By Dr. David Woo - February 6, 2023

Transcranial magnetic stimulation, also known as TMS, has become an increasingly popular treatment for certain mental health disorders, primarily depression. But research has shown that TMS therapy also has a positive effect on individuals with borderline personality disorder (BPD).

Symptoms of Borderline Personality Disorder

Borderline personality disorder affects around 5.9% of American adults (1). This disease can result in severe symptoms that negatively affect an individual’s perception of themselves and the people around them. Symptoms of BPD usually begin to occur by early adulthood and can include:

·       Problems regulating emotions

·       Reckless or impulsive behavior

·       Unstable relationships

·       Intense, intrusive feelings of anger

·       Distorted self-image

·       Fear of abandonment

·       Prolonged feelings of emptiness

BPD can cause extreme emotional disruption and mood swings and should be taken very seriously, as it often leads to some form of self-harm (e.g., cutting) as well as suicide (2). One problem with treating borderline personality disorder is that it is often misdiagnosed. Many BPD symptoms are identical to those of other mood disorders, like anxiety and depression. 

Women and mental health is a critical topic that deserves attention, as research shows that women are more susceptible to certain mental health conditions, such as depression, compared to men. Women often face unique challenges related to hormonal changes, gender roles, and societal expectations that can impact their mental well-being. Additionally, women’s mental health issues can manifest differently, and they may encounter barriers or discrimination when seeking treatment. At Madison Avenue TMS & Psychiatry, we are committed to providing compassionate care and effective treatment options tailored to the specific needs of women, including talk therapy, medication management services, and transcranial magnetic stimulation (TMS). Let´s break down the state of women’s mental health issues today, and how innovative treatments can help patients overcome traditional barriers to wellness.

Jump to:

• Are Women More Susceptible To Certain Mental Health Conditions?
• Do Women Manifest Different Mental Health Symptoms?
• Gender Differences In Symptoms Of Mood Disorders
• Barriers Women Face In Mental Health Treatment
• Treatment Options For Women’s Mental Health Issues
• Get Compassionate Mental Health Care At Madison Avenue TMS & Psychiatry

Are Women More Susceptible To Certain Mental Health Conditions?

Studies indicate that women are more likely than men to experience certain mental health disorders. This discrepancy between the sexes is influenced by a combination of biological, psychological, and social factors. Key statistics include:

• Depression: Women are nearly twice as likely to be diagnosed with depression compared to men (1, 2). Hormonal fluctuations during puberty, menstruation, pregnancy, postpartum, and menopause can contribute to this increased risk.
• Anxiety Disorders: Women are more likely to experience anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and phobias (4).
• Post-Traumatic Stress Disorder (PTSD): Women are more than twice as likely as men to develop PTSD after experiencing traumatic events. Women are also more likely to experience certain types of trauma, such as sexual violence, which further increases the risk of PTSD (5).
• Obsessive-Compulsive Disorder (OCD): OCD affects both men and women, but women tend to have a later onset and are more likely to develop OCD related to contamination fears and compulsive cleaning (6, 7).
• Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is often underdiagnosed in women, who may present with inattentive symptoms rather than hyperactivity. As a result, many women remain undiagnosed until adulthood (8).
• Bipolar Disorder: Women are more likely to experience rapid cycling (more frequent mood changes) and mixed states of bipolar disorder compared to men, making it essential to identify gender-specific symptoms and treatment plans (9).
• Borderline Personality Disorder (BPD): Approximately 75% of those diagnosed with BPD are women, with symptoms often linked to trauma, emotional instability, and interpersonal difficulties (10).

Do Women Manifest Different Mental Health Symptoms?

Women’s mental health issues often manifest differently compared to men, which can impact diagnosis and treatment. Mental health is not one-size-fits-all, and symptoms can present across the entire gender spectrum. However, women as a demographic display some differences in symptoms in certain conditions, such as:

• Depression: Women with depression may experience more physical symptoms such as fatigue, changes in appetite, and sleep disturbances, while men may report more irritability and anger.
• Anxiety: Anxiety in women often manifests as internalizing symptoms like excessive worry, phobias, rumination, and physical complaints (e.g., headaches, fatigue), whereas men tend to present externally, with a higher prevalence of irritability and risky behaviors.
• PTSD: Women are more likely to experience symptoms such as hypervigilance, avoidance, and emotional numbing, while men may exhibit higher levels of aggression.
• ADHD: Women with ADHD often show inattentiveness, forgetfulness, and disorganization, which can be mistaken for anxiety or depression.
• Bipolar Disorder: Women with bipolar disorder tend to have more depressive episodes and fewer manic episodes than men, which can affect how the disorder is perceived and treated.
• OCD: Women are more likely to develop OCD symptoms related to caretaking, contamination, and morality.

Hormonal changes in women, including pregnancy and the menstrual cycle, may also account for variations in symptoms. Pregnant women, new mothers, and pre- and post-menopausal women all experience changes in their body chemistry that can affect their vulnerability to certain mental health disorders as well as the presentation and severity of symptoms. It´s important to note that hormonal factors should not be an excuse for anyone to dismiss or minimize mental health symptoms—our mental health is intimately linked to our biochemistry, and hormones are a natural part of that.

Gender Differences In Symptoms Of Mood Disorders

This table presents an overview of gender-based differences in symptom manifestation in common mental health conditions:

Barriers Women Face In Mental Health Treatment

Despite the higher prevalence of mental health disorders among women, many face significant barriers to accessing effective care due to the negative impacts of sexism and societal expectations of women (11).

• Misdiagnosis: Women are often misdiagnosed or have their symptoms attributed to hormonal changes or emotional overreaction, leading to delayed or inadequate treatment.
• Financial and time constraints: Caregiving responsibilities and lower income levels can prevent women from seeking timely mental health care.
• Gender discrimination: Some women report experiencing discrimination in the healthcare system, where their concerns are not taken seriously or dismissed, impacting their willingness to seek treatment.

Treatment Options For Women’s Mental Health Issues

At Madison Avenue TMS & Psychiatry, we offer a range of treatment options designed to address women’s mental health issues. These include:

• Medication management: Personalized treatment plans to manage conditions such as depression, anxiety, ADHD, and bipolar disorder
• Telehealth consultations: Convenient access to mental health care from the comfort of home, making it easier for women to prioritize their mental well-being.
• Transcranial magnetic stimulation (TMS): A non-invasive and effective treatment option for depression, OCD, and anxiety, particularly for those who have not responded to medication or therapy. 

As a drug-free depression treatment, TMS is safe for women who want to avoid the potential pharmaceutical interactions and side effects that come with taking antidepressants. This means that TMS is an effective treatment to undergo for women who are pregnant, breastfeeding, or on hormonal medications for birth control, menopause, or other reasons.

Get Compassionate Mental Health Care At Madison Avenue TMS & Psychiatry

Women face unique challenges when it comes to mental health, but effective treatments are available.

At Madison Avenue TMS & Psychiatry, we provide compassionate care tailored to the specific needs of women in a supportive environment. Our clinic stands for gender equality and mental health equity, and we encourage women with mental health concerns to contact us for a consultation without fear of discrimination or judgment.

If you or a loved one is struggling with mental health issues and based in the New York area, contact us today via our website or by calling (212) 731-2033. Our team of professionals is here to help you regain control of your mental well-being and lead a healthier, more fulfilling life.

More Resources On Women And Mental Health:

• Understanding Menopause Mood Swings
• BPD In Women: Know The Signs
• Bipolar Disorder In Women: Prevalence, Symptoms, And Treatment

Sources

1. Hyde, Janet S. PhD; Mezulis, Amy H. PhD. Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors. Harvard Review of Psychiatry 28(1):p 4-13, 1/2 2020. Link. Accessed September 16, 2024.
2. Albert, P. R. Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience.. 2015;40(4), 219-221. Link. Accessed September 16, 2024.
3. Farhane-Medina, N. Z., Luque, B., Tabernero, C., & Castillo-Mayén, R. Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Science Progress. 2022. Link. Accessed September 16, 2024.
4. Javaid, S.F., Hashim, I.J., Hashim, M.J. et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry 2023;30, 44. Link. Accessed September 16, 2024.
5. Hiscox, L.V., Sharp, T., Olff, M. et al. Sex-Based Contributors to and Consequences of Post-traumatic Stress Disorder. Curr Psychiatry Rep 25. 2023; 233–245. Link. Accessed September 16, 2024.
6. Tiyatiye, B., & Akosile, W. (2022). A systematic review of prevalence of comorbid obsessive-compulsive disorders and substance use disorders in clinical settings, 1990-2021. Journal of Substance Use. 2022;29(2), 180–185. Link. Accessed September 16, 2024.
7. Dr. Noreena Kausar, Amna Ishaq, & Dr. Muneeb Ahmed Toor. (2023). Prevalence of Obsessive-Compulsive Disorder in Psychiatric Patients. PAKISTAN JOURNAL OF LAW, ANALYSIS AND WISDOM, 2023;2(02), 1032–1041. Link. Accessed September 16, 2024.
8. Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA. Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. J Child Psychol Psychiatry. 2022;Apr;63(4):484-496. Link. Accessed September 16, 2024.
9. Miola, A., Fountoulakis, K. N., Baldessarini, R. J., Veldic, M., Solmi, M., Rasgon, N., Ozerdem, A., Perugi, G., Frye, M. A., & Preti, A. (2023). Prevalence and outcomes of rapid cycling bipolar disorder: Mixed method systematic meta-review. Journal of Psychiatric Research. 2023;164, 404-415. Link. Accessed September 16, 2024.
10. Bozzatello, P., Blua, C., Brandellero, D., Baldassarri, L., Brasso, C., Rocca, P., & Bellino, S. Gender differences in borderline personality disorder: A narrative review. Frontiers in Psychiatry. 2024;15, 1320546. Link. Accessed September 16, 2024.

Garb, H. N. Race bias and gender bias in the diagnosis of psychological disorders. Clinical Psychology Review. 2021;90, 102087. Link. Accessed September 16, 2024.

There are a variety of treatments used for BPD, including DBT (dialectical behavior therapy), CBT (cognitive behavior therapy) and various prescription medications. TMS is also gaining traction as an effective treatment for BPD for the following reasons.

Effects of TMS on Borderline Personality Disorder

TMS (Transcranial Magnetic Stimulation) uses magnetic energy to stimulate brain cells in areas of the brain associated with mood disorders, especially those characterized by depressive symptoms. BPD sufferers often also have depression, but studies have shown that TMS can provide relief for additional symptoms specifically linked to borderline personality disorder.

The first study of TMS treatment for BPD, published in 2013, involved a 22-year-old female patient. Following the treatment, she reported reduced depressive symptoms and impulsive behavior and an increase in motivation, sociability, and emotional stability (3). A 2014 study found improved emotional stability and planning ability in a small group of BPD patients after just 10 TMS sessions (4). More recent research has demonstrated the efficacy of TMS in reducing a range of BPD symptoms, including emotional regulation, impulsivity, mood swing and depressive feelings (5,6).

How Does TMS Work?

Emotional activity in the brain is carried out via electrochemical activity through its various regions. BPD symptoms are caused by irregularities in the amygdala, which regulates emotions  including fear, aggression, and threat perception. The prefrontal cortex, which we use for rational decision-making and planning for the future, can also experience abnormalities that contribute to BPD. TMS can boost activity in these affected regions, which enhances brain function and reduces BPD symptoms.

Try TMS Therapy for BPD Relief

If you’re suffering from BPD, seeking help as early as possible is important. TMS can be a great way to find relief from troubling BPD symptoms, especially if traditional treatments have proven insufficient.

To make an appointment with a licensed healthcare professional at Madison Avenue TMS & Psychiatry, contact us online or call (212) 731-2033.

Resources:

1. Overview of BPD. National Education Alliance for Borderline Personality Disorder. Pulication Date Unknown. Link. Accessed January 04, 2023.
2. Reichl C, Kaess M. Self-harm in the context of borderline personality disorder. Curr Opin Psychol. 2021 Feb;37:139-144. Link. Accessed January 04, 2023.
3. Arbabi M, Hafizi S, Ansari S, Oghabian MA, Hasani N. High frequency TMS for the management of Borderline Personality Disorder: a case report. Asian J Psychiatr. 2013 Dec;6(6):614-7. Link. Accessed January 04, 2023.
4. Cailhol L, Roussignol B, Klein R, Bousquet B, Simonetta-Moreau M, Schmitt L, Thalamas C, Tap G, Birmes P. Borderline personality disorder and rTMS: a pilot trial. Psychiatry Res. 2014 Apr 30;216(1):155-7. Link. Accessed January 04, 2023.
5. Sverak, T., Linhartova, P., Fiala, A., & Kasparek, T. (2017). Repetitive Transcranial Magnetic Stimulation Treating Impulsivity in Borderline Personality Disorder and Attention Deficit/Hyperactivity Disorder. In  (Ed.), Transcranial Magnetic Stimulation in Neuropsychiatry. IntechOpen. Link. Accessed January 04, 2023.
6. Reyes-López J, Ricardo-Garcell J, Armas-Castañeda G, García-Anaya M, Arango-De Montis I, González-Olvera JJ, Pellicer F. Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results. Braz J Psychiatry. 2018 Jan-Mar;40(1):97-104. Link. Accessed January 04, 2023.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.