step in a much larger project of identifying the means by which our society
normalizes certain behaviors and beliefs through the power of our cultural institutions. Such an
analysis is necessary, since in my opinion, a psychologically astute, theologically informed
dialogue will be more attentive to the unnecessary borders and boundaries which characterize
most discussions, hopefully leading to a more open and just conversation about what is or should
be normal.
Appendix
Diagnostic criteria for 301.83 Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and
marked impulsivity beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-
mutilating behavior covered in Criterion 5
2) a pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation
3) identity disturbance: markedly and persistently unstable self-image or sense of self
4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-
mutilating behavior covered in Criterion 5
5) recurrent suicidal behavior, gestures, or threats, or self mutilating behavior
6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and rarely more than a few days)
7) chronic feelings of emptiness
8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper,
constant anger, recurrent physical fights)
9) transient, stress-related paranoid ideation or severe dissociative symptoms
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REFERENCES
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders,
Fourth Edition. Washington, DC: Author.
Becker, D. (1997). Through the looking glass: women and borderline personality disorder.
Boulder, CO: Westview Press.
Benhabib, S. (1992). Situating the self: Gender, community and postmodernism in contemporary
ethics. New York: Routledge.
Brown, L.S. & Ballou, M. (Eds.)., (1992). Personality and psychopathology: feminist
reappraisals. New York: Guilford Press.
Browning, D.S. (1987). Religious thought and the modern psychologies: A critical conversation
in the theology of culture. Philadelphia: Fortress Press.
Chesler, P. (1972), Women and madness. New York: Four Walls Eight Windows.
Chin, J.L. (1994). Psychodynamic approaches. In Comas-Díaz, L. & Greene, B. (Eds.) Women of
Color: Integrating ethnic and gender identities in psychotherapy. New York: Guilford Press.
Chodorow, N. (1989). Feminism and psychoanalytic theory. New Haven: Yale University Press.
Ehrenreich, B. & English, D. (1978). For her own good: 150 years of the experts' advice to
women. Anchor City, NJ: Anchor Books.
Gilman, C.P. (1993). The yellow wallpaper. Erskine, T.L.& Richards, C.L. Eds.
New Brunswick, NJ: Rutgers.
Graham, E.L. (1995). Making the difference: Gender, personhood and theology.
Minneapolis: Fortress.
Greenspan, M. (1983). A New Approach to Women & Therapy. Bradenton, FL:
Human Services Institute.
Greider, K.J. (1996). “Too militant”? Aggression, gender, and the construction of justice.
In Moessner, J.S. (Ed.) Through the eyes of women: Insights for pastoral care. Minneapolis:
Fortress Press.
Keller, C. (1986). From a broken web: Separation, sexism, and self. Boston: Beacon Press.
Kaysen, S. (1993). Girl, Interrupted. New York: Turtle Bay Books.
16
Lilienfeld, S.O. & Marino, L. (1995). Mental disorder as Roschian concept: a critique of
Wakefield's "harmful dysfunction" analysis. Journal of Abnormal Psychology, 104, 411-420.
Livesley, W.J., Schroeder, M.L., Jackson, D.N. & Jang, K.L. (1994). Categorical distinctions in
the study of personality disorder: Implications for classification. Journal of Abnormal
Psychology, 103, 6-17.
Martin, V. (1995). Bright, beautiful, and deeply troubled: Borderline Personality Disorder:
How to help the person and protect yourself. Leadership, 16, 111-116.
McGrath, E., et al. (Eds.). (1990). Women and depression: risk factors and treatment issues:
final report of the American Psychological Association's National Task Force on Women
and Depression. Washington, DC: APA.
Millon, T. (1996). Disorders of personality: DSM-IVTM and beyond. New York:
Wiley-Interscience.
Noddings, N. (1989). Women and Evil. Berkeley: University of California Press.
Samuels, A. (1988). Gender and the borderline. In Schwartz-Salant, N. & Stein, M. (Eds.)
The borderline personality in analysis. Wilmette, IL: Chiron Publications.
Saussy, C. & Clarke, B.J, (1996). The healing power of anger. In Moessner, J.S. (Ed.)
Through the eyes of women: Insights for pastoral care. Minneapolis: Fortress Press.
Siever, L.J. & Davis, K.L. (1991). A psychobiological perspective on the personality disorders.
American Journal of Psychiatry, 148, 1647-1658.
Scheff, T.J. (1984). Being mentally ill: A sociological theory. New York: Aldine.
Schoenewolf, G. (1991). The art of hating. Northvale, NJ: Jason Aronson.
Sprock, J. (1996). Abnormality ratings of the DSM-III-R TM personality disorder criteria for
males vs. females. Journal of Nervous and Mental Disease, 184, 314-316.
Stone, M.H. (1990). The fate of borderline patients: Successful outcome and psychiatric practice.
New York: Guilford Press.
Szasz, T.S. (1961). The myth of mental illness: Foundations of a theory of personal conduct.
New York: Harper & Row.
17
Trull, T.J. (1990). Borderline personality disorder features in nonclinical young adults:
I. Identification and validation. Psychological Assessment, 7, 33-41.
Trull, T.J., Widiger, T.A., & Guthrie, P. (1990). Categorical versus dimensional status of
borderline personality disorder. Journal of Abnormal Psychology, 99, 40-48.
Ussher, J. (1992). Women’s Madness: Misogyny or mental illness? Amherst:
University of MA Press.
Wirth-Cauchon, J. (1993). Borderline: A study of gender and madness. Doctoral dissertation,
Department of sociology, Boston College, 1993.
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