Borderline personality disorder affects people of all genders, but women have historically been more likely to be diagnosed with this condition.
Are there significant differences in BPD symptoms in women and men?
Learn more about our Atlanta mental health treatment programs or verify your insurance today.
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a complex mental health condition that is characterized by instability and impulsivity, primarily in how a person views themselves and interacts with others.
Diagnostic criteria
The DSM-5 includes nine criteria for BPD. To be accurately diagnosed with this condition, a person must meet at least five:
- Frantic efforts to avoid real or imagined abandonment
- Pattern of intense but unstable relationships, during which the individual alternately idealizes and devalues their partner
- Persistent instability in self-image or sense of self
- Impulsivity in at least two areas that can cause considerable harm, such as binge eating, unsafe sex, spending sprees, reckless driving, and substance use
- Recurring thoughts or behaviors related to suicide or self-harm
- Periods of a few hours to a few days that are marked by intense feelings of irritability, anxiety, and dysphoria
- Chronic feelings of emptiness
- Frequent displays of inappropriate and excessive anger, often leading to arguments and/or physical altercations
- Occasional periods of stress-related paranoia or dissociation
Prevalence
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), experts estimate that BPD affects about 1.6% of the general population, though that rate could be as high as 5.9%.
Underscoring the degree to which BPD can negatively impact a person’s life, the prevalence of this condition is considerably higher among people who are receiving mental health treatment. The DSM-5 also reports that the rate of BPD is:
- 10% among people in outpatient mental health programs
- 20% among those in inpatient psychiatric facilities
As we will discuss a bit later in today’s post, women have traditionally been much more likely than men to be diagnosed with BPD, though that diagnostic imbalance may be changing.
BPD Symptoms in Women
The DSM-5 does not contain gender-specific diagnostic criteria for borderline personality disorder. But the symptoms and effects of BPD can vary from one person to another depending on a range of individual factors, including their gender.
BPD symptoms in women may include:
- Histories of volatile friendships and romantic relationships
- Threatening to harm or kill themselves if they fear that a friend or partner is about to end the relationship
- Quickly becoming enamored with another person, then just as quickly losing interest in them
- Reacting to relatively minor stressors or conflicts with uncontrolled rage
- Experiencing profound shame and guilt in the aftermath of angry outbursts
- Engaging in binge eating, substance use, unsafe sex, and other impulsive self-defeating behaviors
- Brief periods during which they feel that they have become detached from their mind and body
Some studies suggest that women with BPD are more likely to experience internalized feelings such as anxiety, depression, and emptiness, while men with the condition are more likely to exhibit outwardly directed behaviors such as anger, aggression, and substance use.
Effects of BPD on women
The impact of untreated BPD symptoms in women can extend to virtually every part of their life. By definition, these symptoms can make it difficult to maintain healthy friendships and romantic partnerships. But the damage is by no means limited to their relationships.
Other effects that women with borderline personality disorder may experience include:
- Substandard performance in school or at work
- Financial difficulties due to job loss and impulsive behaviors
- Onset or worsening of co-occurring mental health concerns
- Substance abuse and addiction
- Being ostracized from family members and former friends
- Being stigmatized and stereotyped
- Increased risk of self-harm and suicide
While any of these effects can be devastating, it’s important not to overlook the very real risk of suicide. A May 2019 article in the journal Medicina reported that as many as 10% of people with borderline personality disorder may die by suicide, and that young women are most likely to make multiple attempts to end their lives.
To put this into perspective, data from the National Institute on Mental Health (NIMH) indicates that the U.S. experienced 14.1 deaths by suicide for every 100,000 people in 2023. This works out to a rate of 0.014%.
Though lifetime rates are not directly comparable to annual rates, the lifetime rate of suicide deaths among people with BPD is more than 10 times higher than the annual rate among the general public.
Gender Differences in BPD Diagnoses
A team of experts from the University of Turin (Italy) Department of Neuroscience explored gender differences in BPD in a narrative review that was published by Frontiers in Psychiatry in 2024.
Noting that there is relatively minimal data on this topic, the review team analyzed the results of 46 prior studies. Their findings included:
- Though “inappropriate and intense anger” is more common among men, diagnosticians may be more likely to identify it as a BPD symptom when displayed by women.
- A study involving diagnoses of four personality disorders (borderline, avoidant, schizotypal, and obsessive-compulsive) found that BPD criteria had the “largest functional disparity between genders.”
- The prevalence of most co-occurring mental health conditions is about the same among men and women with BPD. However, men are more likely to also have a substance use disorder (addiction), while women are more likely to have a co-occurring eating disorder.
- A study involving brain imaging found that, when compared with healthy individuals of the same gender, women with BPD had decreased gray matter volumes in the amygdala and hippocampus, while men with BPD had decreased volume in the anterior cingulate cortex and increased volume in the right putamen.
This review also found that treatment rates were similar between women and men with BPD. However, women were more likely to receive therapy and medication for mental health concerns, while men were more likely to enter addiction treatment programs.
Learn More About Treatment for Borderline Personality Disorder in Atlanta
If you or someone that you care about has been experiencing symptoms of BPD, Buckhead Behavioral Health is here to help.
Treatment options at our outpatient mental health center in Atlanta, GA, include a partial hospitalization program (PHP), an intensive outpatient program (IOP), an evening IOP, and a virtual IOP. Our team can explain the features and benefits of each program to you, and help you determine which ones are best for you or your loved one.
To learn more or to schedule a free assessment, please visit our Admissions page or call us today.
