76. Treating the Pathological Female: Why the Current Model Fails

Most treatments for Borderline Personality Disorder focus on emotional dysregulation. The goal is to reduce distress, self-harm, anxiety, and crises. But that misses the mark. In this episode, I argue that modern psychiatry has adopted a model of Borderline Personality Disorder that is incomplete. By focusing almost exclusively on suffering, it neglects the maladaptive strategies harm others. I also examine the striking contrast between how psychiatry approaches Borderline Personality Disorder—predominantly diagnosed in women—and Antisocial Personality Disorder, diagnosed predominantly in men. Why do we define one disorder primarily by the patient's suffering and the other by the harm inflicted on others? And what has this double standard done to treatment? In the second half of the episode I outline what I believe a more realistic treatment model would look like. If you've ever wondered why Borderline Personality Disorder remains so difficult to treat, this episode offers a very different way of thinking about the problem.