Borderline Personality Disorder in Women: Signs, Symptoms & Treatment
Borderline personality disorder (BPD) in women is characterized by instability in mood and relationships.[1] It often co-occurs with mental health conditions like anxiety, depression, eating disorders, and post-traumatic stress disorder (PTSD). These conditions don’t just happen to appear together, but they often share the same root: childhood trauma.
As borderline personality disorder (BPD) is so frequently associated with traumatic experiences in childhood, many clinicians suggest it should be reclassified as a trauma condition. Furthermore, some experts question whether BPD is an outdated diagnosis that perpetuates discrimination against women, as men with the same symptoms often receive a different diagnosis.
We will explore these ideas and more in this article by discussing:
- What borderline personality disorder in women is and the origins of the diagnosis.
- The symptoms of BPD in women, including emotional dysregulation and relationship instability.
- The causes of BPD, including childhood trauma and genetics.
- Why women receive BPD diagnoses more often than men.
- BPD treatment options and self-support strategies women can use alongside therapy.
What Is Borderline Personality Disorder?
Psychiatrists developed the diagnosis of borderline personality disorder (BPD) in the 1930s. They noticed that some people didn’t respond well to traditional psychiatry and that their symptoms seemed to “border” on multiple conditions.[2] They weren’t clearly depressed or anxious. They seemed to be a bit of everything. So they called it “borderline.”
Borderline personality disorder features elements of many mental health conditions, including:[2]
- Depression.
- Severe anxiety.
- Post-traumatic stress disorder (PTSD).
- Psychosis.
Though some regard it as an outdated term, borderline personality disorder (BPD) is still used today. It describes a certain type of psychological pattern that affects one’s sense of self and relationships with people.[2]
Typically, BPD is characterized by:[2]
- Impulsivity.
- Unstable self-image.
- Fears of abandonment.
- Increased rates of suicidality.
However, the condition is often misunderstood and stigmatized because of how it affects women in relationships.
In particular, there are aspects of a BPD diagnosis that uphold outdated ideas about femininity, and many argue the condition should be seen as a response to trauma. For example, aggression in women tends to be pathologized more than in men, who tend to be praised for assertiveness.[3][4]
Signs and Causes of Borderline Personality Disorder in Women
Borderline personality disorder causes several emotional and behavioral symptoms that overlap with other mental health conditions. Crucially, these symptoms must significantly affect a woman long-term before she receives a BPD diagnosis.
BPD in Women Symptoms
A key indicator of borderline personality disorder in women is the way it impairs their relationships. Those with BPD tend to have unstable relationships as a result of instability in their own emotional lives.[2] Relationships can feel intense and move fast. A new friend or partner might feel like the most important person in the world, and then become an enemy just as quickly over a perceived slight.
Emotional dysregulation can also cause a range of impulsive and self-destructive behaviors, such as:[3]
- Reckless driving.
- Spending.
- Sexual activity.
However, many women with BPD will be extremely successful and seem to function at a very high level in their careers.[2]
A key symptom of BPD is self-harm; up to 85% of people with BPD will self-injure.[5] Self-harm might also be a way to feel something when emotions become numb, or to release emotional pain that feels unbearable. However, people with BPD are also at greater risk of suicide, particularly when they don’t have effective ways to cope with distress.[2]
In summary, BPD symptoms include:[2]
- Fluctuations between confidence and despair.
- Unstable self-image.
- Quick changes in mood.
- Rejection sensitivity.
- Fears of abandonment.
- Suicidal thoughts and self-harm.
- Transient psychotic delusions and hallucinations.
Researchers find that women and men will experience BPD symptoms differently, with women more likely to describe feeling empty and suicidal.[6] In contrast, men with BPD are more likely to report intense and inappropriate anger and impulsivity.[6]
What Causes Borderline Personality Disorder in Women?
Though some women with BPD come from stable families, many don’t. Emotional neglect, physical abuse, and instability in family relationships are likely to contribute to BPD.[2]
The adverse childhood experiences that are likely to cause BPD are interpersonal in nature, which means they occur between parent and child. For example:[7]
- A parent constantly minimizing or ignoring their daughter’s feelings.
- Emotional and physical neglect, which is when basic needs aren’t met and validated.
- Physical, verbal, emotional, or sexual abuse of a child by a caregiver.
- Abandonment of a child by a significant caregiver, whether intentional or not.
Alongside these environmental causes, it’s also thought that BPD may have a genetic component. Studies suggest that BPD has about 50% heritability, but it isn’t clear if this is biological or due to parents perpetuating the childhood environment they grew up in.[7] For example, a mother who was neglected might not know how to be emotionally present for her daughter.
Why Women Are More Likely Than Men to Get a BPD Diagnosis
Women are three times more likely to receive a BPD diagnosis than men.[1] Experts suggest that men who experience trauma are more likely to be diagnosed with post-traumatic stress disorder (PTSD) despite having the same symptoms.[4]
A diagnosis of BPD is seen as a feminist issue by some who suggest that the label imposes negative stereotypes about emotional women being “difficult.”[4] For instance, a woman who responds to traumatic experiences by developing anger or aggression may be pathologized because she’s failed to conform to mainstream norms of femininity.[3]
In contrast, men who are impulsive and prone to anger may not be recognized as having BPD or a trauma response because these qualities in men are more acceptable to society.[6]
However, sexual abuse is most associated with BPD compared to other types of trauma, and girls are more likely to experience sexual abuse than boys.[7] This could explain why BPD is more commonly diagnosed in women. It might not be that women are overdiagnosed, but that more women experience the specific type of trauma most linked to BPD.
Other Criticisms of BPD As A Diagnosis
Alongside feminist criticisms of BPD, other experts question its validity as a diagnosis for other reasons.
For example, borderline personality disorder can occur alongside mental health conditions like anxiety, depression, post-traumatic stress disorder (PTSD), and eating disorders. It may also be overlapping or confused with bipolar disorder, substance use disorders, and psychotic conditions.[2]
The boundaries aren’t clear. A woman with BPD might also meet the criteria for three or four other diagnoses. As a result of these many comorbidities, some experts suggest that BPD should not be classified as a personality disorder but rather within mood or identity disorders.[2]
Furthermore, many argue that BPD should be regarded as a delayed PTSD response, as women with it so often have significant trauma in their pasts.[2] If BPD was seen as a trauma disorder, it could lead to better treatment outcomes because treatment would be focused on addressing adverse experiences.[4]
However, despite these criticisms, psychiatric services can do a great deal of good for women with a BPD diagnosis. Research finds that 50% of people who get treatment for BPD will no longer meet the diagnostic criteria in 5-10 years.[2] This suggests that borderline personality disorder in women can be effectively treated.
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
BPD Treatment: How Can Women Be Supported?
Borderline personality disorder in women can be supported with psychotherapy that understands both women’s mental health and the key features of BPD.
Counseling and Therapy for Women With BPD
Though many types of counseling and psychotherapy will be helpful to women with a BPD diagnosis, it’s important that the approach understands BPD symptoms. The following three approaches can be particularly helpful for treating borderline personality disorder:
- Mentalization-Based Therapy (MBT): MBT is a type of psychotherapy designed by psychoanalysts who wanted to develop a treatment for people with BPD. Its unique focus identifies that people with BPD tend to struggle with mentalization, which is the concept of thinking about one’s own mind and the minds of other people.[8]
MBT aims to develop better mentalization abilities in women with BPD by increasing psychological flexibility. For example, the therapeutic work may focus on accepting conflicting or unclear perspectives and developing a stance of “not knowing.” It can also help cultivate patience for other people and challenge negative assumptions about what other people are thinking. This can help women with BPD navigate future relationships.[8]
- Trauma-Focused Therapy: As explained, women with BPD are likely to have had significant interpersonal trauma in their pasts. When counseling and psychotherapy are trauma-focused, they take special care to work through how painful experiences continue to affect someone. Often, depending on the therapist’s approach, the work will provide practical skills like emotional regulation or challenging negative core beliefs.
- Narrative Therapy: Narrative therapy invites women with BPD to retell the stories of their lives. Instead of focusing on the medical diagnosis of BPD, narrative therapy helps people re-author their experiences, which can feel more meaningful and authentic. It may help women separate themselves from what’s happened to them and forge a healthier relationship with themselves and their emotional responses.[3]
- Dialectical Behavior Therapy (DBT): DBT was developed specifically for BPD and has strong research support. It teaches four sets of skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These are practical skills you can use in daily life. DBT is one of the most researched treatments for BPD and has strong evidence for reducing self-harm and suicidal behavior.
Self-Support for Women With BPD
It’s thought that many women will see an improvement in their symptoms as they get older, more mature, and more self-reflective.[2] Alongside professional mental health support, women with borderline personality can implement the following self-support strategies:[7]
- Taking care of well-being with exercise, diet, and abstaining from alcohol or drugs.
- Developing a mindfulness practice.
- Identifying one’s own personal triggers in relationships.
- Working on catching unhelpful thinking patterns before they affect behavior and mood.
Medication and Hospitalization
Women with BPD might also benefit from medication or staying temporarily in an inpatient facility. These options are most appropriate during moments of crisis, when symptoms are at their most intense. Inpatient stays can help create stability, and medications such as antidepressants and mood stabilizers can target certain symptoms.[9]
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Find Therapy for Female Borderline Personality Disorder With Mission Connection
Borderline personality disorder in women can be incredibly disruptive for work, daily life, and relationships. Those with a BPD diagnosis may also feel stigmatized for being “difficult” and struggle on a daily basis with unprocessed traumatic memories. But BPD is a treatable condition, not a character flaw or some sign that women are overly reactive.
At Mission Connection, our team of licensed mental health professionals goes beyond traditional treatment and provides life-changing care. We offer several options for effective outpatient treatment, including in-person programs at our locations in California, Virginia, and Washington, virtual telehealth, and a hybrid program that combines in-person and virtual care.
We create a personalized, structured care plan for every patient that consists of evidence-based therapies (CBT, DBT, and trauma-informed approaches) and medication management (when appropriate).
Mission Connection is Joint Commission-accredited. We also accept most major insurance providers, so that your recovery is not hindered due to financial issues.
If you’re looking for treatment for female BPD, get started online or call us at 866-833-1822 to find out how we can support your long-term recovery. Our compassionate team is available 24/7 to answer your questions and provide guidance with no obligation.
