Interaction between migration status and personality on BPD

Migration status and implications on personality

Clinicians today are expected to assess personality disorders in an increasingly diverse population. In fact, the term culturally masked personality disorder was coined to describe when cultural differences are overused or misused to show a pattern of behavior that may affect relationships, be stressful or harmful to the individual, and be out of the range of norm for the society in which they currently reside (Najjarkakhaki & Ghane, 2023). Therefore, migrants and ethnic minorities are at risk of being under and over-diagnosed with various personality disorders, specifically borderline personality disorder. Being culturally informed guides clinicians to more appropriate assessments of personality pathology (Najjarkakhaki & Ghane, 2023). 

Migration processes can resemble personality pathology as it may exacerbate vulnerabilities and aggravate pathology that may pre-exist (Najjarkakhaki & Ghane, 2023). Stressors of migration include grief and a struggle to attain psychosocial and economic resources in the new culture (Najjarkakhaki & Ghane, 2023). For example, themes seen in migrants and ethnic minorities that could contribute to misdiagnosis include cultural identity disturbances, attempting to assimilate to a host culture, shifting between idealizing and devaluing abandoned culture, shifts in mood, loss of attachments, displacement, isolation, and paranoid thoughts and dissociation related to complex trauma, among others (Najjarkakhaki & Ghane, 2023). 

Manifestation of BPD in other cultures

In addition to the complications of migration in regard to personality pathology diagnosis, manifestation of personality disorders can vary across cultures (Munson et al., 2022). Moreover, there is debate on whether or not certain personality disorders, including BPD exist outside of Western culture; that is, there is not a deep understanding as to whether BDP goes undiagnosed in non-Western cultures, or if the disorder does not exist (Munson et al., 2022). Some researchers question if more collective societies stop the development of BPD (Munson et al., 2022). Furthermore, several differences exist in the way in which pathology is viewed across cultures. 

China, for example, does not include BPD in their Third Edition of the Chinese Classification of Mental Disorders (CCMD-3) and instead includes a similar disorder, impulsive personality disorder (Munson et al., 2022). In China, many behaviors that are considered in the diagnoses of BPD in Western culture, do not apply, that is, reckless driving as many people in China do not own cars; promiscuity, as it is taboo to discuss such acts and illicit drug use, as China controls illicit drugs more completely than Western culture (Munson et al., 2022). In China, impulsiveness and expression of emotion is also frowned upon (Munson et al., 2022). Additionally, East Asians have been found to be more likely to suppress emotions compared to Americans (Munson et al., 2022). 

In regard to self-harm, which is common among those diagnosed with BPD, Munson et al. (2022) conducted a literature review exploring cultural differences in self-harm and psychological stressors for those diagnosed with BPD and found that self-poisoning and overdose were more common in Eastern Nations. For example, Sundarban (a region of India) tend to use more agrochemical pesticides which may be more readily available. However, in unsuccessful attempts, when participants were asked if they intended to die, they were uncertain; this is said to be because if they say yes, they could face legal issues and if they say no, they could be met with stigma and humiliation (Munson et al., 2022). Whereas, in Western culture self-mutilation is more common, including countries such as Croatia, Italy, Norway, Sweden, United States and Western Australia) (Munson et al., 2022). Research on this topic thus far has not been successful in finding much information on minor forms of self-harm, which are also common among individuals diagnosed with BPD. 

Given the complicated emotional realm in which migrants and ethnic minorities live in combination with their cultural upbringing, it is vital for clinicians to be culturally informed and curious when working with patients that are not from a similar background in order to avoid misdiagnosis and/or overdiagnosis. Migrant and ethnic minority patients may be simply responding to their environment in the best way they know how. A curious clinician will ask questions to better understand a patient, rather than assuming the patients behavioral patterns are pathological, due to a comparison of what is considered normal in Western culture. 

References

Munson, K. A., Janney, C. A., Goodwin, K., & Nagalla, M. (2022). Cultural representations of borderline personality disorder. Frontiers in Sociology, 7, 832497.

Najjarkakhaki, A., & Ghane, S. (2023). The role of migration processes and cultural factors in the classification of personality disorders. Transcultural Psychiatry, 60(1), 99-113.