A produção social do transtorno da personalidade borderline

Abstract

This research consisted of a monographic production whose objective was to critically analyze the main explanations attributed to borderline personality disorder (BPD), under the perspective of the determination theory of the health/disease process. BPD is described by psychiatry as an individual condition marked by affective instability, impulsivity, chronic feeling of emptiness, and interpersonal difficulties. Its global prevalence is estimated to range between 1% and 3% of the population. Nevertheless, one piece of data is striking: about 75% of diagnoses are attributed to women. This gender bias raises the need for an analysis of the social and historical determinations underlying this suffering. This phenomenon occurs in a context marked by the advance of social medicalization and the expansion of psychiatric discourse. In this sense, to understand this phenomenon, this work was based on the historical-dialectical materialist method, seeking the objective essence of suffering beyond the immediate. This framework allows for breaking with the multi-causal and individualizing logic, placing the health-disease process in the social totality. As a methodology, a theoretical-bibliographic research was developed with the purpose of identifying and systematizing the main causes and etiological factors of BPD described in the literature. 31 indexed studies in the Virtual Health Library (VHL) were analyzed, published in a time frame between 2019 and 2024. The data obtained evidenced a panorama of multiple explanations that coexist, but with different weights in the scientific narrative. The main causes related to BPD were grouped into: “traumatic events in childhood,” including sexual violence (n=20); genetic factors (n=14); general environmental factors (n=14); neurophysiological causes (n=12); low economic status (n=5); and temperamental characteristics (n=2). The analysis showed that the majority of studies adopt a predominantly descriptive and "associated factors" approach, only mentioning histories of neglect and abuse in childhood, and emphasizing "biomarkers" as central to their etiology. With the exception of one article, the high prevalence of sexual violence among diagnosed women is a datum that is naturalized as a statistical factor, without discussing how gender violence and structural oppressions traverse the genesis of BPD. This approach fails to consider that, in patriarchal society, women are systematically subjected to violence, inequalities, and forms of oppression that can manifest as psychic suffering. Consequently, reactions to trauma and violence are frequently decontextualized and pathologized as an innate or congenital "personality disorder." The genesis of this suffering must be understood through the dialectical articulation between the singular-particular-universal relationship. From this perspective, the contradictions of the social totality (the universal, given by the capitalist mode of production) materialize in the particular (gender, race, and class oppression relations), determining the forms of suffering at the individual level (the singular). Life conditions marked by precariousness, typical of the capitalist mode of production, sustain relations of subordination and exploitation that disproportionately affect women, especially working-class, Black, and poor women. Patriarchy, by articulating with the reproduction of capitalism, reinforces control over women through the socio-sexual division of labor and the demand for affective and reproductive dedication. This logic is expressed in the medicalization of women's lives, which transforms experiences of oppression into individual pathologies. Feminist history allows us to understand that the ideas of "normality" and "abnormality" related to "being a woman" were constructed according to the needs of patriarchal society. Drawing a parallel, the current BPD diagnosis bears similarities to the characterization of hysteria in the 18th and 19th centuries, when feminine behaviors that challenged the norm were labeled as "incurable madness." Currently, psychiatric discourse multiplies diagnoses that transform women's suffering, derived from adverse social conditions and daily abuses, into predominantly female pathologies. The fact that BPD diagnostic criteria (such as intense anger and impulsivity) are socially accepted behaviors and read as "masculine" when presented by men, but pathologized in women, evidences that the multiplication of diagnoses can be understood as a form of punishment that patriarchal society imposes on women who do not conform to gender norms. The diagnostic discourse denies the lived experience, reducing the woman to the symptoms of the disorder. The diagnostic criteria, such as “problems controlling anger,” are read as an innate characteristic and not as a denunciation of the obstructive processes of their own lives. For historical-cultural psychology, personality is the social within us. Psychic suffering incorporates the social, that is, in line with the thoughts of the Belarusian author Vygotsky, what is interpsychic becomes intrapsychic. The characteristics of BPD, such as “desperate efforts to avoid abandonment,” “destructive impulsivity,” and “self-mutilation,” are read as obstructions to the ways of life of women living in patriarchal capitalist relations. The patterns of wear and tear depend on the actual mode of social life, and not on an innate personality defect. The incidence of BPD linked to traumatic experiences, predominantly childhood rape, cannot be read as associated factors, but as systemic social practices that shake individuals. When analyzing the particular dimension of the outcome that is understood as BPD, we must recognize the patterns of wear and tear and social reproduction of the groups in which diagnosed women participate, considering the imbrications of the gender, race-ethnicity, and class knot. Contrary to what hegemonic psychiatry claims, the biological dimensions are not the cause of what is being characterized as pathological, but results of universality materialized in singularities through the mediation of particularities. The diagnostic practice corroborates the silencing of the deepest determinations and impossibilities in women's way of living. For future studies, it becomes necessary to conduct exploratory and field research, with semi-structured interviews and a qualitative approach based on historical-dialectical materialism, with women diagnosed with BPD, to understand their trajectories and the social and subjective implications of the diagnosis. The unavoidable political relevance of this theme is reinforced to subsidize practices and policies committed to the transformation of the structural conditions that produce suffering, this perspective being vital for collective health and the defense of the depathologization of psychic suffering.