In a recent study, psychologists attempted to determine the diagnostic question of whether or not men and women diagnosed with borderline personality disorder exhibit differences in symptoms. While borderline personality disorder is typically believed to occur more often in women than in men, the authors report that studies suggest that this is not true, and that the disorder is equally prevalent in both men and women. Furthermore, they note that there is a bias in favor of disproportionately diagnosing women with the disorder as opposed to men.
The similaritites, of course, are striking as well. Men and women diagnosed with the disorder both tend to exhibit self-harming behaviors such as cutting. Men, however, are more likely to exhibit emotionally explosive behaviors, antisocial personality traits, substance abuse, and novelty seeking than women. Women, on the other hand, are more likely to exhibit mood disorders, PTSD, anxiety and eating disorders. With respect to treatment history, they report that men are more likely to have had a past history of being treated for substance abuse whereas women are more likely to have been treated for psychological problems.
But what accounts for the previous disparity in diagnosis between men and women? As noted before, the authors report a bias among clinicians in diagnosing women with this disorder as opposed to men. Furthermore, since men with BPD are more likely to end up in jail or substance abuse programs, these are contexts in which they are less likely to be diagnosed with mental illness, as opposed to women who end up in a psychiatric institution because of self-harming.
As noted before, men diagnosed with BPD tend consistently to exhibit high rates of explosive temperament and substance abuse problems, as well as novelty and harm avoidance, whereas women tend to exhibit harm avoidance, but are less likely than men to exhibit novelty-seeking. In studies on gender disparities among patients with BPD, women consistently report a greater disposition towards mood disorders, anxiety and PTSD than men, and men consistently report higher levels of substance abuse than women.
The tendency of the distinct phenotypic expressions of BPD among men to wind them up in legal trouble (antisocial tendencies, novelty-seeking, substance abuse, narcissistic and sadistic personality traits, all of which the authors note) is likely an important explanatory factor in why men are underrepresented in BPD among clinicians.
Randy A. Sansone, MD and Lori A. Sansone, MD. Gender Patterns in Borderline Personality Disorder. Innov Clin Neurosci. May 2011; 8(5): 16-20.