What Are The Symptoms Of BPD?

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By Dr. David Woo - June 19, 2023

Borderline personality disorder, or BPD, is a mood disorder characterized by having an unstable self-image and problems with emotional regulation that can be disruptive to the sufferer’s well-being, career, family, and social life. BPD can be difficult to live with, but it is treatable, and it’s important to recognize symptoms early so that the correct treatment can be sought as soon as possible. When the disease is recognized and treated, BPD sufferers actually have a better long-term prognosis than sufferers of other disorders such as depression (1). In this article, we will look at the symptoms of BPD, including quiet BPD symptoms, and explore treatment options for BPD.

Symptoms of BPD

BPD produces a range of symptoms, which can be grouped into 4 main categories(2). These are:

Emotional instability, also known as “affective dysregulation,” includes intense feelings of rage, despair, loneliness, unworthiness, and other negative emotions.
Disturbed patterns of thinking or perception, also known as “cognitive or perceptual distortions,” can include hallucinations or fears (e.g., that your loved ones secretly hate you).
Impulsivity, especially urges to self-harm or engage in risky behavior.
Intense but unstable relationships characterized by an intense fear of abandonment and/or of smothering/closeness that creates a love/hate dynamic.

‘Quiet’ BPD Symptoms To Watch Out For

Research has shown that dramatic, acute symptoms of BPD (e.g., self-mutilation or suicide attempts) attract more attention and treatment than the so-called ‘quieter’ symptoms such as feelings of loneliness and isolation, that tend to persist (3,4).

Not every BPD symptom will be dramatic or public, so it’s important to be aware of and watch for these so-called ‘quiet’ symptoms too.

BPD Symptoms In Women Vs BPD Symptoms In Men

Symptoms of BPD in females can often differ from male BPD symptoms. For instance, male BPD sufferers are more likely to display aggression, anger, and impulsivity. Among women, mood swings and self-harm are more common. Unfortunately, men with BPD are also slower to seek care and receive a diagnosis than women (5,6).

It also is worth noting that studies of BPD among transgender or gender-diverse (TGD) individuals suggest a higher rate of occurrence among this group compared to cisgender people, but concluded that this is likely due to the additional societal stressors that affect gender non-conforming people.

Despite these differences, not everyone is typical and it is important not to let gender bias lead us to dismiss signs of BPD or delay seeking help. Whatever an individual’s gender, they should be encouraged to seek treatment.

Treatment Options For BPD

Typical treatments for BPD include cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), and medications. Patients for whom prescription drugs have not worked, or who wish to avoid potential side effects, should also consider Transcranial Magnetic Stimulation (TMS).

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.

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:

Mental Health Disorder	Men	Women
Depression	More likely to present irritability, anger, substance abuse, risk-taking behavior, and physical pain (e.g., back pain, headaches).	More likely to experience sadness, excessive crying, fatigue, sleep disturbances, and rumination.
Anxiety	Externalizing symptoms like irritability, anger, restlessness; may self-medicate with alcohol or drugs.	Internalizing symptoms such as excessive worry, fear, avoidance, and physical symptoms (e.g., headaches, muscle tension).
Bipolar Disorder	More prone to manic episodes characterized by irritability, aggression, and impulsive behavior; higher risk of substance abuse.	More prone to depressive episodes; rapid cycling is more common, along with mixed states of mania and depression.
Borderline Personality Disorder (BPD)	Often underdiagnosed; may show aggression, substance abuse, or reckless behavior; stigma around “masculine” emotional expression.	More likely to exhibit mood swings, intense emotional reactions, fear of abandonment, and self-harm behaviors.
Obsessive-Compulsive Disorder (OCD)	More likely to have obsessions related to symmetry, checking, and contamination; less likely to seek treatment.	More likely to have obsessions related to cleanliness, contamination, and compulsive cleaning; higher rates of comorbid anxiety.
Attention-Deficit/Hyperactivity Disorder (ADHD)	Often presents with externalizing behaviors like impulsivity, hyperactivity, and risk-taking; more diagnosed in childhood.	Often presents with inattentiveness, forgetfulness, and disorganization; underdiagnosed and often identified in adulthood.
Post-Traumatic Stress Disorder (PTSD)	More likely to experience irritability, anger, emotional numbing, and substance abuse; symptoms linked to combat or accidents.	More likely to experience hypervigilance, flashbacks, avoidance, and emotional distress; symptoms often linked to sexual trauma or abuse.

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:

Sources

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.
Albert, P. R. Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience.. 2015;40(4), 219-221. Link. Accessed September 16, 2024.
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.
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.
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.
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.
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.
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.
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.
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.

TMS uses a head-mounted device to reach the areas of the brain associated with mood disorders by sending tiny electromagnetic pulses to stimulate neurons in a way that alleviates symptoms. TMS has a great success rate in treating depression and anxiety, and studies have shown it to be also effective in treating BPD symptoms.

TMS For BPD In NYC

If you or a loved one is experiencing symptoms of BPD, it is important to seek help as early as possible. TMS can be a great drug-free way to find relief from BPD symptoms, especially if other treatments have not been effective.

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

Sources:

Borderline Personality Disorder (BPD). Health Guide. Link. Accessed May 7, 2023.
Symptoms – Borderline personality disorder. NHS. November 7 2022. Link. Accessed May 7, 2023.
Zanarini, Mary C. Ed.D. Frankenburg, Frances R. M.D.D. Reich, Bradford M.D. Silk, Kenneth R. M.D. Hudson, James I.M.D., Sc.D. McSweeney, Lauren B. B.A. The Subsyndromal Phenomenology of Borderline Personality Disorder: A 10-Year Follow-Up Study. The American Journal of Psychiatry. 2007; Published Online. Link. Accessed May 7, 2023.
Choi-Kain, Lois W., Zanarini, Mary C., Frankenburg, Frances R., Fitzmaurice, Garrett M., and Reich, Bradford. A Longitudinal Study of the 10-Year Course of Interpersonal Features in Borderline Personality Disorder. Journal of Personality Disorders. 2010;24(3). Link. Accessed May 7, 2023.
Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLOS ONE. 2022;17(12). Link. Accessed May 7, 2023.
Busch, Alexander J., Balsis, Steve, Morey, Leslie C., and Oltmanns, Thomas F. Gender Differences in Borderline Personality Disorder Features in an Epidemiological Sample of Adults Age 55–64: Self Versus Informant Report. Journal of Personality Disorders. 2016;30(3). Link. Accessed May 7, 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.

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