Is Borderline Personality a Woman's Disease?

A policeman pulls over a weaving, speeding car. The driver, crying uncontrollably, recounts a terrible break-up with a fiance, resulting in overindulgence in alcohol, and exclaiming wishes to commit suicide. If the driver is a woman, the officer may wish to deliver her to a hospital where she will be hospitalized with diagnoses of depression, and, perhaps, borderline personality disorder. If a man, the policeman may be more inclined to deliver him to jail, where he will be labeled a drunk.

In treatment settings borderline personality disorder is diagnosed much more commonly in women than in men, some research suggesting a ratio of 3 to 1, or more. Yet in general population studies, prevalence rates are similar. Several factors may account for the disparity.

First of all, women seek help more often than men. In women, impulsive, destructive behaviors may more often be attributed to illness that can be treated. In men, similar conduct may be seen as antisocial, where the only response is law enforcement. Just as borderline personality disorder may be under-diagnosed in men, so also the male prevalence of the antisocial personality disorder diagnosis may reflect an under-diagnosis in women.

A soon-to-be published study (Psychiatry Research, vol. 257, pp. 197-202, November, 2017) examines these distinctions. Men with the BPD diagnosis displayed more "externalizing" behavior, such as interpersonal aggression, more violent self-harming patterns, and more antisocial traits, including heavier substance abuse. Women exhibited more "internalizing" features. These may include more overt emotional expressions, such as crying or clinging dependency.

Since long-term prognosis for BPD is much better than that for ASPD, it is important to recognize the distinction, in order to direct treatment efforts where they are most needed and helpful.