A lot of statistical data about Borderline Personality Disorder (BPD) has been published over the past 30 years. Most of it is accurate. However, there is one particular statistic that makes me wonder. How is it that three out of four people diagnosed with BPD are women? I have some doubts about that.

Now, I’m neither a medical nor mental health professional. I’m actually a journalist who has covered Borderline Personality Disorder for more than 35 years. I’m also an NIMH funded researcher of BPD and other health conditions. That said… here are some thoughts and facts that have piqued my curiosity about the 75% female to 25% male ratio of people diagnosed with BPD.

What are the Odds?
Let’s say I flip a two sided coin (heads and tails) 99 times. Now imagine that the coin lands on heads on every one of the 99 flips. I offer you a wager. If it lands on heads again I will give you $10. But, if it lands on tails, you will have to give me $10. Would you accept the bet? I wouldn’t.

That’s because each coin flip is a separate event. There is always only a one in two chance it will come up on either side of the coin. The probability of the coin turning up heads or tails is equal: 50%.

Statistics can be misleading
Are there that many more women in the world than men? No.

According to a census conducted by the United Nations in 2019, there are 7.2 billion people inhabiting our planet: 3.8 billion of them are women and 3.9 billion are males. There is virtually equal gender representation: 50%.

Is there is something in human genetic makeup that makes women more vulnerable to developing BPD than men?

Given that the ratio of women to men in the population is about equal, it seems reasonable to think any risk of inheriting BPD is also equal. Again 50%

Both women and men produce ‘sex’ hormones- estrogen and testosterone. Women produces far more estrogen than testosterone and men more testosterone than estrogen.

Estrogen is associated with female behavioral traits such as maternal care and nurturing. Testosterone is associated with male behavioral traits such as risk taking and aggression.

Men who commit aggressive acts that injure others often wind up in the criminal justice system. Some experts contend that many incarcerated males would likely meet criteria for BPD but are frequently diagnosed with Antisocial Personality Disorder (APD) instead. There is also the possibility that women are more inclined to seek help from mental health providers than men. Accounting for these two influences may make the prevalence of BPD in men and women more equal.

A Brief History of BPD
However, Robert O. Friedel, MD, noted in his book Borderline Personality Disorder Demystified, that ‘’the symptoms of borderline disorder were first mentioned in the medical literature almost 3000 years ago.”

In the mid-1800’s women experiencing life interrupting emotional difficulties such as depression and anxiety were given the diagnosis of “hysteria”. The term derives from the Greek term for the female uterus.

Hysteria was a demeaning and stigmatizing label for women presenting with highly dysregulated emotions. Over time most doctors practicing Western medicine stopped accepting hysteria as a medical diagnosis. But the belief that hysteria was a ‘woman’s’ disorder contributed to the widespread notion that women were ‘the weaker sex’.

The term “borderline” was first introduced in the United States in 1938 to try and describe people (mostly women) who presented with emotional problems on a spectrum somewhere between neurosis (e.g. anxiety and depression ) and psychosis (e.g.,delusional disorders such as schizophrenia).

In 1980 Borderline Personality Disorder was first included in the Diagnostic and Statistical Manual (DSM) as a mental disorder. So Borderline Personality Disorder has only been officially recognized as a mental illness for 40 years. However, this milestone stimulated a number of breakthroughs in BPD research and clinical practice.

The long history of Borderline Personality Disorder is rife with inaccuracies, lack of awareness, misdiagnoses and invalidating stigma. Perhaps its time to rigorously reexamine the idea that women are three times more likely to have BPD than men.

Graphic: Women’s March 2020


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