When Laura Brown was in her mid-twenties, she was in and out of a psychiatric hospital because of suicide attempts. Throughout the years, she was treated by various psychiatrists at the institutions, but it wasn’t until she found her own therapist at age 30 that she received a diagnosis: borderline personality disorder (BPD). (She’s also been diagnosed with post-traumatic stress disorder, or PTSD, and depression.)
“Sometimes I think that BPD sounds just like me, and other times I don’t,” she says. “I have an intense fear of being alone — one of the hallmarks of BPD — and I hate rejection,” she adds.
Indeed, BPD is a mental illness governed by a struggle to regulate emotion, explains Jill Weber, PhD, a psychologist in Washington, D.C. “This can be problems with joy, anxiety, hurt, or abandonment. People go from 0 to 100 quickly. They don’t have the coping mechanisms to bring emotion down appropriately,” she explains.
To be able to cope with her own problems with abandonment and rocky relationships, Brown practiced self-injury, had an eating disorder, and attempted suicide. “I was dysfunctional. I didn’t do drugs or drink, but otherwise, you name it, I had it,” Brown says. That pattern is typical of someone with BPD, Dr. Weber says. “These are things that people with BPD do in order to cope, which may be things that others think are unhealthy or strange. For them, it makes sense,” Weber explains.
Because of this intense display of emotion, clinicians may be more apt to assign women with borderline personality disorder over men. “There’s definitely a bias in the field. Some of it has to do with how we are socialized in our culture at large. Clinicians can also fall into this bias,” Weber says. On the other hand, when men display intense emotions — often appearing as anger — they’re diagnosed with an anger management problem, she says.
That’s one reason behind the popular myth that women suffer more often from borderline personality disorder. “While BPD is reported to be more prevalent in women than men, that is not correct. What is correct is that patients in clinical treatment settings are much more likely to be women than men,” says John Oldham, MD, professor of psychology at Baylor College of Medicine in Houston and author of the classic personality-type manual, The New Personality Self-Portrait. He notes that population-based epidemiological studies show that there’s no difference.
Indeed, whereas the thought once was that women were three to four times more likely to have BPD, men and women experience the disorder equally. (1) An older study of more than 34,000 adults in the Journal of Clinical Psychology found that 5.6 percent of men and 6.2 percent of women suffered from borderline personality disorder, a difference that was not significant, researchers say. (2)
Usually, symptoms of BPD begin to appear in adolescence or early adulthood, and a diagnosis can be made before age 18. In fact, nearly one-third of youth with BPD self-harm when they were younger than 12 years old. (1)
One misnomer is that BPD is something a person struggles with chronically, but that’s likely not the case. Research has shown that people with the illness do improve, at least for periods of time. In a study on adults ages 18 to 45, 85 percent experienced remission over a 10-year period, though sufferers still experienced problems with their ability to relate to others, succeed in relationships, and fulfill their obligations. (3)
How Borderline Personality Looks Different in Men and Women
Why was there the perception that women were suffering more from BPD? For one, they may show up in doctor’s offices in bigger numbers. Women may be more likely to seek help than men, which is true when it comes to medical illnesses as well. Women may also have a co-occurring mood disorder, like major depression, Dr.?Oldham says. “Those are the kinds of things that lead patients to feel so terrible they will come in for treatment,” he says.
While women may be more likely to deal with depression and BPD, men may suffer from the illness along with antisocial personality disorder. “They’re more likely to show up in a correctional facility because of trouble with the law,” Oldham notes. It’s easy to see how they may then be missed by the system, should they be labeled as being aggressive and violent rather than considering the possibility of BPD.
That said, BPD can look different in men and women. One study published in the Journal of Personality Disorders,?which?included more than 700 people with?BPD?between the ages of 18 and 65,?found that women with BPD experience more troubled relationships compared with men, and are more likely to have symptoms of depression and anxiety. (4)
But overall, “there are more similarities between men and women with BPD than differences,” Weber says. Where they diverge may be in how the illness appears. Women may have more internalizing symptoms, with ruminating, obsessive thought patterns. Men may have more externalizing behaviors, Weber says. Passively hurting themselves by driving recklessly or getting in fights are all ways the disorder may manifest in a male. “It’s a careless behavioral pattern,” Weber says. Both sexes may cut, drink excessively, or punch themselves to deal with intense emotions.
Men and women with BPD may also be diagnosed with PTSD, and for women, sexual abuse is often a driving factor. In a study published in the journal?Psychiatry Research, 58 percent of women with BPD who had a history of suicidal behavior also had PTSD. Sexual abuse in a woman’s past was most often explained as a trigger of the PTSD diagnosis, and over half of the women in the study reported experiencing two or more traumatic events in their past. (5)
Indeed, extremely distressing childhood life events, like abuse, abandonment, or growing up in a hostile, violent household can be one reason BPD develops in the first place, according to the National Institute of Mental Health (NIMH). Genetics and brain abnormalities in certain regions that control emotions can also factor into BPD. (6)
Unfortunately, sometimes, borderline traits — such as troubled interpersonal relationships, anger, fear of abandonment, and regular self-harm — can obscure the diagnosis of PTSD. In fact, some clinicians argue PTSD is under-recognized in the BPD population.
But for those who are affected and able to receive these diagnoses, know that neither condition has to last as long as the other. In many instances, it gets better. That said, research has shown that in those people with BPD who had a history of childhood sexual abuse were less likely to see their PTSD wane over time, while those who suffered sexual abuse as an adult were more likely to suffer a relapse. (7)
Seeking Treatment for Borderline Personality Disorder
Today, Brown remains single by choice, despite her history of rocky relationships and three divorces. “I didn’t know what I liked about anything. Whatever person I was with, I just liked what they liked. I truly knew nothing about me,” she explains. So she had a wild idea: She was going to make turning 40 her best year yet. Rather than going back to therapy, she made a move back to her home state of Montana for a fresh start and then started saying yes to everything anyone would ask her to do. Through that experiment, she discovered the things she loved, like kayaking. Brown is now the owner of Life Is Now In Session, a website dedicated to overcoming the disorder and living your best life.
Brown opted to overhaul more than just her outlook — she’s made-over her lifestyle, too. She put herself on a strict sleep schedule, started exercising at the gym for an hour a day, and is committed to staying single. Getting out of dramatic situations (like her former relationships) allowed her to experience normalcy in a way she couldn’t before. “I did everything I could do to change my life. Now I’d say I’m as close to normal as I’ll probably ever be,” Brown says.
While most mental health professionals support lifestyle changes, they also suggest therapy. One, in particular is called dialectical behavioral therapy (DBT). “This has enormous research behind it,” says Weber, who also recommends it for people who have depression, anxiety, or bipolar disorder.
DBT aims to help people acquire the learning skills to cope with their emotions. In fact, it’s a variation of cognitive behavioral therapy. The central points to DBT are mindfulness skills (observing emotions or thoughts without judgment), emotional regulation (through problem solving, tuning into reality, and learning how to take appropriate actions), interpersonal effectiveness (to help you interact effectively in relationships), and distress tolerance (how to handle crisis and calming yourself down without self-injury).
As research has pointed out, DBT especially shines when treating BPD that occurs with other conditions, like substance abuse, eating disorder, PTSD, and depression. In those ways, it may be especially helpful for women with these co-occurring problems. (8)
And seeking help is key. According to the NIMH, people with BPD who don’t get help are more likely to develop both chronic medical and mental illnesses and are more likely to remain in a cycle of unhealthy choices and harmful behavior. (6) Ultimately, this truth remains: The younger someone is when they?get help for their BPD, the greater their chance at living a successful, full life. (1)
If you suspect that you may have?BPD, check out the?NIMH’s?Help for Mental Illness website. If you’re a family member or friend who thinks a loved one may suffer from?BPD, remember to stand firm in offering support and understanding. Family therapy and individual therapy (for you) may also help. (6)
Editorial Sources and Fact-Checking
- Biskin RS. The Lifetime Course of Borderline Personality Disorder. The Canadian Journal of Psychiatry. July 2015.
- Grant BF, Chou PS, Goldstein RB, et al. Prevalence, Correlates, Disability, and Comorbiditiy of DSM-IV Boderline Personality Disorder: Results From the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. May 2009.
- Gunderson JG, Stout RL, McGlashan TH, et al. Archives of General Psychiatry. August 2011.
- Silberschmidt A, Lee S, Zanarini M, Schulz SC. Gender Differences in Borderline Personality Disorder: Results From a Multinational, Clinical Trial Sample. Journal of Personality Disorders. December 2014.
- Sinai C, Hirvikoski T, Wiklander M, et al. Exposure to Interpersonal Violence and Risk of Post-Traumatic Stress Disorder Among Women With Boderline Personality Disorder. Psychiatry Research. April 2018.
- Borderline Personality Disorder: Treatments and Therapies. National Institute of Mental Health. December 2017.
- Zanarini MC, Horz S, Frankenburg FR, et al. The 10-Year Course of PTSD in Borderline Patients and Axis II Comparison Subjects. Acta Psychiatrica Scandinavica. May 2011.
- Fassbinder E, Schweiger U, Martius D, et al. Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy. Frontiers in Psychology. September 2016.