Borderline personality disorder is a serious mental health disorder that usually develops during adolescence. Young people with BPD think, act, and experience emotions very differently from how others might expect. They might experience very intense emotions that change quickly and find themselves in patterns of unstable, intense relationships. These experiences can make daily life distressing and hard to navigate without effective support.
Borderline personality disorder diagnoses are more common among girls and women than boys and men (unfortunately, research papers that include other gender identities are lacking). But it’s still unclear whether this is because of the way that diagnostic criteria are designed, the readiness of individuals to seek help, or actual differences in how many people from different genders live with BPD.
Research also shows that borderline personality disorder symptoms may look different in men and boys than in women and girls. Different genders are socialised in distinct ways, meaning that as young people grow up, the way they are treated and responded to often depends on their gender. This treatment directly impacts the kind of feelings, behaviours, and thinking patterns a child develops. This can cause certain traits to be more common in one gender than another.
This blog explores some of the gender differences in different aspects of borderline personality disorder. Unfortunately, most studies include adults and not adolescents, and include only women and men. We’ve included some of the key research findings here.
What Is Borderline Personality Disorder?
Borderline personality disorder is a kind of personality disorder. Having a personality disorder doesn’t mean there’s something wrong with a young person’s personality. Personality disorders traits develop as a normal response to difficult past experiences that, while they may have been protective during a threatening situation, make day-to-day life hard to manage.
Borderline personality disorder is characterised by instability in moods, relationships, and sense of self. Each individual experiences BPD differently, but some common traits include:
- Experiencing intense emotional reactions that are hard to manage, especially when things happen in relationships
- Having a strong fear of abandonment by others
- Experiencing a changing or incoherent sense of self
- Engaging in impulsive behaviours
- Self-harm and suicidality
- Experiencing patterns of intense and unstable relationships
- Having chronic feelings of emptiness
- Experiencing hallucinations, paranoia, dissociation, or delusions
BPD is a very stigmatised illness, and some people, including some clinicians, might tell you that it can’t be treated. But this isn’t true: there are effective, evidence-based treatments for BPD that can reduce symptoms and lead to lasting recovery.
Are BPD Symptoms Different Among Boys and Men and Girls and Women?
Most research suggests that BPD traits and symptoms are relatively similar in men and women. However, some studies have identified certain differences.
One study found that women with BPD were more likely to experience negative emotions, like anxiety and depression, than men. They also showed higher levels of agreeableness. On the other hand, men were more likely to engage in disocial behaviours: actions that go against social norms or harm the well-being of others.
These distinctions reflect widespread differences between genders in broader society. Socially-constructed gender norms and gender roles mean that women are more likely to express distress inwardly, experiencing worry, low self-esteem, and sadness. Men, on the other hand, are more likely to express distress outwardly, in their behaviours towards others. These differences are rooted in the way girls and boys are brought up and the types of behaviours that are viewed as ‘acceptable’ in society.
Other studies have found that:
- Females have higher levels of anxiety, depression, and OCD than males
- Females experience more identity disturbances
- Men showed more frequent outbursts of anger
It’s worth noting, however, that not all experts agree that there are major gender differences in BPD symptoms and traits. Some authors maintain that there are more similarities between genders than differences, while others haven’t found significant differences in levels of emotional distress.
Are There Gender Differences in Co-Occurring Disorders of BPD?
When a person experiences another mental health condition alongside BPD, it’s known as a co-occurring disorder. Research shows that the types of co-occurring disorders that people tend to experience vary between genders.
One study found that while men with BPD are more likely to have co-occurring substance or alcohol use disorder, women are more likely to have co-occurring eating disorders. Women are also more likely to have co-morbid post-traumatic stress disorder.
As with BPD traits and symptoms, gender differences in co-occurring disorders are closely related to inward-facing and outward-facing characteristics. Women and girls are more likely to have co-occurring disorders that are internalising, affecting the way they feel and understand themselves. Men are more likely to have externalising disorders that affect their behaviours and actions.
Diagnosis and Prevalence of BPD
In the past, BPD diagnoses have been more common in women and girls than in men and boys. Most studies found that around 75% of people diagnosed with BPD are female.
However, some studies among the general population have found that there are no significant differences between the number of men and women meeting criteria for a BPD diagnosis.
Experts aren’t sure why there are more BPD diagnoses among females than males. One idea is that because women are more likely to seek help for mental health challenges than men, they are more likely to see a mental health professional and receive a diagnosis.
Another possibility is that the diagnostic criteria for BPD are more likely to be met by women than men with the disorder. Gender biases in diagnostic criteria can happen when criteria refer to symptoms of disorders that are more commonly experienced by one gender, while overlooking those more often experienced by others. Or, it could be that because gender norms tend to propagate stricter standards about what kind of behaviours are acceptable for women than men, women’s behaviours are more likely to be considered as mental health symptoms.
Some authors also suggest that there may actually be more women than men with BPD, although this is not reflected in some community studies. BPD almost always develops after traumatic experiences and is closely linked with childhood trauma. Some people suggest that because girls are more likely to experience certain kinds of trauma, particularly sexual abuse, they are more likely to develop BPD.
Gender Differences in Neuroimaging
The way we experience emotions and react to situations is reflected in our brain structures involved in these functions. For example, severe anxiety and heightened stress responses have been associated with changes to the amygdala, an area of the brain involved in regulating emotions. People with borderline personality disorder tend to show different structures in some brain regions compared to those without the disorder.
Some neuroimaging studies suggest that these changes may look different among men and women with BPD. However, because research is limited, it’s still not possible to form reliable conclusions.
Treating Borderline Personality Disorder
Living with borderline personality disorder is hard, regardless of someone’s gender identity. However, there is help and support available that can reduce symptoms, make daily life more manageable, and lead to long-term recovery.
Treatment for borderline personality disorder usually involves a combination of different professionals, including occupational support, social workers, and psychologists. They can help people with BPD to navigate challenges in different aspects of their lives, developing stability and resilience.
Psychological approaches for BPD usually involve talk therapy, in particular dialectical-behavioural therapy, a combination of individual therapy and group skills sessions specifically designed for BPD. Other approaches include:
- Mentalisation-based therapy
- Transference-focused therapy
- Adolescent identity treatment
- Arts therapies
- Family therapy
Treatment for borderline personality disorder can be residential or outpatient. Residential treatment may be necessary when a young person’s safety is at risk and they require more constant monitoring and support. It can also help individuals to develop new patterns of behaviour and ways of relating to others in a supported setting, away from triggers and stressors.
The Wave Clinic: Making a Difference in the Lives of Young People
The Wave Clinic offers specialist support for children, teenagers, young adults, and families living with mental health challenges. Our residential programs combine exceptional clinical care with personal learning programs, vocational education, and enriching experiences, supporting young people to develop life skills, resilience, and self-confidence.
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