by Mariana

March 8^th is marked internationally as Women’s Day, it is not a day to celebrate the delicate beauty of women but to reflect on the struggles we still face to access rights as a vulnerable group despite being a majority in the planet.  From pay gaps, to violence, discrimination, limiting gender roles, to the lack of representation in many professional and leadership spheres, today is a good opportunity to reflect on mental health and women too.

It is no news that women are pushed into gender roles. These are socially constructed behaviors that are expected of an individual based only in their genitalia: women are soft, women are weak, women are more caring, women cry lots, women are hormonal, women lose it all the time… So it’s no surprise that one of the early and most common mental illness diagnosis was hysteria. During the late 1800s, hysteria was framed as a psychological disorder. Symptoms included partial paralysis, hallucinations, and nervousness.

The word hysteria originates from the Greek word for uterus, (ὑστέρα). The Greeks believed that the uterus moved through a woman’s body, eventually strangling her and inducing disease, so these symptoms linked to the female’s anatomy, suggested that the disorder could mainly or only be found in us women. Because we are soooo emotional, you see? Bullshit.

Fortunately, this condition was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. But it is only an example of how women have been generally labeled to be more likely to have mental illness.

However, gender roles also affect men, as they are expected to be stoic, resilient, strong. Until today, in most cultures, men are still limited to embrace their emotions openly; which has fed a higher rate of death by suicide on them. The global Male:Female ratio of age-standardized suicide rates was 1.8 in 2016, meaning there were more males suicides than females suicides (World Health Organization).

Women and BPD

The Diagnostic and Statistical Manual of Mental Disorders states that borderline personality disorder is diagnosed predominantly (about 75%) in women… mmm… but you reading this, and me writing this, know a couple of things about BPD:

It is a serious disorder diagnosed after complying with at least 5 of 9 specific criteria, starting generally during teenage years, but boiling since childhood.

Many traumatic experiences have been found to be deeply linked to its development during the individual’s early years: neglect, sexual abuse, violence. -Aren’t boys vulnerable to these abuses too but are socially more limited to speak up and talk about it?-

It is not yet clear whether the predominant component is biological or environmental/traumatic… how much of both?

In bloody 2021, research and the scientific and medical community, still know almost nothing in regards of mental illness!

So, it is worth questioning:

Is this higher rate of BPD observed in women a result of a diagnostic bias?

Is it only a reflection of biological or sociocultural differences between women and men?

Despite there is a general reluctance to seek professional care, are women just more likely to seek for expert support (given the gender role that allows us to be more “emotional” and “caring”), get a diagnosis and therefore contribute to a mirage larger scale versus men?

As it turns out, “the differential gender prevalence of BPD in clinical settings appears to be largely a function of sampling bias. True prevalence by gender is unknown. The modest empirical support for diagnostic biases of various kinds would not account for a wide difference in prevalence between the genders. Biological and sociocultural factors provide potentially illuminating hypotheses, should the true prevalence of BPD differ by gender”. (source)

More interesting facts…

Source World Health Organization

• Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women.
• Depression is not only the most common women’s mental health problem but may be more persistent in women than men. More research is needed. (Ha!)
• Reducing the overrepresentation of women who are depressed would contribute significantly to lessening the global burden of disability caused by psychological disorders.
• The lifetime prevalence rate for alcohol dependence, another common disorder, is more than twice as high in men than women. In developed countries, approximately 1 in 5 men and 1 in 12 women develop alcohol dependence during their lives. (is this some gender role thing again?)

And unfortunately…

• An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.
• Lifetime prevalence rate of violence against women ranges from 16% to 50%.
• At least one in five women suffer rape or attempted rape in their lifetime.

So, in general, supporting gender equality and free of violence environments currently targeting women will also help us reduce mental illness. Join the cause, be part of the change!

And also, let’s reflect on BPD, does it really affect more women than men? Not sure. It seems the approach to mental health is biased, it lacks gender perspective.

#IWD2021 #ChooseToChallenge