By Dr. David Woo - May 20, 2024

Borderline personality disorder (BPD) is a mood disorder characterized by extreme emotional dysregulation or ‘affective instability’ (1). Although BPD affects both men and women, the symptoms and experiences can vary between genders. Recognizing the signs of borderline personality disorder in women is crucial for accurate diagnosis and effective treatment. Women with BPD often face unique challenges and societal stigmas, making it essential to understand the condition and provide compassionate support. We dive into BPD  differences in women and men to dispel misconceptions and explore effective treatment options for BPD.

Jump to:

• Symptoms of Borderline Disorder In Women
• Borderline Personality Disorder In Women And Men: Is There A Difference?
• Unique Challenges For Women With BPD
• Therapy Options For BPD
• Treatment for BPD in New York

Symptoms of Borderline Disorder In Women

Symptoms of BPD in women and men can include:

• Intense and unstable relationships, characterized by extremes of idealizing and devaluing partners, friends, or family.
• Strong fear of abandonment, leading to frantic efforts to avoid real or imagined rejection.
• Risk-taking and impulsive behavior such as reckless spending, substance abuse, or self-harm.
• Identity confusion, marked by uncertainty about self-image, goals, and values.
• Emotional instability that can range from feelings of emptiness to intense anger or inner turmoil.
• Dissociation, or feeling detached from oneself, one’s body, or reality.

As a complex mood disorder, BPD symptoms can also overlap with related conditions such as anxiety and depression. In fact, it is more common to have depression and BPD than BPD on its own (2).

Borderline Personality Disorder In Women And Men: Is There A Difference?

Historically, BPD was presumed to be more common in women than men, with early research and diagnosis patterns suggesting that symptoms of BPD in females occurred three times as often as in males. However, more recent research indicates that the prevalence of BPD is evenly distributed among the sexes, even if more women tend to receive a diagnosis. This gender disparity may be attributed to various factors, including a sexist bias in clinicians, hormonal influences, socialization patterns, and cultural expectations (2).

Although people across the gender spectrum can experience a range of BPD symptoms at all levels of severity, studies have shown differences in how they present in men and women (3).

For example, compared to women with BPD, men with the disorder reported higher rates of lifetime substance abuse and antisocial behavior—something that may have something to do with the under-diagnosis of men as they come to the attention of law enforcement before they can get psychiatric help.

Conversely, women with BPD reported higher rates of lifetime eating disorders and co-morbid mood disorders such as anxiety and depression. These results highlight distinct lifetime patterns of impulse-related disorders in male and female BPD patients, even if both genders suffer similar levels of emotional distress.

Unique Challenges For Women With BPD

In addition to differences in the presentation of symptoms, women may also face particular challenges, both biological and social, that relate to BPD.

The Effect Of Menstrual Cycles

Studies have shown a potential relationship between premenstrual syndrome (PMS) and BPD. PMS symptoms appear before a period and can include:

• Mood swings
• Irritability or moodiness
• Tension or anxiety
• Fatigue
• Bloating
• Breast tenderness or swelling
• Headaches or migraines
• Food cravings or appetite changes
• Trouble sleeping (insomnia)
• Changes in libido
• Joint or muscle pain
• Acne or skin changes
• Digestive issues like constipation or diarrhea

Not everyone with a menstrual cycle experiences these symptoms to the same degree (or at all). However, PMS can also interact with mood disorders, such as depression, anxiety, and BPD, intensifying symptoms in a phenomenon called premenstrual exacerbation (PME).

In the case of BPD, women with borderline personality disorder who are undergoing medication treatment commonly experience prolonged menstrual cycles and stronger mood fluctuations corresponding to different phases of the menstrual cycle (4).

The interactions of PMS symptoms with those of mood disorders like BPD can be challenging to navigate, which is why it is important to share all relevant information with your doctor so that it can be taken into consideration during treatment.

Stigma And Stereotypes

Unfortunately, women with BPD can face significant stigma and stereotypes, both within the medical community and society at large. They may be unfairly labeled as attention-seeking, manipulative, or unstable, perpetuating harmful misconceptions about the condition. Stereotypes of women as overly emotional can lead to the term “BPD” being unfairly applied as an excuse to dismiss legitimate grievances (5). 

These stereotypes can lead to misdiagnosis, inadequate treatment, and social isolation for women with BPD, exacerbating their distress and impairing their recovery. It’s important not to let sexism or social stigma surrounding BPD hold you back from seeking help—at Madison Avenue TMS & Psychiatry, patients will always find a sympathetic ear and compassionate treatment, regardless of their circumstances.

Therapy Options For BPD

While BPD can be challenging to live with, it is treatable, with several avenues of treatment available for anyone looking for relief from their symptoms, including:

• Talk therapy, particularly dialectical behavioral therapy (DBT), a method that specializes in helping people who experience intense emotions, has been proven to be effective in combatting BPD symptoms (6).
• Medications, including antidepressants, antipsychotics, and anti-anxiety medications, may be prescribed for BPD, depending on the patient’s symptoms. It’s important to note that medications are not one-size-fits-all, and different people respond in distinct ways to different types and doses of medications, taking some time to find out what works for them. As part of making this journey smoother, Madison Avenue TMS & Psychiatry offers personalized medication management services to help patients find the best treatment regime for their symptoms.
• Transcranial Magnetic Stimulation (TMS) is a non-invasive, drug-free procedure that uses a head-mounted device to stimulate specific areas of the brain associated with mood regulation. By “resetting” the brain’s neural connections, TMS can help alleviate the symptoms of depression, anxiety, and emotional dysregulation commonly seen in BPD. TMS has been proven to help BPD patients and is an option for individuals who have not found relief from medications.

Treatment For BPD In New York

At Madison Avenue TMS & Psychiatry, we understand the unique needs of women with BPD and provide personalized care to support their mental health journey. If you or someone you love is struggling with BPD and is based in New York, don’t hesitate to reach out to us today at (212) 731-2033 or via our contact form.

Our compassionate team is here to provide guidance, understanding, and evidence-based treatments, including medication management services, video consultations, and TMS therapy to help you beat BPD, reclaim your life, and thrive.

Additional resources on depression and women’s health:

• Exploring Transcranial Magnetic Stimulation (TMS) For Postpartum Depression
• Women and Mental Health: Understanding the Gender Depression Gap
• Depression Treatments That Are Safe For Pregnant Women

Resources:

1. Richetin J, Preti E, Costantini G, De Panfilis C. The centrality of affective instability and identity in Borderline Personality Disorder: Evidence from network analysis. PLoS One. 2017;12(10):e0186695. Link. Accessed April, 23, 2024.
2. Beatson JA, Rao S. Depression and borderline personality disorder. Med J Aust. 2012;1(4):24-27. Link. Accessed April, 25, 2024.
3. Sansone, R. A., & Sansone, L. A. Gender Patterns in Borderline Personality Disorder. Innovations in Clinical Neuroscience. 2011;8(5), 16-20. Link. Accessed April, 23, 2024.
4. Zlotnick, C. Rothschild, L. Zimmerman, M. The Role of Gender in the Clinical Presentation of Patients with Borderline Personality Disorder. Journal of Personality Disorders. 2005;16:3, 277-282. Link. Accessed April, 23, 2024.
5. Rasgon, N., Bauer, M., Glenn, T., Elman, S., & Whybrow, P. C. Menstrual cycle related mood changes in women with bipolar disorder. Bipolar Disorders. 2004;5(1), 48-52. Link. Accessed April, 23, 2024.
6. Shaw, C., & Proctor, G. I. Women at the Margins: A Critique of the Diagnosis of Borderline Personality Disorder. Feminism & Psychology. 2005;15 (4), 483-490  Link. Accessed April, 23, 2024.
7. Schmidt, C., Soler, J., Vega, D., & Pascual, J. C. Practice matters: The role of mindfulness skills in emotion dysregulation in borderline personality disorder. Journal of Contextual Behavioral Science. 2024;32, 100756. Link. Accessed April, 24, 2024.

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.