Sex differences in borderline personality disorder: A scoping review

Abstract

Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of ‘sex’ was employed in the present review, future research could also investigate the social construct ‘gender’. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.

Gender differences in borderline personality disorder: a narrative review

“…A review on gender differences in borderline personality disorder has been recently published (2) and deserves a comparison between its results and our findings. While conclusions concerning symptoms and comorbid disorders, developmental and biological factors, and treatment issues are mainly concordant in the two studies, our review contains a detailed examination of differences concerning prevalence of BPD and more common diagnostic criteria endorsed by male and female patients.…”

“…These psychopathological features are exhibited in both genders, but whether they are more common for men or women is still debated in the literature and remains an open empirical question. Studies that specifically investigated clinical differences among gender in BPD patients are still limited (2). Some of these indicated that certain BPD features are more commonly found in women (3)(4)(5)(6)(7)(8)(9) others showed no significant difference across gender (10)(11)(12)(13) and the minority of them reported that some clinical manifestations are more common in men (3,6,14).…”

Frecuencia y factores asociados con el trastorno de la personalidad límite en estudiantes de Medicina

“…La asociación entre el sexo y el TPL coincide con lo hallado en la mayoría de los estudios epidemiológicos, revelando una mayor incidencia de este trastorno en mujeres que en hombres. Nuestros resultados son similares a los reportados por investigaciones como las de Sansone et al ( 16) y Qian et al (17), que identificaron una predominancia de mujeres con TPL, tanto en poblaciones clínicas como no clínicas. Sin embargo, esta disparidad podría verse afectada por aspectos culturales o de género, que podrían influir en la manifestación o detección del TPL.…”

Components of event-related potentials and borderline personality disorder: a meta-analysis

“…Finally, a meta-regression was performed (Mod; p < .05; R 2 > .5) based on a mixed effects model and maximum likelihood method aiming to examine the effect of variables that theoretically may be influencing the relationship between ERP and BPD symptoms. Indicators of exposed groups such as the female ratio (percentage of women in the sample), inequality index (Gini of the country) and gross domestic product (GDP of the country) were chosen as it has been shown that socioeconomic status and inequality are frequently linked to mental health issues (Harnett et al, 2023 ; O’Donoghue et al, 2023 ; Winsper et al, 2020 ), and mixed results have been reported on the gender-based prevalence of BPD across populations (Arranz et al, 2021 ; Qian et al, 2022 ; Sansone & Sansone, 2011 ). Thus, we hypothesize that these variables could potentially moderate the link between ERP and BPD symptoms.…”