Elsevier

Comprehensive Psychiatry

Volume 44, Issue 4, July–August 2003, Pages 284-292
Comprehensive Psychiatry

Gender differences in borderline personality disorder: findings from the collaborative longitudinal personality disorders study

https://doi.org/10.1016/S0010-440X(03)00090-7Get rights and content

Abstract

A majority of the literature on borderline personality disorder (BPD) focuses on its occurrence in women or does not specifically assess for gender differences in clinical presentations. Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences in BPD. Using baseline data from the Collaborative Longitudinal Personality Disorders Study (CLPS), men and women who met criteria for BPD were compared on current axis I and II disorders, BPD diagnostic criteria, childhood trauma histories, psychosocial functioning, temperament, and personality traits. Men with BPD were more likely to present with substance use disorders, and with schizotypal, narcissistic, and antisocial PDs, while women with BPD were more likely to present with PTSD, eating disorders, and the BPD criterion of identity disturbance. Generally speaking, women and men with BPD displayed more similarities than differences in clinical presentations. The differences that did emerge are consistent with those found in epidemiological studies of psychopathology and therefore do not appear unique to BPD. Additionally, many gender differences traditionally found in epidemiological samples did not emerge in BPD subjects. For example, no difference was found in rates of major depressive disorder, a condition that is more prevalent in females. Thus, BPD pathology may be a prevailing characterization that can attenuate usual gender-based distinctions.

Section snippets

Method

The present investigation is part of a larger study of the longitudinal course of PDs, the Collaborative Longitudinal Personality Disorders Study (CLPS). The aims, methods, and sample of CLPS have been extensively described elsewhere.35, 36 Briefly, participants between the ages of 18 and 45 were eligible to participate if they met criteria for schizotypal PD, borderline PD, avoidant PD, obsessive-compulsive PD, or a comparison group of major depressive disorder and no PD. Participants were

Demographics

Of the total CLPS sample of 668 subjects, 240 participants (175 women and 65 men) met DIPD-IV criteria for BPD. No significant difference was found for subjects’ age (mean [SD], = 31.55 [8.14] for women, 32.78 [7.57] for men). A summary of the remaining demographics for each gender is found in Table 1. No significant differences were found between men and women on these demographic variables (P > .05).

Gender differences in co-occurring axis I disorders

The frequencies of co-occurring current axis I disorders for men and women are displayed in

Discussion

Overall, relatively few gender differences emerged in a sample of BPD participants that was sufficiently large to detect meaningful differences. Women with BPD were more likely to have co-occurring diagnoses of PTSD and eating disorders, while men were more likely to have co-occurring diagnoses of substance use disorders, as well as schizotypal, narcissistic, and antisocial PDs. Additionally, proportionally more women then men met the borderline diagnostic criterion for identity disturbance. To

References (57)

  • Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • J.G. Gunderson et al.

    Current overview of the borderline diagnosis

    J Clin Psychiatry

    (1987)
  • T.A. Widiger et al.

    Epidemiology of borderline personality disorder

    Hosp Commun Psychiatry

    (1991)
  • M.C. Zanarini et al.

    Reported pathological childhood experiences associated with the development of borderline personality disorder

    Am J Psychiatry

    (1997)
  • M.C. Zanarini et al.

    Violence in the lives of adult borderline patients

    J Nerv Ment Dis

    (1999)
  • S.L. Shearer et al.

    Frequency and correlates of childhood sexual and physical abuse histories in adult female borderline inpatients

    Am J Psychiatry

    (1990)
  • K.R. Silk et al.

    Borderline personality disorder symptoms and severity of sexual abuse

    Am J Psychiatry

    (1995)
  • T.J. Trull

    Relationships of borderline features to parental mental illness, childhood abuse, axis I disorder, and current functioning

    J Personal Disord

    (2001)
  • H.J. Jackson et al.

    Diagnosing personality disorders in psychiatric inpatients

    Acta Psychiatr Scand

    (1991)
  • Grilo CM. Are there gender differences in DSM-IV personality disorders? Compr Psychiatry. In...
  • C.M. Grilo et al.

    DSM-IV axis II co-morbidity with borderline personality disorder in monolingual Hispanic psychiatric outpatients

    J Nerv Ment Dis

    (2002)
  • C.M. Grilo et al.

    Gender differences in personality disorders in psychiatrically hospitalized young adults

    J Nerv Ment Dis

    (1996)
  • M. Golumb et al.

    Gender differences in personality disorders

    Am J Psychiatry

    (1995)
  • J.D. Carter et al.

    Gender differences in the frequency of personality disorders in depressed outpatients

    J Personal Disord

    (1999)
  • L. Else et al.

    Personality characteristics of men who physically abuse women

    Hosp Commun Psychiatry

    (1993)
  • J. Hastings et al.

    Personality characteristics of spouse abusersa controlled comparison

    Violence Vict

    (1988)
  • D.G. Dutton

    The origin and structure of the abusive personality

    J Personal Disord

    (1994)
  • A. Holtzworth-Monroe

    A typology of men who are violent toward their female partnersmaking sense of the heterogeneity in husband violence

    Curr Direct Psychol Sci

    (2000)
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    The CLPS is an ongoing, longitudinal multisite study of personality disorders supported by the National Institute of Mental Health. Award sites are Brown University, Department of Psychiatry and Human Behavior, Providence, RI (MH-50837); Columbia University and New York State Psychiatric Institute, New York, NY (MH-50839); Harvard Medical School and Mclean Hospital, Boston (MH-50840); Texas A & M University, College Station, TX (MH-50838); and Yale University School of Medicine, New Haven, CT (MH-50850).

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