Episode 75

Published on:

24th Jun 2022

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

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 https://rethinkime.org/ and https://genspect.org/ to learn more.

For more about our show: https://linktr.ee/WiderLensPod

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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

* We are sponsored by ReIME and Genspect.
Rethink Identity Medicine Ethics (ReIME) is a non-profit organization dedicated to improving long term care for gender variant individuals. To learn more, visit https://rethinkime.org/

Genspect is an international alliance of parent and professional groups whose aim is to advocate for parents of gender-questioning children and young people. Parents are concerned that their kids are not receiving appropriate treatment and support; many do not feel free to speak out about their concerns.
To learn more, visit https://genspect.org/
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About your hosts

Stella O'Malley

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Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

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Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.