Gender differences in the treatment of patients with borderline personality disorder.

Abstract

It is debated whether men with borderline personality disorder (BPD) are less often treated for their disorder, compared to women, even when they have sought care. Here, the aim was to examine gender differences in the treatment of patients with BPD. Through linkage to Swedish health and administrative registers, we identified all patients diagnosed with BPD (n = 5530) in Stockholm County from 2012 to 2016. We ascertained information on sociodemographic characteristics, comorbid psychiatric diagnoses, and all mental health care utilization within inpatient and outpatient mental health care, including receipt of psychiatric medication and various psychological therapies. We identified 802 men and 4,728 women with BPD during the study period. Men with BPD were less likely than their female counterparts to be treated with psychotherapy as well as psychiatric medication. Most of the differences in treatment with psychological therapies were nonsignificant in the multivariate model, indicating they are likely the result of differences in sociodemographic variables and comorbidity between men and women with BPD. Men with BPD were in average 4 years older than women at the time of the first BPD diagnosis, had lower education, and were also more likely to receive social welfare support. In conclusion, few men are diagnosed with BPD and those who are diagnosed are likely to receive somewhat less psychiatric medication and psychological therapies compared to women. Researchers and clinicians need to focus more on men with BPD to improve help-seeking and recognition of this disabling condition in men and enable equal treatment.

Clinical trials in personality disorders: Recommendations for study design and conduct.

“…However, this is misleading and limits the applicability of research findings to large proportions of individuals with BPD, that is, persons of the male gender, adolescents, or elderly. While BPD is usually postulated to be substantially more common in women (3:1 ratio; American Psychiatric Association, 2013), epidemiologic studies in the general population indicate that the prevalence rates might be relatively equal in male and female gender (Dehlbom et al, 2021). Therefore, a substantial part of those individuals who suffer from BPD would not be considered adequately in BPD research.…”

Sex differences in borderline personality disorder: A scoping review

“…Mixed-sex comparisons showed that compared with males, females were more likely to receive psychological treatment, such as DBT and CBT [49, 62,65,133], and psychotropic medication, especially antidepressants and anti-anxiety agents [26,49,133]. In contrast, males were more likely to be prescribed with antipsychotic medication [75].…”

“…In contrast, males were more likely to be prescribed with antipsychotic medication [75]. Males are also more likely to have their first BPD diagnosis assessed in a Drugs and Alcohol (D&A) clinic [133], referred to D&A rehabilitation [49] or get treatment in a combination of D&A clinics and psychiatric care [133]. Males with BPD were also less likely to find psychotherapy or hospital admissions helpful compared with females [62], and tend to have fewer therapy sessions [133] or drop out of treatment [64,105].…”

“…Males are also more likely to have their first BPD diagnosis assessed in a Drugs and Alcohol (D&A) clinic [133], referred to D&A rehabilitation [49] or get treatment in a combination of D&A clinics and psychiatric care [133]. Males with BPD were also less likely to find psychotherapy or hospital admissions helpful compared with females [62], and tend to have fewer therapy sessions [133] or drop out of treatment [64,105]. Among same-sex comparisons, studies reported that females with BPD were more likely to be restrained and separated using time-out strategy, screened for D&A use, readmitted [122], and have longer stays in hospital than controls [46].…”

Parental identity formation in mothers is linked to borderline and depressive symptoms: A person-centered analyses

“…Since a well-formed parental identity appears to be a protective factor against stress ( Schrooyen et al, 2021 ; Piotrowski, 2022 ), a good understanding of the determinants of its development in mothers and the links to mental health is necessary. Although studies on the prevalence of borderline personality disorder among men and women are ambiguous (some studies show higher prevalence among women and others show similar prevalence among men and women, Ellison et al, 2018 ; Dehlbom et al, 2022 ), for depression, the prevalence among women is twice as high as among men ( Hyde et al, 2008 ; Hyde and Mezulis, 2020 ), putting mothers at particular risk. The present study aimed to better understand the relationship between mothers’ parental identity and their mental health.…”