Leo Sher, M.D.

Our research report, “Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder” has been published in Acta Psychiatrica Scandinavica online ahead of print (1).

We examined gender differences and similarities in aggression, impulsivity, suicidal behaviour, and psychiatric comorbidity in men and women with borderline personality disorder (BPD) compared with healthy controls. A community sample of 511 participants (healthy controls: 81 men and 82 women; BPD patients: 145 men and 203 women) were characterized using structured diagnostic interviews and symptom severity assessments.

The results indicate that both men and women with BPD are less educated, less socially adjusted, more labile, depressed, impulsive, and aggressive in comparison with healthy controls. This indicates that a community sample of individuals with BPD is very sick and impaired compared with the general population.

In comparison with women with BPD, men with BPD are less educated, have higher total Barratt Impulsivity Scale (BIS), BIS—motoric impulsiveness and BIS—non‐planning impulsiveness subscale, total Buss–Perry Aggression Questionnaire (BPAQ), and BPAQ—physical aggression subscale scores. Men with BPD are more likely to have comorbid narcissistic, antisocial, paranoid, and schizotypal personality disorders, alcohol and substance use disorders but less likely to have dependent and obsessive–compulsive personality disorders compared to women with BPD. There is a trend toward higher maximum lethality of suicide attempts in men suicide attempters compared with women suicide attempters but no difference between men and women with regard to the proportion of suicide attempters or the number of suicide attempts.

The results of our study indicate that men with BPD are more aggressive, impulsive, and overall impaired in comparison with women with BPD.

The results of our study also suggest that men with BPD may be at a higher risk of dying by suicide than women with BPD. Our study shows that men with BPD have many more risk factors for suicide death in comparison with women with BPD including male gender, lower level of education, higher impulsivity and aggression, and more frequent comorbidity with substance use disorders, antisocial and other personality disorders. Taken together, these findings suggest that men with BPD may be at a higher suicide risk in comparison with women with BPD. Additionally, there is a trend toward a higher lethality of suicide attempts in men with BPD vs. women with BPD.

In the general population of the United States and other Western countries, men die by suicide more frequently than women but women more often make suicide attempts. Our study indicates that gender differences in proportion of suicide attempters observed in the general population (women > men) are absent in individuals with BPD.

References

1. Sher L, Rutter SB, New AS, Siever LJ, Hazlett EA. Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder. Acta Psychiatr Scand. 2018 Oct 24. doi: 10.1111/acps.12981. [Epub ahead of print]