Symptoms And Risk Factors Of Borderline Personality Disorder In Women
Borderline personality disorder (BPD) can lead to relationship difficulties, poor self-image, and dangerous, sometimes suicidal behavior. However, the specific ways this mental health condition manifests may not be the same for everyone. Some research suggests that female and male patients may experience BPD in different ways, with risk levels and patterns of symptoms varying across gender lines. What does the latest psychological research tell us about borderline personality disorder in women?
Clinical evidence indicates that some specific symptoms of BPD may occur more frequently in women, including relationship instability, emotional disruptions, and a distorted sense of self. Certain kinds of co-occurring mental illness, such as eating disorders and depression, also appear to be more common in female patients. In addition, traumatic experiences like bullying might be more significant BPD risk factors for women. However, regardless of gender, individuals with borderline personality disorder may find it helpful to work with a licensed mental health professional.
Core characteristics of borderline personality disorder
BPD is one of several personality disorders — persistent and dysfunctional modes of thinking, worldview, and behavior that tend to affect a person’s ability to function in society and relate to others. These conditions tend to be chronic and difficult to treat, since affected individuals may have a hard time recognizing that their thoughts and actions are problematic.
According to current diagnostic criteria, the primary symptoms of borderline personality disorder include the following:
- Intense efforts to prevent others from abandoning them (and a higher tendency to expect or imagine abandonment)
- Episodes of paranoia or dissociation in response to stress
- Difficulty maintaining a stable sense of identity or self-image
- Persistent feelings of “emptiness,” often described as numbness, disconnection, and lack of purpose or selfhood
- A history of tumultuous and unstable relationships, in which the individual may shift between unrealistically positive and negative views of other people
- Impulsive or reckless behavior, such as excessive substance use, gambling, binge eating, or high-risk sexual choices
- Challenges with controlling anger, including repeated angry outbursts, frequent conflicts, and overly intense or inappropriately directed anger
- Repeated self-harm or suicidal thoughts, threats, and actions
Not everyone with BPD displays all of these symptoms, but a clinical diagnosis typically requires the presence of five or more. This disorder often becomes apparent in adolescence or early adulthood, though some signs may be seen in childhood.
Do more women than men have borderline personality disorder?
Many people regard BPD as a predominantly female disorder. This view was common in psychological literature published during the 1980s and 1990s, which suggested that borderline personality disorder was roughly three times as common in women as in men.
More recent studies have contradicted this view, finding little to no gender difference in BPD prevalence in the population at large.
Some findings indicate that women could be overrepresented in clinical samples, suggesting that they may be more likely to be diagnosed with and treated for this illness. Since there are relatively few studies on gender and BPD prevalence, the reasons for this possible disparity are still debated among psychologists.
Possible explanations include the following:
- Differences in treatment-seeking: There’s evidence that women tend to seek help for mental health difficulties more often than men, which could increase their chances of being diagnosed with BPD.
- Stereotyped behavioral norms: Certain traits commonly associated with borderline personality disorder, such as risk-taking, aggression, and impulsive sexual behavior, might be more socially stigmatized in women and, therefore, more likely to be seen as pathological.
- Gender bias in diagnosis: Some researchers have argued that the diagnostic criteria for BPD could have a gender-related bias, or that clinicians may have biases that make them more likely to diagnose women with this disorder.
- Greater exposure to risk factors: Research suggests that certain known risk factors for severe BPD symptoms, such as childhood experiences of sexual abuse, tend to be more common in women.
Symptoms of borderline personality disorder in women
- Emotional disruptions, including mood swings, depression, anxiety, hopelessness, and difficulty recognizing and regulating feelings
- Relationship instability, such as difficulty sustaining friendships, frequent conflicts with family members, and repeated intense but short-lived romantic relationships
- Identity disturbance, which can involve poor self-esteem, frequent self-criticism, and uncertain or inconsistent beliefs, preferences, goals, and self-concept; a person with BPD may adopt different characteristics and attitudes based on the people around them without a coherent sense of what their “real self” is like
- A chronic sense of emptiness, such as a sense of being emotionally numb, aimless, detached from the world, or somehow “unreal” or “nonexistent”
In contrast, female patients with borderline personality disorder seem to be less likely to exhibit impulsive behavior or explosive anger than male patients.
Are gender differences less pronounced in BPD?
The differential patterns of symptoms described above may be largely due to underlying behavioral discrepancies between men and women in general. For example, impulsive behavior may be more common in men regardless of the presence or absence of mental health conditions.
Some studies indicate that borderline personality disorder might decrease certain gender-related differences. Researchers have found that men and women with borderline personality disorder may exhibit the following behaviors or disorders at similar rates:
- Unhealthy substance use
- Panic disorder
- Obsessive-compulsive disorder
- Aggression
- Suicidality
In the general population, these conditions, traits, and behaviors tend to show significant gender differences.
Comorbidities of borderline personality disorder in women
Some other mental health conditions may be more likely to appear alongside borderline personality disorder, depending on gender. Multiple studies have reported higher rates of co-occurring post-traumatic stress disorder (PTSD), eating disorders, and major depressive disorder (MDD). There are also indications that comorbid anxiety disorders might be more common in female BPD patients compared to males.
One paper from 2022 reported that psychosis was more frequently observed in women than men with BPD. This finding excludes affective psychoses like schizoaffective disorder or bipolar disorder with psychotic features.
However, other conditions may be less common in women with borderline personality disorder compared to their male counterparts. These include substance use disorders and some other personality disorders, such as antisocial or narcissistic personality disorder.
What causes borderline personality disorder in women?
Scientists don’t fully understand the causes of borderline personality disorder. The existing evidence indicates that it’s likely caused by a combination of genetic and environmental factors.
A family history of BPD or mental illness can increase an individual’s chances of developing this condition. Studies have identified some genes that may predispose a person to borderline personality disorder, several of which are associated with the parts of the brain that regulate stress and fear responses.
Other known risk factors include the following:
- Unhelpful parental care behaviors, such as overly cold, harsh, controlling, or neglectful treatment
- Traumatic life experiences, such as sexual abuse or bullying
- Personality traits like high novelty seeking, high harm avoidance, and poor emotional control
Borderline personality disorder may result from a lack of care and emotional support from parents combined with traumatizing experiences in childhood or adolescence. Affected individuals may develop maladaptive worldviews, thinking styles, and behavioral habits, potentially leading to the symptoms associated with BPD. This could be more likely to occur in people with neurological differences that hamper their ability to respond to distress in healthy ways.
Most of these risk factors seem to affect males and females equally. However, some researchers have found evidence that experiencing bullying and social ostracization might increase the risk of borderline personality disorder in women but not men.
Treatment for women with borderline personality disorder
Psychotherapy is currently considered the most effective form of treatment for borderline personality disorder. While a variety of treatment approaches may be used, certain specific therapies may be more helpful than others.
- Dialectical behavior therapy (DBT): Developed specifically to help female patients with borderline personality disorder experiencing suicidality, DBT generally involves building skills like emotional regulation, mindfulness, stress tolerance, and relationship management. It’s considered one of the most effective treatments for BPD, and the evidence for its effects in women appears to be particularly strong.
- Psychodynamic therapy: This therapeutic approach typically explores a patient’s thoughts and life experiences to help them gain insight into the underlying emotional causes of psychological and behavioral disorders. A 2017 meta-analysis identified it as one of two therapies more effective than most for BPD (along with dialectical behavioral therapy).
The interpersonal challenges of borderline personality disorder may make it hard to trust and open up to a therapist. Seeking therapy online might make it easier to find a mental health professional with whom you work well. Internet therapy services like BetterHelp can match you with a qualified provider who fits your preferences and helps you feel comfortable.
Although there haven’t yet been many studies specifically investigating online treatments for BPD, the available research has found largely positive results. Several trials of internet-delivered treatments showed significant decreases in borderline personality disorder symptoms such as impulsivity, mood instability, and interpersonal difficulties.
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