Gender: A Wider Lens
Gender: A Wider Lens
75 - Borderline Personality: Distorted Attempts to Integrate - A Conversation w/ Lisa Duval

75 - Borderline Personality: Distorted Attempts to Integrate - A Conversation w/ Lisa Duval


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Lisa Duval is a licensed clinical psychologist who has worked with children, teens, and families for over 30 years. She is also the mother of a “fiercely gender-questioning” 18-year-old daughter, who has been male-identified for the last 5 years. She works with ROGD teens in an exploratory, empowering, feminist, and body-positive way, affirming their beautiful, complicated selves but not simply their trans identities.

We start with Lisa describing the old DSM multiaxial system, which was actually discarded in the current version, version 5. In Axis 2, we had cognitive and personality disorders, including borderline personality disorder. Listeners often ask me and Stella about potential links between borderline personality constellations and gender issues, so we were really excited to speak with Lisa about this. For starters, Lisa shares why borderline personality disorder should rarely ever be diagnosed in teens, though sometimes you might hear psychiatrists say a child has some “borderline traits.” We delve into how common, and almost quintessential, these traits are as a part of normal adolescent development.

Lisa then explains a fascinating theory: not only are kids with these traits perhaps more vulnerable to ROGD but also that aspects of gender identity ideology iatrogenically create borderline dynamics in dysphoric kids. In other words, gender ideology and a dogmatic affirmation approach could be causing and exacerbating these borderline traits. We also have a chance to explore the overlap between expressions of Autism and Borderline, and Lisa comments on a previous discussion we had about this with Dr. Susan Bradley in Ep. 65. At the end of the episode, Lisa shares a really interesting way she and her clients have been able to circumvent the issue of picking a new cross-sex name while exploring gender identity.

Extended Notes

  • Lisa explains the personality disorders in Axis 2.

  • Lisa grew up with parents who were diagnosed with personality disorders.

  • If you work with people at a young age you can make a difference.

  • Personality disorders can be trauma-based or genetically sourced.

  • Diagnosing a disorder or behavior during the teenage years is not advised.

  • Teenagers may naturally have a persecution fantasy.

  • Falsely diagnosing gender dysphoria creates a personality structure that is in opposition to integration.

  • A borderline personality disorder is in between neurosis and psychosis.

  • Most gender therapists believe they are helping children.

  • Lisa shares ways ROGD parents can connect with their kids and how clinicians can work with Cluster B people.

  • Examining incredibly liberal parents and the response from teens who want their own thing.

  • Lisa stresses the importance of giving children the agency to figure things out on their own.

  • Kids are hearing from multiple sources that if their parents don’t support them the parents are wrong.

  • Lisa pioneered the concept of an iatrogenic personality disorder.

  • For children, it is important for them to integrate the different parts of themselves.

  • Strategies for integration and gender roles that encourage children to maintain all sides of themselves.

This podcast is sponsored by ReIME and Genspect. Visit and to learn more.

For more about our show:

Gender: A Wider Lens
Gender: A Wider Lens
Therapists Stella O’Malley and Sasha Ayad explore diverse perspectives through a psychological lens, fostering open dialogue on gender identity, transition, and the transgender umbrella. Their work with gender dysphoric clients and unique experiences yield an informed outlook delving into gender's psychological nuances. Interviews with clinicians, academics, transgender individuals, parents, detransitioners, and others touched by gender provide varied insights and intimate inquiry into the taboo yet relevant topic.