Gender differences in Axis i and Axis II comorbidity in patients with borderline personality disorder
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.
- SourceAvailable from: Kate Saunders
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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. "
ABSTRACT: Borderline personality disorder (BPD) and bipolar disorder (BD) have overlapping clinical presentations and symptoms - sources of persistent clinical confusion. Game-theory can characterize how social function might be sub-optimal in the two disorders and move the field beyond the anecdotal description of clinical history. Here, we tested the hypothesis that BPD and BD can be distinguished on the basis of diminished reciprocal altruism in iterated Prisoner's Dilemma (PD) games. Twenty females with BPD, 20 females with euthymic BD and 20 healthy (non-clinical) females, matched for age and cognitive ability, were assessed for Axis-I and personality disorders, and completed psychometric measures of state affect, impulsivity and hostility. Participants completed two iterated PD games and a test of gaze-cueing. In the PD games, BPD participants failed to show statistically stable preferences to cooperate with social partners (playing tit-for-tat) and made significantly fewer cooperative responses compared to BD or controls (ANOVA main effect p = 0.03, post-hoc Tukey p < 0.05 for both comparisons). BPD participants were also less likely to sustain cooperation following experiences involving mutual cooperation than the other groups. Neither BPD nor BD participants demonstrated impairments in shifting visual attention on the basis of other peoples' gaze. These data indicate that BPD is (selectively) associated with difficulties in establishing, and then maintaining, reciprocal cooperation, involving altruism. These difficulties are not seen in euthymic BD. Our data support the differentiation of BPD from BD and offer fresh insights into the social difficulties experienced by individuals with diagnoses of BPD.Psychological Medicine 02/2015; 45(08):1-10. DOI:10.1017/S0033291714002475 · 5.43 Impact Factor
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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). "
ABSTRACT: The objective of this study was to quantify the relative contributions of gender and traumatic life experience to psychiatric disorders in a sample of 320 offenders entering a state prison. Women were more likely than men to report traumatic events and personal and family mental health treatment histories; and were more likely to meet criteria for posttraumatic stress, borderline personality, and eating disorders. People reporting traumatic life experiences were more likely than those not so reporting to have family mental histories and to meet criteria for mood, anxiety, psychotic, antisocial personality, and borderline personality disorders, as well as elevated suicide risk. With both gender and trauma included in the logistic regression models, only trauma was a significant predictor of mood, anxiety, psychotic, attention deficit hyperactivity, and antisocial personality disorders, as well as suicide risk. Trauma-informed programming, regardless of gender, is important for incarcerated offenders. To the extent that trauma is also criminogenic, these data suggest that women and men share the risk. Copyright © 2012 John Wiley & Sons, Ltd.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. "
ABSTRACT: Research is increasingly focusing on identifying factors distinguishing patients who complete vs. dropout of residential substance abuse treatment. One potentially relevant factor that has received relatively little attention is borderline personality disorder (BPD). This study sought to examine the effect of BPD on residential substance abuse treatment dropout within a sample of 159 male patients with substance use disorders-a population often understudied with regard to BPD and at high-risk for treatment dropout. Patients were administered a structured diagnostic interview to establish BPD diagnoses. Patients were then followed throughout the course of residential substance abuse treatment to identify those who completed treatment and those who prematurely dropped out of treatment. Patients with BPD were significantly more likely to prematurely dropout of treatment, and this finding remained even when taking into account relevant covariates (i.e., court-ordered treatment status, contract duration, and major depressive disorder). Further, patients with BPD were more likely to experience center-initiated dropout as opposed to voluntary withdrawal from treatment. These findings add to the literature on BPD-SUD co-occurrence, suggesting that the presence of co-occurring BPD among male SUD patients may increase the risk for dropout from residential substance abuse treatment, necessitating targeted interventions focused on decreasing dropout within this patient subgroup.Drug and alcohol dependence 09/2011; 121(1-2):97-102. DOI:10.1016/j.drugalcdep.2011.08.014 · 3.28 Impact Factor