Gender differences in Axis i and Axis II comorbidity in patients with borderline personality disorder

Department of Psychiatry, University of Mainz, Germany.
Psychopathology (Impact Factor: 1.56). 07/2009; 42(4):257-63. DOI: 10.1159/000224149
Source: PubMed

ABSTRACT Differences in the clinical presentation of men and women with borderline personality disorder (BPD) are of potential interest for investigations into the neurobiology, genetics, natural history, and treatment response of BPD. The purpose of this study was to investigate gender differences in axis I and axis II comorbidity and in diagnostic criteria in BPD patients.
110 women and 49 men with BPD were assessed with the computer-based version of the Munich-Composite International Diagnostic Interview and the Structured Clinical Interview for DSM-IV Personality Disorders. Gender differences were investigated for the following outcomes: (a) lifetime, 12-month and 4-week prevalence of axis I disorders; (b) axis II disorders, and (c) DSM-IV BPD diagnostic criteria.
With regard to lifetime prevalence of axis I disorders, men more often displayed a substance use disorder, in particular alcohol dependency (65 vs. 43%); on the other hand, women more frequently had an affective (94 vs. 82%), anxiety (92 vs. 80%) or eating disorder (35 vs. 18%), in particular anorexia nervosa (21 vs. 4%). Regarding the 12-month prevalence, we found significantly more women suffering from anorexia nervosa (13 vs. 0%). Considering the 4-week prevalence, there were no significant gender differences. With regard to axis II disorders, men had a higher frequency of antisocial personality disorder (57 vs. 26%). Regarding the BPD diagnostic criteria, men more often displayed 'intensive anger' (74 vs. 49%), whereas women more frequently showed 'affective instability' (94 vs. 82%).
In this German study, we could replicate and extend the findings from previous US studies, where men and women with BPD showed important differences in their pattern of psychiatric comorbidity. The implications for clinicians and researchers are discussed.

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    • "Extensive research shows that tit-for-tat is an effective strategy for eliciting cooperation from social partners (Axelrod & Dion, 1988) and so for measuring when it is deficient in BPD or BD. Second, we included only female participants because BPD is thought to be more prevalent in women and there are significant gender differences in its co-morbidity (Tadic et al. 2009) and associated personality traits (Sansone & Sansone, 2011) including novelty seeking (Sansone & Sansone, 2011). Finally, to be sure that any sub-optimal behaviour in the PD game was not due to problems with basic processing of social stimuli, we included a choice reaction-time task to test the ability to use joint attention to speed categorization of visual targets; this latter task also provided an appropriate control for motivational deficits in our two clinical samples. "
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    • "Findings indicated that only gender was associated with interpersonal problems; only trauma was associated with impulsivity, recurrent suicidal threats/attempts, unstable mood, intense inappropriate anger, feelings of emptiness, and stress-related dissociation or suspiciousness ; and neither gender nor trauma contributed to the prediction of avoiding abandonment or identity disturbance. The findings related to gender were in partial contrast to a community study that found women more commonly reported identity disturbance and mood instability, and men more commonly reported intense anger and explosiveness (Johnson et al., 2003; Tadic et al., 2009). The association of trauma with BPD was more consistent with a recent study indicating that overall symptoms of BPD were associated with traumatic experiences in adulthood, while stress-related dissociation was associated with general traumatization in childhood, and depression with emotional abuse (Wingenfeld et al., 2011). "
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    Behavioral Sciences & the Law 09/2012; 30(5):615-30. DOI:10.1002/bsl.2037 · 0.96 Impact Factor
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    • "In light of evidence of higher rates of treatment dropout among male versus female SUD patients (Maglione et al., 2000), as well as evidence that men (vs. women) with BPD may present with more severe substance use, comorbid personality disorders (e.g., ASPD), and difficulties with anger (Johnson et al., 2003; Tadić et al., 2009), it may be particularly important to focus on men specifically when examining the impact of BPD on substance abuse treatment dropout. "
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