Gender differences in aggression of borderline personality disorder

Abstract

Aggression is a core feature of borderline personality disorder (BPD). Well-replicated results from the general population indicate that men engage in aggression more frequently than women. This article addresses the question of whether gender also influences aggression in BPD, and whether the neurobiological mechanisms underlying aggressive behavior differ between male and female BPD patients. Data show that most self-reports, interviews and behavioral tasks investigating samples of BPD patients do not find enhanced aggressiveness in male patients, suggesting that BPD attenuates rather than aggravates gender differences usually present in the general population. Neurobiological studies comparing BPD patients with gender-matched healthy controls, however, reveal a number of interesting gender differences: On the one hand, there are well-replicated findings of reduced amygdala and hippocampal gray matter volumes in female BPD patients, while these findings are not shared by male patients with BPD. On the other hand, only male BPD patients exhibit reduced gray matter volume of the anterior cingulate cortex, increased gray matter volume of the putamen, reduced striatal activity during an aggression task, and a more pronounced deficit in central serotonergic responsivity. These neurobiological findings point to a particular importance of impulsivity for the aggression of male BPD patients. Limitations include the need to control for confounding influences of comorbidities, particularly as male BPD patients have been consistently found to show higher percentages of aggression-predisposing comorbid disorders, such as antisocial personality disorder, than female BPD patients. In the future, studies which include systematic comparisons between females and males are warranted in order to disentangle gender differences in aggression of BPD patients with the aim of establishing gender-sensitive treatments where needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s40479-015-0028-7) contains supplementary material, which is available to authorized users.

Borderline personality disorder symptoms and aggression: A within-person process model.

“…Moreover, these results suggest that BPD symptoms accentuate negative emotional reactivity specifically in attachment-relevant contexts characterized by rejection, exclusion, or abandonment, but not in the context of more general provocations such as criticism or insult. These findings build on previous work suggesting that affective dysregulation (Mancke, Bertsch, et al, 2015; Newhill et al, 2012; Scott et al, 2014) and interpersonal threat hypersensitivity (Mancke, Herpertz, et al, 2015), especially in response to rejection, are key processes that enhance risk for aggression in those with BPD. Furthermore, our results suggest that these affective and interpersonal mechanisms set apart BPD and ASPD-related aggression, at least after controlling for features shared across these disorders.…”

“…Recent findings suggest that affective dysregulation serves as one important mechanism that enhances risk for aggression in those with BPD (Mancke, Bertsch, & Herpertz, 2015; Newhill et al, 2012; Scott, Stepp, & Pilkonis, 2014). However, the specific form and context of this dysregulation remains poorly understood.…”

Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study

“…The female patients had significantly higher scores than men on all five factors of the BPRS‐E, suggesting that their clinically problematic behaviour is more severe than that of male patients. This contrasts with earlier findings that men with BPD either showed more aggressive behaviour than women, or at least as much (Bradley et al, ; Mancke et al, ).…”

“…Though a few studies found that women with BPD have higher rates of comorbid histrionic personality disorder (McCormick et al, ) or paranoid personality disorder (Grant et al, ), other studies did not (Johnson et al, ; Tadić et al, ). Behavioural comorbidities have also been noted, for example, boys meeting diagnostic criteria for BPD being more aggressive than girls (Bradley, Zittel Conklin, & Westen, ), although Mancke, Bertsch, and Herpertz () did not find this.…”

Experimentally Assessed Reactive Aggression in Borderline Personality Disorder

“…In another study, Mancke and colleagues (2015) presented a multidimensional model of aggression in BPD patients [39]. This model explains the formation of aggression from the perspective of the bio-behavioural dimensions of affective dysregulation, impulsivity, threat hypersensitivity, and empathic functioning.…”