Queering the diagnostic trajectory of borderline personality disorder

There is increasing evidence that LGBTQIA+ people are diagnosed with borderline personality disorder (BPD) at higher rates than cisgender and heterosexual populations. Despite this, limited qualitative research has critically examined the social, cultural, institutional, and diagnostic processes that shape these disparities. BPD is a highly stigmatised and contested psychiatric diagnosis, with a long history of debate across disciplines, including psychiatry. Critically unpacking these diagnostic trajectories is essential for understanding how gender and sexual diversity, and LGBTQIA+ people more broadly, are responded to within mental health and social care systems. Drawing on in-depth interviews with 13 LGBTQIA+ individuals who had received a BPD diagnosis, this study is informed by the sociology of diagnosis and queer theory. This framework enables a critical interrogation of how gender and sexual diversity intersect with dominant psychiatric discourses that continue to pathologise non-normative identities, emotional expression and relational practices. Findings are organised around three interrelated themes. First, participants described how limited understanding, validation, and access to LGBTQIA+ -affirming care contributed to experiences of distress that were subsequently interpreted through a diagnostic lens. Second, participants highlighted how BPD diagnostic criteria risk pathologising identity exploration and self-expression that diverge from cisnormative and heteronormative expectations. Third, clinical judgements were frequently shaped by superficial assumptions about appearance, gender expression and sexuality, compounded by limited queer-specific training among practitioners. Collectively, our findings suggest everyday clinical interactions, diagnostic practices and healthcare cultures contribute to the disproportionate application of BPD diagnoses among LGBTQIA+ people. The study underscores the need for further critical research, practitioner education and the resourcing of LGBTQIA+ -affirming mental health services.