Bias in the Diagnosis of Borderline Personality Disorder Among Sexual- and Gender-Minority Persons: Results From a Vignette-Based Experiment
Why this work is in the frame
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Bibliographic record
Abstract
Sexual- and gender-minority (SGM) individuals are diagnosed with borderline personality disorder (BPD) more than cisgender heterosexuals. Using a large sample of mental-health practitioners in the United States and Canada ( N = 426), we examined bias in the diagnosis of BPD. Mental-health practitioners were randomly assigned to receive one of three clinical vignettes (cisgender heterosexual man, cisgender gay man, or transgender woman) and asked to provide psychiatric diagnoses based on the vignette. Mental-health practitioners demonstrated a predilection to diagnose BPD when presented with the transgender vignette (odds ratio [ OR ] = 1.99, p = .01) but not the cisgender-gay vignette ( OR = 1.34, p = .29) compared with practitioners presented the cisgender-heterosexual vignette. Psychiatrists, mental-health counselors, and clinical social workers were significantly more inclined to diagnose BPD than psychologists, although reasons for underdiagnosis differed across groups. These findings bear important implications for future training given the nature of the mental-health workforce in the United States.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.005 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it