BPD In Women: Know The Signs

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By Dr. David Woo - May 20, 2024

Symptoms-Of-Borderline-Personality-Disorder-In-Women

Borderline personality disorder (BPD) is a mood disorder characterized by extreme emotional dysregulation or ‘affective instability’ (1). Although BPD affects both men and women, the symptoms and experiences can vary between genders. Recognizing the signs of borderline personality disorder in women is crucial for accurate diagnosis and effective treatment. Women with BPD often face unique challenges and societal stigmas, making it essential to understand the condition and provide compassionate support. We dive into BPD differences in women and men to dispel misconceptions and explore effective treatment options for BPD.

Symptoms of Borderline Disorder In Women

Symptoms of BPD in women and men can include:

Intense and unstable relationships, characterized by extremes of idealizing and devaluing partners, friends, or family.
Strong fear of abandonment, leading to frantic efforts to avoid real or imagined rejection.
Risk-taking and impulsive behavior such as reckless spending, substance abuse, or self-harm.
Identity confusion, marked by uncertainty about self-image, goals, and values.
Emotional instability that can range from feelings of emptiness to intense anger or inner turmoil.
Dissociation, or feeling detached from oneself, one’s body, or reality.

As a complex mood disorder, BPD symptoms can also overlap with related conditions such as anxiety and depression. In fact, it is more common to have depression and BPD than BPD on its own (2).

Borderline Personality Disorder In Women And Men: Is There A Difference?

Historically, BPD was presumed to be more common in women than men, with early research and diagnosis patterns suggesting that symptoms of BPD in females occurred three times as often as in males. However, more recent research indicates that the prevalence of BPD is evenly distributed among the sexes, even if more women tend to receive a diagnosis. This gender disparity may be attributed to various factors, including a sexist bias in clinicians, hormonal influences, socialization patterns, and cultural expectations (2).

Although people across the gender spectrum can experience a range of BPD symptoms at all levels of severity, studies have shown differences in how they present in men and women (3).

For example, compared to women with BPD, men with the disorder reported higher rates of lifetime substance abuse and antisocial behavior—something that may have something to do with the under-diagnosis of men as they come to the attention of law enforcement before they can get psychiatric help.

Conversely, women with BPD reported higher rates of lifetime eating disorders and co-morbid mood disorders such as anxiety and depression. These results highlight distinct lifetime patterns of impulse-related disorders in male and female BPD patients, even if both genders suffer similar levels of emotional distress.

Unique Challenges For Women With BPD

In addition to differences in the presentation of symptoms, women may also face particular challenges, both biological and social, that relate to BPD.

The Effect Of Menstrual Cycles

Studies have shown a potential relationship between premenstrual syndrome (PMS) and BPD. PMS symptoms appear before a period and can include:

Mood swings
Irritability or moodiness
Tension or anxiety
Fatigue
Bloating
Breast tenderness or swelling
Headaches or migraines
Food cravings or appetite changes
Trouble sleeping (insomnia)
Changes in libido
Joint or muscle pain
Acne or skin changes
Digestive issues like constipation or diarrhea

Not everyone with a menstrual cycle experiences these symptoms to the same degree (or at all). However, PMS can also interact with mood disorders, such as depression, anxiety, and BPD, intensifying symptoms in a phenomenon called premenstrual exacerbation (PME).

In the case of BPD, women with borderline personality disorder who are undergoing medication treatment commonly experience prolonged menstrual cycles and stronger mood fluctuations corresponding to different phases of the menstrual cycle (4).

The interactions of PMS symptoms with those of mood disorders like BPD can be challenging to navigate, which is why it is important to share all relevant information with your doctor so that it can be taken into consideration during treatment.

Stigma And Stereotypes

Unfortunately, women with BPD can face significant stigma and stereotypes, both within the medical community and society at large. They may be unfairly labeled as attention-seeking, manipulative, or unstable, perpetuating harmful misconceptions about the condition. Stereotypes of women as overly emotional can lead to the term “BPD” being unfairly applied as an excuse to dismiss legitimate grievances (5).

These stereotypes can lead to misdiagnosis, inadequate treatment, and social isolation for women with BPD, exacerbating their distress and impairing their recovery. It’s important not to let sexism or social stigma surrounding BPD hold you back from seeking help—at Madison Avenue TMS & Psychiatry, patients will always find a sympathetic ear and compassionate treatment, regardless of their circumstances.

Therapy Options For BPD

While BPD can be challenging to live with, it is treatable, with several avenues of treatment available for anyone looking for relief from their symptoms, including:

Talk therapy, particularly dialectical behavioral therapy (DBT), a method that specializes in helping people who experience intense emotions, has been proven to be effective in combatting BPD symptoms (6).
Medications, including antidepressants, antipsychotics, and anti-anxiety medications, may be prescribed for BPD, depending on the patient’s symptoms. It’s important to note that medications are not one-size-fits-all, and different people respond in distinct ways to different types and doses of medications, taking some time to find out what works for them. As part of making this journey smoother, Madison Avenue TMS & Psychiatry offers personalized medication management services to help patients find the best treatment regime for their symptoms.
Transcranial Magnetic Stimulation (TMS) is a non-invasive, drug-free procedure that uses a head-mounted device to stimulate specific areas of the brain associated with mood regulation. By “resetting” the brain’s neural connections, TMS can help alleviate the symptoms of depression, anxiety, and emotional dysregulation commonly seen in BPD. TMS has been proven to help BPD patients and is an option for individuals who have not found relief from medications.

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.

Treatment For BPD In New York

At Madison Avenue TMS & Psychiatry, we understand the unique needs of women with BPD and provide personalized care to support their mental health journey. If you or someone you love is struggling with BPD and is based in New York, don’t hesitate to reach out to us today at (212) 731-2033 or via our contact form.

Our compassionate team is here to provide guidance, understanding, and evidence-based treatments, including medication management services, video consultations, and TMS therapy to help you beat BPD, reclaim your life, and thrive.

Additional resources on depression and women’s health:

Resources:

Richetin J, Preti E, Costantini G, De Panfilis C. The centrality of affective instability and identity in Borderline Personality Disorder: Evidence from network analysis. PLoS One. 2017;12(10):e0186695. Link. Accessed April, 23, 2024.
Beatson JA, Rao S. Depression and borderline personality disorder. Med J Aust. 2012;1(4):24-27. Link. Accessed April, 25, 2024.
Sansone, R. A., & Sansone, L. A. Gender Patterns in Borderline Personality Disorder. Innovations in Clinical Neuroscience. 2011;8(5), 16-20. Link. Accessed April, 23, 2024.
Zlotnick, C. Rothschild, L. Zimmerman, M. The Role of Gender in the Clinical Presentation of Patients with Borderline Personality Disorder. Journal of Personality Disorders. 2005;16:3, 277-282. Link. Accessed April, 23, 2024.
Rasgon, N., Bauer, M., Glenn, T., Elman, S., & Whybrow, P. C. Menstrual cycle related mood changes in women with bipolar disorder. Bipolar Disorders. 2004;5(1), 48-52. Link. Accessed April, 23, 2024.
Shaw, C., & Proctor, G. I. Women at the Margins: A Critique of the Diagnosis of Borderline Personality Disorder. Feminism & Psychology. 2005;15 (4), 483-490 Link. Accessed April, 23, 2024.
Schmidt, C., Soler, J., Vega, D., & Pascual, J. C. Practice matters: The role of mindfulness skills in emotion dysregulation in borderline personality disorder. Journal of Contextual Behavioral Science. 2024;32, 100756. Link. Accessed April, 24, 2024.

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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