Her-say: The History of Women’s Mental Health and Misdiagnosis

How Women’s Trauma Responses Have Been Pathologised

For centuries, women’s natural responses to trauma have been misunderstood, medicalised and mislabelled as mental illness. Rather than being recognised as valid reactions to abuse and adversity, these responses are often interpreted through a biased and patriarchal medical lens. The pathologisation of women’s mental health has deep historical roots that continue to influence modern psychiatric diagnoses.

From Witch Hunts to Modern Misogyny

Between 1450 and 1750, an estimated 100,000 women were executed during witch hunts across the British Isles and Europe. These women were frequently unwell, disabled, non-conforming, intelligent, outspoken - or survivors of abuse and trauma. Their suffering was weaponised against them, and they were silenced through violence. Today, modern-day witch hunts persist in regions such as India, Papua New Guinea, the Amazon, and parts of Africa. These acts of persecution, often against vulnerable and marginalised women, reflect the same underlying misogyny seen centuries ago.

The Invention of ‘Female Madness’: From Hysteria to Borderline Personality Disorder

In the 19th and 20th centuries, women expressing emotional distress were often diagnosed with hysteria. The term derives from the Greek word hystera, meaning womb. At one time, doctors believed that the uterus could move around the body and cause psychological symptoms - a theory known as “wandering womb syndrome.”

Hysteria remained a recognised diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) until the late 20th century. In 1896, Sigmund Freud presented a paper, The Aetiology of Hysteria, suggesting that childhood sexual abuse was the root cause of the condition. However, this idea was met with resistance. Freud later abandoned his findings in favour of the Oedipus Complex, theorising that children imagined abuse rather than experienced it. This shift contributed to a long-standing culture of denial, silencing survivors and legitimising widespread abuse.

From Hysteria to Borderline: The New Psychiatric Label for Women

When hysteria was removed from the DSM-III, it was replaced with Borderline Personality Disorder (BPD). Though the label had changed, the gender bias remained. The diagnostic criteria for BPD and hysteria are notably similar and both have disproportionately affected women.

By 2019, studies showed that women and girls were seven times more likely than men to be diagnosed with BPD, even when presenting with identical symptoms. Despite guidance from the National Institute for Health and Care Excellence (NICE) stating that children under 18 should not be diagnosed with personality disorders, BPD is often first diagnosed during adolescence. This diagnosis is especially common among girls in residential care or those who have disclosed abuse. Rather than addressing trauma, the system frequently labels their distress as disordered - a pattern that echoes the silencing of women throughout history.

Breaking the Silence: A Call for Trauma-Informed Care

From the burning of ‘witches’ to the branding of traumatised girls as hysterical or borderline, women have been repeatedly silenced, punished, and misrepresented by systems that should support them. These diagnostic trends obscure the true causes of distress and instead blame women for their own suffering. It’s time for mental health services to adopt a trauma-informed, gender-sensitive approach - one that validates women’s experiences rather than pathologising them. Only then can we begin to dismantle the centuries-old stigma surrounding women’s mental health.

Would you like support on your journey? Get in touch here to book a session or ask a question.

By Melissa Rose Spencer | Creative & Somatic Counsellor, Psychotherapist, Supervisor & Breathwork Coach in Huddersfield & Online Across the UK

References

AMERICAN PSYCHIATRIC ASSOCIATION., 1968. Diagnostic and Statistical Manual of Mental Disorders (online). 2nd ed. Washington, USA: American Psychiatric Association.

AMERICAN PSYCHIATRIC ASSOCIATION., 1980. Diagnostic and Statistical Manual of Mental Disorders (online). 3rd ed. Washington, USA: American Psychiatric Association.

AMERICAN PSYCHIATRIC ASSOCIATION., 2013. Diagnostic and Statistical Manual of Mental Disorders (online). 5th ed. Washington, USA: American Psychiatric Association.

BOWLBY, J., 1991. Attachment and Loss. London, UK: Penguin.

FREUD, S., 1896. The Aetiology of Hysteria. Acta Psychiatrica Scandinavica. 43 (2), pp. 144-162.

HOLMES, J., 2004. Disorganized Attachment and Borderline Personality Disorder: A Clinical Perspective. Attachment and Human Development (online). 6 (2), pp. 181–190.

HORSLEY, R. J and HORSLEY, R. A., 1987. On the Trail of the “Witches:” Wise Women, Midwives and the European Witch Hunts. Women in German Yearbook (online). 3, pp. 1-28.

PLATFORM., 2022. Briefing on Boderline Personality Disorder and the Labelling of Survivors of Abuse and Violence.

SHARP, C., VENTA, A., VANWOERDEN, S., SCHRAMM, A., HA, C; NEWLIN, E., REDDY, R and FONAGY, P., 2016. First Empirical Evaluation of the Link between Attachment, Social Cognition and Borderline Features in Adolescents. Comprehensive Psychiatry (online). 64, pp. 4–11.

TAYLOR, J., 2020. Why Woman are Blamed for Everything: Exposing the Culture of Victim-Blaming. London, UK: Constable.

TYRER, P., 2014. The Likely Classification of Borderline Personality Disorder in Adolescents in ICD-11 (online). In: SHARP, C and TACKETT, J, eds. Handbook of Borderline Personality Disorder in Children and Adolescents. New York, USA: Springer. pp. 451-457.