Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of ‘sex’ was employed in the present review, future research could also investigate the social construct ‘gender’. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
Citation: Qian X, Townsend ML, Tan WJ, Grenyer BFS (2022) Sex differences in borderline personality disorder: A scoping review. PLoS ONE 17(12): e0279015. https://doi.org/10.1371/journal.pone.0279015
Editor: Stephan Doering, Medical University of Vienna, AUSTRIA
Received: July 30, 2022; Accepted: November 28, 2022; Published: December 30, 2022
Copyright: © 2022 Qian et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the article and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Borderline personality disorder (BPD) is a complex mental health disorder. It is marked by a pervasive pattern of unstable interpersonal relationships, identity disturbances, affective instability, and impulsive and self-damaging behaviours . Epidemiological studies have estimated that 0.5% to 5.9% of the adult population in the world have BPD [2–4].
Since the introduction of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980’s, BPD has been viewed by clinicians as a female-specific disorder . The DSM-5, for example, indicated that approximately 75% of individuals diagnosed with BPD are females . As a result, the original studies of BPD treatment have focused mainly on females . The field has developed a database of evidence that has largely not included the male experience. More recent research, however, suggest that prevalence rates are not significantly different between males and females [7, 8]. Despite this, BPD is still often perceived to be a female-predominant disorder in both research and clinical contexts.
Due to the lack of conclusive findings, current literature on sex differences in BPD remains fragmented and unclear. For example, findings from an earlier literature review that investigated sex difference across personality disorders was inconclusive . This poses a significant challenge with potential repercussions on treatment applicability and efficacy, especially for males with BPD. Many studies of BPD therapies have primarily been conducted with female participants. For example, the original studies on Dialectical Behaviour Therapy (DBT), one of the most empirically supported treatment for BPD, were female-only . Presently, a handful of studies have examined the effectiveness of DBT for males with BPD . A recent scoping review suggests the relationship between withdrawal behaviours in men with BPD and low utilization of treatment services . This further highlights the need to investigate and develop specific intervention for this group.
Consolidating data on sex and BPD could provide greater insight to treatment effectiveness and guide future research and clinical directions. As such, a scoping review is required to advance the understanding of sex differences in BPD by providing an overview and synthesis of the available research evidence on potential sex differences in BPD, and to identify potential knowledge gaps in literature. As this scoping review was limited by the previous classifications in the literature, it is more accurate to use the biological term ’sex’ instead of the social construct ’gender’ which is rarely reported and not the focus of this review. Specifically, the present scoping review aimed to answer the research question: What are the sex differences and/or similarities of individuals diagnosed with BPD in relation to symptoms, comorbid disorders, developmental factors, biological markers and treatment?
The review was conducted systematically using the Joanna Briggs Institute (JBI) guidelines for Scoping Reviews  and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) checklist . As the intention of this scoping review was to synthesize the literature on sex differences in BPD, all relevant literature were included regardless of methodology quality to provide a more thorough overview of the topic . Prior to conducting the scoping review, a preliminary search was conducted in Medline, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis to ensure that no current or ongoing systematic reviews or scoping reviews on the topic were identified. A librarian at the University of Wollongong supported the research team in the development of the search strategy involving sex and BPD. Primary research studies that examined sex specific results in mixed sex samples were considered for this scoping review. As the aim of the study was to investigate sex differences, studies that recruited transgender participants were excluded due to the complexity in classification. Participants in these studies had a primary diagnosis of BPD as defined either by a classification system (any versions of the DSM or the International Classification of Diseases [ICD]), a validated structured clinical interview, or by a health practitioner. The search strategy included key terms regarding five main areas of interest including, BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment. Literature search was conducted in PubMed, PsycINFO, Scopus and Web of Science from their date of inception to 2 July 2022. All search strategies used are included in S1 File.
All studies were exported to a referencing software (Clarivate Analytics, PA, United States of America [USA]) where duplicates were removed. The remaining papers were then uploaded to the Covidence review platform, an online web application for screening systematic reviews . This was to facilitate the screening and full-text review processes. The titles and abstracts of the papers were screened independently by two reviewers (X.Q. and W.J.T.). Papers were considered in the present scoping review if they: 1) explored potential sex differences in the population of interest, 2) were retrospective, cross-sectional or prospective primary research studies, 3) were published in English. Studies were excluded if: 1) participants were diagnosed with BPD and another personality disorder, or 2) they were either case reports, letters to editor, protocols, book chapters, conference abstracts, qualitative research, or review study designs. There was no age-based restriction for the included studies. If the relevance of a study was unclear from the title and abstract, then a full-text review was warranted. Differences in opinions between the reviewers were resolved through team discussions until consensus was reached.
Data extraction and summary
Data was extracted independently by two reviewers (X.Q. and W.J.T.). Extracted data were classified into five overarching categories including symptoms, comorbid disorders, developmental factors, biological markers, and treatment. Each main category was then further broken down into more specific subcategories. For the subcategory of symptomatology, any finding related to the nine DSM-5 symptoms was recorded. For the subcategory of comorbid disorders, any finding of comorbid Axis 1 and Axis 2 disorders were recorded. For the subcategories of developmental, biological, and treatment, any reported differences were recorded. The full table is presented in the data extraction form (S1 Table). Other information such as countries in which the studies took place, population size, and demographic information were also extracted whenever possible. Depending on the population that was recruited in each study, the extracted data was classified into two groups: BPD mixed-sex (i.e., male and female comparisons), and BPD same-sex (i.e., male-only or female-only comparisons).
Data is primarily summarized using two methods. The first method was the use of vote counting to synthesize results in this review [16, 17]. The vote counting method is appropriate for heterogeneous studies and used in recent published research [18, 19]. In mixed-sex comparisons, when a significant difference towards a particular sex was reported, it was quantified as ‘1’ for the respective sex (e.g., male) and category (e.g., impulsivity). The numeric scores were then summed up for each sex, and the difference between the sexes were calculated for each subcategory. This method of vote counting is often used in scoping reviews to investigate the prevalence of a phenomenon , or the prevalence of specific phenomenon on binary variables [21–23]. While most previous research only reported vote count in terms of percentage, implementing a set of rules relevant to the number of studies found in the literature search could serve as a way to synthesize results. For this reason, the following rules were predetermined after the number of included studies were determined, but before data extraction commenced. If the number of studies that reported sex differences is smaller than 2, there is neutral evidence. If the difference is between 2 and 3, there is slight evidence for a particular sex. If the difference is 4 to 5, there is some evidence for a particular sex. If the difference is greater than 5, there is substantial evidence for a particular sex. Data from studies that were conducted with only a single sex was recorded but not compared with studies which included both sexes. This was to ensure that the results were not biased due to more studies being conducted with a certain sex.
The second method of summarizing the results was through a narrative synthesis approach. This approach is used when there is insufficient data, i.e., fewer than three studies per researched category. This method is appropriate when no other method of comparison is feasible .
Database searches in July 2022 located 7,612 records, with 2,049 remaining after duplicates were removed. The titles and abstracts of the papers were screened, and 1,771 papers were removed as they did not meet the inclusion criteria. The remaining 278 papers were retrieved for full-text review, where 83 papers were excluded. Reasons for the exclusion are presented according to the PRISMA flow chart  in Fig 1. The final 118 papers were included in the scoping review [10, 26–142].
Studies included in the scoping review were published between 1982 and July 2022. Papers published in the last decade (between 2013 and July 2022) made up almost 30.0% of all included studies, with 35 papers published in the last five years (S1 Fig). Among the 118 included studies, the region with the greatest number of published papers that examined sex differences in BPD were in Europe (n = 56), with the majority from Germany (n = 22). Nearly half of the studies were from the Americas (n = 52), with 45 studies from the USA alone. Relatively fewer studies were conducted in Asia (n = 5), Oceania (n = 3), Middle East (n = 1), or of mixed samples (n = 1). The full description of the included studies is presented in the study characteristics tables in S2 Table.
Symptoms and comorbid disorders
Among mixed-sex comparisons on BPD, there was substantial evidence that males tend to display more aggressiveness and impulsivity, and some evidence that females tend to display symptoms of affective instability, suicidal or self-harm behaviours, and unstable relationship/s. Aggressiveness [33, 52, 67, 69, 73, 82, 88, 91, 102, 103] and impulsiveness [33, 48, 58, 69, 88, 91, 109] appeared to be the focus of research for males with BPD in single sex studies. There was substantial evidence from mixed-sex studies that males with BPD are more likely to have comorbid substance abuse and cluster A and B personality disorders than females. Comorbid substance abuse disorder for males with BPD also appeared to be the focus of research in single sex studies [26, 30, 35, 51, 81, 97, 111, 119, 141]. In contrast, mixed-sex studies have displayed substantial evidence for females with BPD to have comorbid anxiety and eating disorders, while some evidence was found for females with BPD to have greater likelihood of mood disorders compared to males with BPD. The full description of the subcategories of BPD symptoms and comorbid disorders in mixed-sex comparison is shown in Table 1.
There was slight evidence indicating that females with BPD experience may be more likely to experience child maltreatment than males with BPD in the mixed-sex comparisons (Table 1). Early abuse in females with BPD was also a focus of research in single sex female studies [28, 36, 38, 39, 47, 94, 107, 123, 132].
It is important to highlight that while BPD symptoms and comorbid disorders are widely reported in current literature, there is still a paucity of information for the other categories on biological markers and treatment. As such, available findings for these categories were subsequently summarized narratively.
There were 28 papers regarding biological markers of BPD. Mixed-sex comparisons showed that females have greater cerebellum distribution volume , higher cortisol awakening responses , increased single nucleotide polymorphism (SNP) 3 and 5 frequencies , and larger activations in centro-parietal regions . Trait impulsiveness was negatively related to binding potential values in medial frontal cortex for females but not for males . Males with BPD, had higher activation in the certain regions of the brain, including the left-side cluster (comprising the amygdala, hippocampus, precuneus, and temporal lobe), in clusters of the medial prefrontal cortex, and in the right lateral orbitofrontal cortex (LOFC) and dorsolatera prefrontal cortex (dlPFC) .
When compared to controls, females with BPD displayed higher levels of testosterone , cortisol awakening response [79, 128, 142], SNP 10 frequency , and total plasma homocysteine . Alterations of gut microbial composition was also found, where females with BPD have greater Bacteroidetes/Firmicutes-ratio than healthy controls . There was also weaker activation in the left dlPFC and stronger activation in the posterior cluster in the right dlPFC reported in females with BPD . Several studies reported increased grey matter concentration in the left middle frontal gyrus and right anterior cerebellum, but reductions in the several regions of the brain such as the hippocampus, amygdala, frontal gyri, temporal gyri, and medial temporal lobe [92, 107, 118]. Self-reported trait dissociation was found to be positively correlated with stronger resting-state functional connectivity between the left amygdala and right dlPFC .
Males with BPD had lower skin conductance reactivity , delta- prolactin, peak- prolactin, and area-under-curve-prolactin , and SNP 3 frequency than controls . There was also diminished concentration in the right anterior cerebellum  and grey matter volume in several regions of the brain, such as the frontal gyri, LOFC, anterior cingulate cortex, and parietal lobe [92, 109]. Aggressiveness and trait anger was associated with the amygdala, antero prefrontal cortex (aPFC), dlPFC, and right posterior thalamus [33, 53, 67]. Compared to healthy controls, salivary cortisol levels increased in males with BPD, but decreased in females after a social stress exposure .
Mixed-sex comparisons showed that compared with males, females were more likely to receive psychological treatment, such as DBT and CBT [49, 62, 65, 133], and psychotropic medication, especially antidepressants and anti-anxiety agents [26, 49, 133]. In contrast, males were more likely to be prescribed with antipsychotic medication . Males are also more likely to have their first BPD diagnosis assessed in a Drugs and Alcohol (D&A) clinic , referred to D&A rehabilitation  or get treatment in a combination of D&A clinics and psychiatric care . Males with BPD were also less likely to find psychotherapy or hospital admissions helpful compared with females , and tend to have fewer therapy sessions  or drop out of treatment [64, 105].
Among same-sex comparisons, studies reported that females with BPD were more likely to be restrained and separated using time-out strategy, screened for D&A use, readmitted , and have longer stays in hospital than controls . Females with BPD were also more likely to take psychoactive and antipsychotic medication [94, 107, 122]. A female-only study found Fluvoxamine to be an effective for treatment of BPD , and a male-only study found that Topiramate was associated with better anger processing and control . DBT was found to improve symptoms of BPD in both female- [10, 63, 98] and male-only studies [10, 35]. However, male-only comparisons indicated that patients with BPD were more likely to drop out of treatment compared to controls .
The present scoping review provides an overview of available research evidence on sex-related differences in symptoms, comorbid disorders, developmental factors, biological markers, and treatment of BPD. A total of 118 papers were identified and the extracted data highlight several findings. More than half of the reviewed papers were published in the last decade. Among the included studies, literature published in Western countries, specifically the USA, dominated the field. This indicates a potential literature gap regarding the cross-cultural generalisability of findings to non-Western populations. The scoping review also revealed that a large proportion of literature were cross-sectional studies. Although cross-sectional designs are useful for establishing preliminary evidence, they are unable to investigate variable patterns over time and the temporal relations between outcomes and risk factors. This is particularly important when elucidating the long-term course of BPD symptoms or the causal inference of the development of BPD and comorbid disorders, developmental factors, biological markers, or treatment outcomes.
Findings from the present scoping review corroborate previous studies (e.g., ) that there is a propensity for males with BPD to present externalising symptoms (i.e., aggressiveness and impulsivity), while females with BPD tend to display internalising symptoms (e.g., affective instability). These differences that emerged are consistent with those found in population and epidemiological studies. Males are more likely to display aggression, and exhibit high novelty seeking [31, 144]. Females, on the other hand, tend to score higher on harm avoidance and lower on novelty seeking [31, 145], and are more prone to express and talk about their emotions . Thus, BPD pathology may magnify usual sex-based distinction. Interestingly, evidence for sex differences in the present review was more substantial for symptoms that are more prevalent in males with BPD (aggression and impulsivity), but moderate to weak for symptoms that are more prevalent in females (affective instability, self-harm, unstable relationship, identity disturbance, and dissociation). This could potentially be explained by the classification and diagnostic criteria for BPD in the DSM. There are comparatively more items for internalizing symptoms than externalizing symptoms, which could have concentrated the scores for externalizing symptoms due to the narrow classification range. A study found that it is more likely for males to be rated as exhibiting symptoms of aggression and impulsivity than females at the same level of BPD liability .
Data from the scoping review also suggest that males with BPD have a higher likelihood of exhibiting comorbid substance use disorder while females have comorbid anxiety and eating disorders. This is in line with sex differences in symptomatic manifestation. Males may have a propensity to express distress outwards (i.e., externalization), which is a factor connecting substance use and antisocial behaviour . In contrast, females may have a propensity to express distress inwards (i.e., internalization) which is a factor that characterises mood and anxiety disorders . This sex difference in comorbid disorders, however, could also be due to clinician’s bias regarding sex prevalence of various disorders during diagnosis [5, 148]. For example, with similar symptoms, males are more likely to be diagnosed with anti-social personality disorder while females are more likely to be diagnosed with BPD . Overall, in the present review, the strength of evidence for comorbid disorders is more substantial, apart from mood disorders, compared to symptoms. This could be attributed to the greater number of studies conducted on comorbid symptoms than BPD symptoms included in this review. There are 20 different papers which contributed to 43 counts of evidence for symptoms, while 25 papers contributed to 64 counts of evidence for comorbid disorders. As the research evidence grows, sex differences may be more substantial and more evident.
Despite the growing number of studies examining sex-related differences in BPD, a greater amount of attention was given to BPD symptoms and comorbid disorders. Substantially fewer papers on developmental factors, biological markers, and treatment were identified in the scoping review. This is despite biological markers and psychosocial factors being proposed to potentially contribute to sex differences in symptom manifestation . This posed as a challenge when comparing the findings across studies in these areas due to a dearth of available data. Nonetheless, several noteworthy trends were observed.
Childhood maltreatment or early abuse was more prevalent in females with BPD. This could be explained by differences in the type of abuse reported. Sexual abuse is more often reported in females . In comparison, physical punishment happens more often in males and certain cultures , and could be normalized to a certain extent and not perceived and reported as abuse. Furthermore, data could be skewed as males are less prone to report experiences of abuse , thus explaining the greater proportion of females with childhood abuse histories.
Females with BPD were also more likely to receive psychological treatment, whereas males were more often referred to D&A rehabilitation. This could be influenced by the difference in symptoms exhibited. As females tend to exhibit internalising symptoms, they are more likely to seek mental health services. Males, in contrast, tend to experience externalising symptoms and therefore may be more likely to seek help for D&A related issues. This form of sample bias in current literature could contribute to the sex bias in BPD prevalence . Although several papers found DBT to be effective in improving symptoms for both females and males with BPD [10, 35, 63, 98], males were less likely to find psychotherapy or hospital admissions helpful  and were more likely to drop out [64, 104, 105]. This could be due to males conforming to traditional masculine norms, hence are more reluctant to engage in mental health treatment . It is important to note that available information in these areas is fragmented and scarce. Thus, sex patterns in developmental factors, biological markers and treatment are still inconclusive.
The scoping review methodology has some limitations. Firstly, there is no risk of bias assessment in this review which may lead to biases in the conclusion of this study. Secondly, while the method of vote counting and narrative synthesis are sufficient in providing a broad overview of the literature, the current review is unable to reach a conclusive resolution to all sex related questions in BPD due the relatively small body of literature. Hence, findings from this review raises more questions and highlights the need for further studies, in particular on sex differences in treatment, developmental factors, or biological markers, to fill the gaps in the current literature. As the literature regarding sex differences in BPD grows, further reviews are essential for deeper understanding regarding the topic.
Given the nature of the scoping review, various non-published literature, such as conference abstracts or protocols, were omitted from the content of this paper. Similarly, the papers published in languages other than English were also excluded. Hence, important information in this research area could have been overlooked.
With the growth of literature, further systematic reviews and potentially meta-analyses, with risk of bias and quality appraisal assessments are important for the deeper understanding of sex differences in BPD. Apart from the variables investigated in the current review, other moderating factors such as age, population, type of measure, and culture could also be investigated.
Longitudinal research designs could be employed to better understand sex differences in symptoms and comorbid disorders in BPD populations across time. Future research could investigate if sex differences in BPD is simply a product of typical sex-based distinctions also observed in the general population, or if the disorder has an effect on these differences. As the body of research grows, using meta-analysis methods may become feasible. In the present scoping review, the biological construct of ‘sex’ was employed. Future research could also investigate the social construct ‘gender’.
The present scoping review provides a synthesis of current literature on sex differences in BPD. There is particular focus on symptoms and comorbid disorders, which shows a tendency of males with BPD to more likely exhibit externalizing symptoms and comorbid disorders, while females with BPD to more likely exhibit internalizing symptoms and comorbid disorders. In contrast, there were fewer papers investigating biological markers, environmental factors, and treatment for BPD. Due to the lack of current literature in these areas, results remain inconclusive and more research is required to fill this literature gap.
S1 File. Literature search strategies.
S1 Fig. Data of publication of included studies.
S1 Table. Data extraction form.
S2 Table. Study characteristics table.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
- 2. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet. 2011;377(9759):74–84. pmid:21195251
- 3. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the national comorbidity survey replication. Biological Psychiatry (1969). 2007;62(6):553–64. pmid:17217923
- 4. Ten Have M, Verheul R, Kaasenbrood A, van Dorsselaer S, Tuithof M, Kleinjan M, et al. Prevalence rates of borderline personality disorder symptoms: A study based on the Netherlands Mental Health Survey and Incidence Study-2. BMC Psychiatry. 2016;16(1):249. pmid:27435813
- 5. Skodol AE, Bender DS. Why are women diagnosed borderline more than men? Psychiatr Q. 2003;74(4):349–60. pmid:14686459
- 6. Linehan MM, Dimeff L, Koerner K, Miga EM. Research on dialectical behavior therapy: Summary of non-RCT studies. 2016. Available from: https://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf.
- 7. Grant BF, Chou SP, Ruan WJ, Goldstein RB, Huang B, Stinson FS, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry. 2008;69(4):533–45. pmid:18426259
- 8. Sansone RA, Sansone LA. Gender patterns in borderline personality disorder. Innovations in Clinical Neuroscience. 2011;8(5):16–20. pmid:21686143
- 9. Schulte Holthausen B, Habel U. Sex differences in personality disorders. Current Psychiatry Reports. 2018;20(12):107. pmid:30306417
- 10. Wetterborg D, Dehlbom P, Långström N, Andersson G, Fruzzetti AE, Enebrink P. Dialectical behavior therapy for men with borderline personality disorder and antisocial behavior: A clinical trial. J Pers Disord. 2020;34(1):22–39. pmid:30355023.
- 11. Larivière N, Beauregard-Laliberté R, Brière A, Fontaine AS, Lamarre A, Tremblay-Perreault P, et al. Daily living functioning in men with borderline personality disorders: A scoping review. Journal of Psychosocial Rehabilitation and Mental Health. 2022.
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis: JBI; 2020.
- 13. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine. 2018;169(7):467–73. pmid:30178033
- 14. Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5(4):371–85. pmid:26052958
Covidence. Covidence systematic review software. Melbourne, Australia: Veritas health innovation; [25 July 2021]. Available from: https://www.covidence.org/.
- 16. Bushman B, Wang MC. Vote-counting procedures in meta-analysis. The Handbook of Research Synthesis and Meta-Analysis. 2009:207–20.
- 17. Hedges LV, Olkin I. Vote-counting methods in research synthesis. Psychological Bulletin. 1980;88(2):359–69.
- 18. Nosratnejad S, Rashidian A, Dror DM. Systematic review of willingness to pay for health insurance in low and middle income countries. PLOS ONE. 2016;11(6):e0157470. pmid:27362356
- 19. De Brier N, Stroobants S, Vandekerckhove P, De Buck E. Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): A rapid systematic review. PLOS ONE. 2020;15(12):e0244052. pmid:33320910
- 20. Massazza A, Kienzler H, Al-Mitwalli S, Tamimi N, Giacaman R. The association between uncertainty and mental health: A scoping review of the quantitative literature. Journal of Mental Health. 2022:1–12. pmid:35014927
- 21. Colley SK, Kane PKM, MacDonald Gibson J. Risk communication and factors influencing private well testing behavior: A systematic scoping review. Int J Environ Res Public Health. 2019;16(22). pmid:31703259
- 22. Patel K, Kouvonen A, Close C, Väänänen A, O’Reilly D, Donnelly M. What do register-based studies tell us about migrant mental health? A scoping review. Systematic Reviews. 2017;6(1):78. pmid:28399907
- 23. Mah JC, Stevens SJ, Keefe JM, Rockwood K, Andrew MK. Social factors influencing utilization of home care in community-dwelling older adults: A scoping review. BMC Geriatrics. 2021;21(1):145. pmid:33639856
- 24. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme2006.
- 25. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P, and the PG. Reprint—preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Physical Therapy. 2009;89(9):873–80. pmid:19723669
- 26. Andrulonis PA, Glueck BC, Stroebel CF, Vogel NG. Borderline personality subcategories. The Journal of Nervous and Mental Disease. 1982;170(11):670–9. pmid:7119767
- 27. Arola R, Antila H, Riipinen P, Hakko H, Riala K, Kantojärvi L. Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland. Forensic Science International. 2016;266:389–95. pmid:27399875
- 28. Atlas JA. Association between history of abuse and borderline personality disorder for hospitalized adolescent girls. Psychol Rep. 1995;77(3 Pt 2):1346. pmid:8643803
- 29. Banzhaf A, Ritter K, Merkl A, Schulte-HerbrÜGgen O, Lammers C-H, Roepke S. Gender Differences in a clinical sample of patients with borderline personality disorder. Journal of Personality Disorders. 2012;26(3):368–80. pmid:22686225
- 30. Bardeen JR, Dixon-Gordon KL, Tull MT, Lyons JA, Gratz KL. An investigation of the relationship between borderline personality disorder and cocaine-related attentional bias following trauma cue exposure: The moderating role of gender. Comprehensive Psychiatry. 2014;55(1):113–22. pmid:24138957
- 31. Barnow S, Herpertz SC, Spitzer C, Stopsack M, Preuss UW, Grabe HJ, et al. Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account. Psychopathology. 2007;40(6):369–78. pmid:17652949
- 32. Barrachina J, Pascual JC, Ferrer M, Soler J, Rufat MJ, Andión O, et al. Axis II comorbidity in borderline personality disorder is influenced by sex, age, and clinical severity. Comprehensive Psychiatry. 2011;52(6):725–30. pmid:21349508
- 33. Bertsch K, Krauch M, Roelofs K, Cackowski S, Herpertz SC, Volman I. Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder. Neuropharmacology. 2019;156:107463-. pmid:30553826
- 34. Bertsch K, Roelofs K, Roch PJ, Ma B, Hensel S, Herpertz SC, et al. Neural correlates of emotional action control in anger-prone women with borderline personality disorder. Journal of Psychiatry & Neuroscience. 2018;43(3):161–70. pmid:29688872
- 35. Bianchini V, Cofini V, Curto M, Lagrotteria B, Manzi A, Navari S, et al. Dialectical behaviour therapy (DBT) for forensic psychiatric patients: An Italian pilot study. Criminal Behaviour and Mental Health. 2019;29(2):122–30. pmid:30648303
- 36. Biskin RS, Paris J, Renaud J, Raz A, Zelkowitz P. Outcomes in women diagnosed with borderline personality disorder in adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2011;20(3):168–74. pmid:21804844
- 37. Black DW, Gunter T, Allen J, Blum N, Arndt S, Wenman G, et al. Borderline personality disorder in male and female offenders newly committed to prison. Comprehensive Psychiatry. 2007;48(5):400–5. pmid:17707246
- 38. Bouchard S, Godbout N, Sabourin S. Sexual attitudes and activities in women with borderline personality disorder involved in romantic relationships. Journal of Sex & Marital Therapy. 2009;35(2):106–21. pmid:19266380
- 39. Bouchard S, Sabourin S, Lussier Y, Villeneuve E. Relationship quality and stability in couples when one partner suffers from borderline personality disorder. Journal of Marital and Family Therapy. 2009;35(4):446–55. pmid:19785701
- 40. Castaneda R, Franco H. Sex and ethnic distribution of borderline personality disorder in an inpatient sample. The American Journal of Psychiatry. 1985;142(10):1202–3. pmid:4037135
- 41. Chabrol H, Montovany A, Chouicha K, Callahan S, Mullet E. Frequency of borderline personality disorder in a sample of French high school students. Can J Psychiatry. 2001;46(9):847–9. pmid:11761637
- 42. De Genna NM, Feske U, Angiolieri T, Gold MA. Race and sexually transmitted diseases in women with and without borderline personality disorder. Journal of Women’s Health (Larchmont, NY 2002). 2011;20(3):333–40. pmid:21219244
- 43. de Vogel V, Stam J, Bouman YHA, Ter Horst P, Lancel M. Violent women: a multicentre study into gender differences in forensic psychiatric patients. The Journal of Forensic Psychiatry & Psychology. 2016;27(2):145–68.
- 44. Dulit RA, Fyer MR, Miller FT, Sacks MH, Frances AJ. Gender differences in sexual preference and substance abuse of inpatients with borderline personality disorder. Journal of Personality Disorders. 1993;7(2):182–5.
- 45. Euler S, Stöbi D, Sowislo J, Ritzler F, Huber Christian G, Lang Undine E, et al. Grandiose and vulnerable narcissism in borderline personality disorder. Psychopathology. 2018;51(2):110–21. pmid:29466803
- 46. Faulkner CJ, Grapentine WL, Francis G. A behavioral comparison of female adolescent inpatients with and without borderline personality disorder. Comprehensive Psychiatry. 1999;40(6):429–33. pmid:10579374
- 47. Flasbeck V, Enzi B, Brüne M. Altered empathy for psychological and physical pain in borderline personality disorder. Journal of Personality Disorders. 2017;31(5):689–708. pmid:28072040
- 48. Goodman M, Patel U, Oakes A, Matho A, Triebwasser J. Developmental trajectories to male borderline personality disorder. Journal of Personality Disorders. 2013;27(6):764–82. pmid:23795759
- 49. Goodman M, Patil U, Steffel L, Avedon J, Sasso S, Triebwasser J, et al. Treatment utilization by gender in patients with borderline personality disorder. Journal of Psychiatric Practice. 2010;16(3):155–63. pmid:20485103
- 50. Ha KS, Kim SJ, Yune SK, Kim JH, W. Hwang J, Lee NY, et al. Three‐year follow up of women with and without borderline personality disorder: Development of Cloninger’s character in adolescence. Psychiatry and Clinical Neurosciences. 2004;58(1):42–7. pmid:14678456
- 51. Hatzitaskos P, Soldatos CR, Kokkevi A, Stefanis CN. Substance abuse patterns and their association with psychopathology and type of hostility in male patients with borderline and antisocial personality disorder. Comprehensive Psychiatry. 1999;40(4):278–82. pmid:10428187
- 52. Hatzitaskos PK, Soldatos CR, Sakkas PN, Stefanis CN. Discriminating borderline from antisocial personality disorder in male patients based on psychopathology patterns and type of hostility. The Journal of Nervous and Mental Disease. 1997;185(7):442–6. pmid:9240362
- 53. Herpertz SC, Nagy K, Ueltzhöffer K, Schmitt R, Mancke F, Schmahl C, et al. Brain mechanisms underlying reactive aggression in borderline personality disorder–sex matters. Biological Psychiatry (1969). 2017;82(4):257–66. pmid:28388995
- 54. Hoertel N, Peyre H, Wall MM, Limosin F, Blanco C. Examining sex differences in DSM-IV borderline personality disorder symptom expression using Item Response Theory (IRT). Journal of Psychiatric Research. 2014;59:213–9. pmid:25258339
- 55. Inoue A, Oshita H, Maruyama Y, Tanaka Y, Ishitobi Y, Kawano A, et al. Gender determines cortisol and alpha-amylase responses to acute physical and psychosocial stress in patients with borderline personality disorder. Psychiatry Research. 2015;228(1):46–52. pmid:25979467
- 56. Johnson DM, Shea MT, Yen S, Battle CL, Zlotnick C, Sanislow CA, et al. Gender differences in borderline personality disorder: Findings from the collaborative longitudinal personality disorders study. Comprehensive Psychiatry. 2003;44(4):284–92. pmid:12923706
- 57. Kahl KG, Greggersen W, Schweiger U, Cordes J, Correll CU, Frieling H, et al. Prevalence of the metabolic syndrome in patients with borderline personality disorder: Results from a cross-sectional study. European Archives of Psychiatry and Clinical Neuroscience. 2013;263(3):205–13. pmid:22777277
- 58. Kirkpatrick T, Joyce E, Milton J, Duggan C, Tyrer P, Rogers RD. Altered emotional decision-making in prisoners with borderline personality disorder. Journal of Personality Disorders. 2007;21(3):243–61. pmid:17536938
- 59. Krause-Utz A, Veer IM, Rombouts SARB, Bohus M, Schmahl C, Elzinga BM. Amygdala and anterior cingulate resting-state functional connectivity in borderline personality disorder patients with a history of interpersonal trauma. Psychological Medicine. 2014;44(13):2889–901. pmid:25066544
- 60. Kulacaoglu F, Solmaz M, Ardic FC, Akin E, Kose S. The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD. Psychiatry and Clinical Psychopharmacology. 2017;27(4):393–402.
- 61. Kullgren G. Factors associated with completed suicide in borderline personality disorder. The Journal of Nervous and Mental Disease. 1988;176(1):40–4. pmid:2826681
- 62. Lawn S, McMahon J. Experiences of care by Australians with a diagnosis of borderline personality disorder. Journal of Psychiatric and Mental Health Nursing. 2015;22(7):510–21. pmid:26122817
- 63. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry. 2006;63(7):757–66. pmid:16818865
- 64. Links PS, Mitton JE, Steiner M. Predicting outcome for borderline personality disorder. Comprehensive Psychiatry. 1990;31(6):490–8. pmid:2265533
- 65. Löffler-Stastka H, Voracek M, Leithner K, Fischer-Kern M, Presslich E, Kunz C, et al. Predicting psychotherapy utilization for patients with borderline personality disorder. Psychotherapy Research. 2003;13(2):255–64.
- 66. Magerl W, Burkart D, Fernandez A, Schmidt LG, Treede R-D. Persistent antinociception through repeated self-injury in patients with borderline personality disorder. Pain (Amsterdam). 2012;153(3):575–84. pmid:22197694
- 67. Mancke F, Herpertz SC, Hirjak D, Knies R, Bertsch K. Amygdala structure and aggressiveness in borderline personality disorder. European Archives of Psychiatry and Clinical Neuroscience. 2018;268(4):417–27. pmid:27878376
- 68. McCormick B, Blum N, Hansel R, Franklin JA, St. John D, Pfohl B, et al. Relationship of sex to symptom severity, psychiatric comorbidity, and health care utilization in 163 subjects with borderline personality disorder. Comprehensive Psychiatry. 2007;48(5):406–12. pmid:17707247
- 69. Michonski JD, Sharp C, Steinberg L, Zanarini MC. An item response theory analysis of the DSM-IV borderline personality disorder criteria in a population-based sample of 11- to 12-year-old children. Personality Disorders. 2013;4(1):15–22. pmid:22642465
- 70. Miller FT, Abrams T, Dulit R, Fyer M. Substance abuse in borderline personality disorder. Am J Drug Alcohol Abuse. 1993;19(4):491–7. pmid:8273769
- 71. Newhill CE, Vaughn MG, DeLisi M. Psychopathy scores reveal heterogeneity among patients with borderline personality disorder. The Journal of Forensic Psychiatry & Psychology. 2010;21(2):202–20.
- 72. Nickel MK, Nickel C, Kaplan P, Lahmann C, Mühlbacher M, Tritt K, et al. Treatment of aggression with topiramate in male borderline patients: A double-blind, placebo-controlled study. Biological Psychiatry (1969). 2005;57(5):495–9. pmid:15737664
- 73. Paris J, Zweig-Frank H, Bond M, Guzder J. Defense styles, hostility, and psychological risk factors in male patients with personality disorders. The Journal of Nervous and Mental Disease. 1996;184(3):153–8. pmid:8600218
- 74. Paris J, Zweig-Frank H, Guzder J. Risk factors for borderline personality in male outpatients. The Journal of Nervous and Mental Disease. 1994;182(7):375–80. pmid:8021636
- 75. Pascual JC, Corcoles D, Castano J, Gines JM, Gurrea A, Martin-Santos R, et al. Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service. Psychiatric Services (Washington, DC). 2007;58(9):1199–204.
- 76. Penner F, Wall K, Jardin C, Brown JL, Sales JM, Sharp C. A study of risky sexual behavior, beliefs about sexual behavior, and sexual self-efficacy in adolescent inpatients with and without borderline personality disorder. Personality Disorders. 2019;10(6):524–35. pmid:31259605
- 77. Perez-Rodriguez MM, Hazlett EA, Rich EL, Ripoll LH, Weiner DM, Spence N, et al. Striatal activity in borderline personality disorder with comorbid intermittent explosive disorder: Sex differences. Journal of Psychiatric Research. 2012;46(6):797–804. pmid:22464337
- 78. Picci RL, Vigna-Taglianti F, Oliva F, Mathis F, Salmaso S, Ostacoli L, et al. Personality disorders among patients accessing alcohol detoxification treatment: Prevalence and gender differences. Comprehensive Psychiatry. 2012;53(4):355–63. pmid:21821240
- 79. Rausch J, Gäbel A, Nagy K, Kleindienst N, Herpertz SC, Bertsch K. Increased testosterone levels and cortisol awakening responses in patients with borderline personality disorder: Gender and trait aggressiveness matter. Psychoneuroendocrinology. 2015;55:116–27. pmid:25796037
- 80. Rinne T, van den Brink W, Wouters L, van Dyck R. SSRI treatment of borderline personality disorder: A randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. The American Journal of Psychiatry. 2002;159(12):2048–54. pmid:12450955
- 81. Robitaille M-P, Checknita D, Vitaro F, Tremblay RE, Paris J, Hodgins S. A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder. Borderline Personality Disorder and Emotion Dysregulation. 2017;4(1):25–. pmid:29225887
- 82. Ross JM, Babcock JC. Proactive and reactive violence among intimate partner violent men diagnosed with antisocial and borderline personality disorder. Journal of Family Violence. 2009;24(8):607–17.
- 83. Rubio G, Jimenez M, Rodriguez-Jimenez R, Martinez I, Iribarren MM, Jimenez-Arriero MA, et al. Varieties of impulsivity in males with alcohol dependence: The role of cluster-B personality disorder. Alcoholism, Clinical and Experimental Research. 2007;31(11):1826–32. pmid:17850221
- 84. Sansone RA, Lam C, Wiederman MW. The relationship between illegal behaviors and borderline personality symptoms among internal medicine outpatients. Comprehensive Psychiatry. 2012;53(2):176–80. pmid:21550032
- 85. Schaaff N, Karch S, Segmiller F, Koch W, Reicherzer M, Mulert C, et al. Loudness dependence of auditory evoked potentials in patients with borderline personality disorder—impact of psychopathology. Psychiatry Research. 2012;199(3):181–7. pmid:22542953
- 86. Schienle A, Haas-Krammer A, Schöggl H, Kapfhammer H-P, Ille R. Altered state and trait disgust in borderline personality disorder. The Journal of Nervous and Mental Disease. 2013;201(2):105–8. pmid:23364118
- 87. Sharp C, Michonski J, Steinberg L, Fowler JC, Frueh BC, Oldham JM. An investigation of differential item functioning across gender of BPD criteria. Journal of Abnormal Psychology (1965). 2014;123(1):231–6. pmid:24661173
- 88. 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 Psychiatrica Scandinavica. 2019;139(2):145–53. pmid:30353921
- 89. Silberschmidt A, Lee S, Zanarini M, Schulz SC. Gender differences in borderline personality disorder: Results from a multinational, clinical trial sample. Journal of Personality Disorders. 2015;29(6):828–38. pmid:25562535
- 90. Skinstad AH, Swain A. Comorbidity in a clinical sample of substance abusers. The American Journal of Drug and Alcohol Abuse. 2001;27(1):45–64. pmid:11373036
- 91. Skinstad AH, Troland K, Mortensen JK. Rorschach responses in borderline personality disorder with alcohol dependence. European Journal of Psychological Assessment. 1999;15(2):133–42.
- 92. Soloff P, Nutche J, Goradia D, Diwadkar V. Structural brain abnormalities in borderline personality disorder: A voxel-based morphometry study. Psychiatry Research Neuroimaging. 2008;164(3):223–36. pmid:19019636
- 93. Soloff PH, Chiappetta L, Mason NS, Becker C, Price JC. Effects of serotonin-2A receptor binding and gender on personality traits and suicidal behavior in borderline personality disorder. Psychiatry Research Neuroimaging. 2014;222(3):140–8. pmid:24751216
- 94. Soloff PH, Chowdury A, Diwadkar VA. Affective interference in borderline personality disorder: The lethality of suicidal behavior predicts functional brain profiles. Journal of Affective Disorders. 2019;252:253–62. pmid:30991253
- 95. Soloff PH, Kelly TM, Strotmeyer SJ, Malone KM, Mann JJ. Impulsivity, gender, and response to fenfluramine challenge in borderline personality disorder. Psychiatry Research. 2003;119(1):11–24. pmid:12860356
- 96. Stepp SD, Lazarus SA. Identifying a borderline personality disorder prodrome: Implications for community screening: BPD prodrome for community screening. Personality and Mental Health. 2017;11(3):195–205. pmid:28786230
- 97. Streeter CC, Reekum RV, Shorr RI, Bachman DL. Prior head injury in male veterans with borderline personality disorder. The Journal of Nervous and Mental Disease. 1995;183(9):577–81. pmid:7561819
- 98. Sunseri PA. Preliminary outcomes on the use of dialectical behavior therapy to reduce hospitalization among adolescents in residential care. Residential Treatment for Children & Youth. 2004;21(4):59–76.
- 99. Tadić A, Baskaya Ö, Victor A, Lieb K, Höppner W, Dahmen N. Association analysis of SCN9A gene variants with borderline personality disorder. Journal of Psychiatric Research. 2008;43(2):155–63. pmid:18439623
- 100. Tadić A, Wagner S, Hoch J, Başkaya Ö, von Cube R, Skaletz C, et al. Gender differences in axis I and axis II comorbidity in patients with borderline personality disorder. Psychopathology. 2009;42(4):257–63. pmid:19521142
- 101. Thompson KN, Betts J, Jovev M, Nyathi Y, McDougall E, Chanen AM. Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Intervention in Psychiatry. 2019;13(3):502–8. pmid:29076247
- 102. Tikkanen R, Holi M, Lindberg N, Tiihonen J, Virkkunen M. Recidivistic offending and mortality in alcoholic violent offenders: A prospective follow-up study. Psychiatry Research. 2009;168(1):18–25. pmid:19467714
- 103. Trahan LH, Babcock JC. Emotional reactivity of partner violent men with personality disorder during conflict. Journal of Family Violence. 2019;34(7):645–54.
- 104. Tull MT, Gratz KL. The impact of borderline personality disorder on residential substance abuse treatment dropout among men. Drug and Alcohol Dependence. 2011;121(1):97–102. pmid:21907503
- 105. van den Bosch LMC, Hysaj M, Jacobs P. DBT in an outpatient forensic setting. International Journal of Law and Psychiatry. 2012;35(4):311–6. pmid:22560672
- 106. van den Brink C, Harte JM, Denzel AD. Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study. Criminal Behaviour and Mental Health. 2018;28(4):324–34. pmid:29971844
- 107. van Zutphen L, Siep N, Jacob GA, Domes G, Sprenger A, Willenborg B, et al. Always on guard: emotion regulation in women with borderline personality disorder compared to nonpatient controls and patients with cluster-C personality disorder. Journal of Psychiatry & Neuroscience. 2018;43(1):37–47. pmid:29252164
- 108. Veague HB, Hooley JM. Enhanced sensitivity and response bias for male anger in women with borderline personality disorder. Psychiatry Research. 2014;215(3):687–93. pmid:24485062
- 109. Völlm BA, Zhao L, Richardson P, Clark L, Deakin JFW, Williams S, et al. A voxel-based morphometric MRI study in men with borderline personality disorder: Preliminary findings. Criminal Behaviour and Mental Health. 2009;19(1):64–72. pmid:19172640
- 110. Wang L, Ross CA, Xiao Z, Zhang T, Dai Y, Zhang H, et al. Frequency of borderline personality disorder among psychiatric outpatients in Shanghai. Journal of Personality Disorders. 2012;26(3):393–401. pmid:22686227
- 111. Wetterborg D, Långström N, Andersson G, Enebrink P. Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden. Comprehensive Psychiatry. 2015;62:63–70. pmid:26343468
- 112. Wixom J, Ludolph P, Westen D. The quality of depression in adolescents with borderline personality disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32(6):1172–7. pmid:8282661
- 113. Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, et al. Axis I comorbidity of borderline personality disorder. The American Journal of Psychiatry. 1998;155(12):1733–9. pmid:9842784
- 114. Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, et al. Axis II comorbidity of borderline personality disorder. Comprehensive Psychiatry. 1998;39(5):296–302. pmid:9777282
- 115. Zanarini MC, Frankenburg FR, Reich DB, Marino MF, Haynes MC, Gunderson JG. Violence in the lives of adult borderline patients. The Journal of Nervous and Mental Disease. 1999;187(2):65–71. pmid:10067945
- 116. Zanarini MC, Laudate CS, Frankenburg FR, Reich DB, Fitzmaurice G. Predictors of self-mutilation in patients with borderline personality disorder: A 10-year follow-up study. Journal of Psychiatric Research. 2010;45(6):823–8. pmid:21129758
- 117. Zanarini MC, Williams AA, Lewis RE, Reich RB, Vera SC, Marino MF, et al. Reported pathological childhood experiences associated with the development of borderline personality disorder. The American Journal of Psychiatry. 1997;154(8):1101–6. pmid:9247396
- 118. Zetzsche T, Preuss UW, Frodl T, Schmitt G, Seifert D, Münchhausen E, et al. Hippocampal volume reduction and history of aggressive behaviour in patients with borderline personality disorder. Psychiatry Research Neuroimaging. 2006;154(2):157–70. pmid:17306512
- 119. Zhang C, Luo T, Liu L, Dong H, Hao W. Prevalence rates of personality disorder and its association with methamphetamine dependence in compulsory treatment facilities in China. Frontiers in Psychiatry. 2018;9:698–. pmid:30618872
- 120. Zlotnick C, Rothschild L, Zimmerman M. The role of gender in the clinical presentation of patients with borderline personality disorder. Journal of Personality Disorders. 2002;16(3):277–82. pmid:12136683
- 121. Zubenko GS, George AW, Soloff PH, Schulz P. Sexual practices among patients with borderline personality disorder. The American Journal of Psychiatry. 1987;144(6):748–52. pmid:3591995
- 122. Gintalaite-Bieliauskiene K, Dixon R, Bennett L. A retrospective survey of care provided to patients with borderline personality disorder admitted to a female psychiatric intensive care unit. Journal of Psychiatric Intensive Care. 2020;16(1):35–42.
- 123. Rössler H, Flasbeck V, Gatermann S, Brüne M. Alterations of the gut microbiota in borderline personality disorder. Journal of Psychosomatic Research. 2022;158:110942–. pmid:35594813
- 124. Mundt AP, Baranyi G. The unhappy mental health triad: Comorbid severe mental illnesses, personality disorders, and substance use disorders in prison populations. Frontiers in Psychiatry. 2020;11:804–. pmid:32922316
- 125. Koolen R, Keulen-de Vos M. The relationship between adverse childhood experiences, emotional states and personality disorders in offenders. Journal of Forensic Psychology Research and Practice. 2022;22(1):18–37.
- 126. Carlson EM, Cox DW, Kealy D, Chapman AL, Ogrodniczuk JS. Social role dysfunction and coping in borderline personality disorder. Personality and Mental Health. 2020;14(2):227–39. pmid:32056384
- 127. Vahap K, Cuneyt E, İzgi A, Ozlem Helin C, Gokhan U, Turan C, et al. Relationship between suicide attempt history and borderline personality disorder, aggression, impulsivity, and self-mutilative behavior among male inpatients with substance use disorder. Psychiatry and Clinical Psychopharmacology. 2021;31(2):139–47.
- 128. Cavelti M, Rinnewitz L, Walter M, van der Venne P, Parzer P, Josi J, et al. Psychobiological correlates of aggression in female adolescents with borderline personality disorder. Psychopathology. 2022;55(1):37–48. pmid:34872101
- 129. Newton-Howes G, Cunningham R, Atkinson J. Personality disorder prevalence and correlates in a whole of nation dataset. Social Psychiatry and Psychiatric Epidemiology. 2020;56(4):679–85. pmid:32394007
- 130. López-Toro E, Wolf CJH, González RA, Brink Wvd, Schellekens AFA, Vélez-Pastrana MC. Network analysis of DSM symptoms of substance use disorders and frequently co-occurring mental disorders in patients with substance use disorder who seek treatment. Journal of Clinical Medicine. 2022;11(10):2883. pmid:35629008
- 131. Bortolla R, Galli M, Ramella P, Sirtori F, Visintini R, Maffei C. Negative bias and reduced visual information processing of socio-emotional context in borderline personality disorder: A support for the hypersensitivity hypothesis. Journal of Behavior Therapy and Experimental Psychiatry. 2020;69:101589–. pmid:32502878
- 132. Kern K, Sinningen K, Engemann L, Maiß C, Hanusch B, Mügge A, et al. Homocysteine as a potential indicator of endothelial dysfunction and cardiovascular risk in female patients with borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation. 2022;9(1):11–. pmid:35255991
- 133. Dehlbom P, Wetterborg D, Lundqvist D, Maurex L, Dal H, Dalman C, et al. Gender differences in the treatment of patients with borderline personality disorder. Personality Disorders. 2022;13(3):277–87. pmid:34735192
- 134. Plakolm Erlač S, Bucik V, Gregorič Kumperščak H. Explicit and implicit measures of identity diffusion in adolescent girls with borderline personality disorder. Frontiers in Psychiatry. 2021;12:805390–. pmid:35046857
- 135. Miano A, Barnow S, Wagner S, Roepke S, Dziobek I. Dyadic emotion regulation in women with borderline personality disorder. Cognitive Therapy and Research. 2021;45(6):1077–92.
- 136. Golshani S, Ghanbari S, Firoozabadi A, Shakeri J, Hookari S, Rahami B, et al. Dissociative symptoms and self-reported childhood and current trauma in male incarcerated people with borderline personality disorder–results from a small cross-sectional study in Iran. Neuropsychiatric Disease and Treatment. 2020;16:2407–17. pmid:33116540
- 137. Lee Y-J, Keum M-S, Kim H-G, Cheon E-J, Cho Y-C, Koo B-H. Defense mechanisms and psychological characteristics according to suicide attempts in patients with borderline personality disorder. Psychiatry Investigation. 2020;17(8):840–9. pmid:32791818
- 138. Bonagura AG, Widom CS. Child maltreatment and psychiatric disorders increase risk for stalking victimization. Journal of Interpersonal Violence. 2022:8862605221078889-. pmid:35236175
- 139. Aouidad A, Cohen D, Mirkovic B, Pellerin H, Garny de La Rivière S, Consoli A, et al. Borderline personality disorder and prior suicide attempts define a severity gradient among hospitalized adolescent suicide attempters. BMC Psychiatry. 2020;20(1):525–. pmid:33148207
- 140. Andermann M, Izurieta Hidalgo NA, Rupp A, Schmahl C, Herpertz SC, Bertsch K. Behavioral and neurophysiological correlates of emotional face processing in borderline personality disorder: Are there differences between men and women? European Archives of Psychiatry and Clinical Neuroscience. 2022. pmid:35661904
- 141. Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention deficit hyperactivity disorder in prisoners: Increased substance use disorder severity and psychiatric comorbidity. European Addiction Research. 2020;26(4–5):179–90. pmid:32615575
- 142. Rausch J, Flach E, Panizza A, Brunner R, Herpertz SC, Kaess M, et al. Associations between age and cortisol awakening response in patients with borderline personality disorder. Journal of Neural Transmission. 2021;128(9):1425–32. pmid:34390395
- 143. Bayes A, Parker G. Borderline personality disorder in men: A literature review and illustrative case vignettes. Psychiatry Research. 2017;257:197–202. pmid:28768209
- 144. Staniloiu A, Markowitsch H. Gender differences in violence and aggression–a neurobiological perspective. Procedia—Social and Behavioral Sciences. 2012;33:1032–6.
- 145. Deng Y, Chang L, Yang M, Huo M, Zhou R. Gender differences in emotional response: Inconsistency between experience and expressivity. PLOS ONE. 2016;11(6):e0158666. pmid:27362361
- 146. Liddon L, Kingerlee R, Barry JA. Gender differences in preferences for psychological treatment, coping strategies, and triggers to help‐seeking. British Journal of Clinical Psychology. 2018;57(1):42–58. pmid:28691375
- 147. Krueger RF, Caspi A, Moffitt TE, Silva PA. The structure and stability of common mental disorders (DSM-III-R): A longitudinal-epidemiological study. Journal of Abnormal Psychology (1965). 1998;107(2):216–27. pmid:9604551
- 148. Norman J. Gender bias in the diagnosis and treatment of depression. International Journal of Mental Health. 2004;33(2):32–43.
- 149. Cappelleri JC, Eckenrode J, Powers JL. The epidemiology of child abuse: Findings from the second national incidence and prevalence study of child abuse and neglect. American Journal of Public Health. 1993;83(11):1622–4. pmid:8238691
- 150. Peltzer K, Pengpid S. Childhood physical and sexual abuse, and adult health risk behaviours among university students from 24 countries in Africa, the Americas and Asia. Journal of Psychology in Africa. 2016;26(2):149–55.
- 151. Lev-Wiesel R, First M. Willingness to disclose child maltreatment: CSA vs other forms of child abuse in relation to gender. Child Abuse & Neglect. 2018;79:183–91. pmid:29477611
- 152. Seidler ZE, Dawes AJ, Rice SM, Oliffe JL, Dhillon HM. The role of masculinity in men’s help-seeking for depression: A systematic review. Clin Psychol Rev. 2016;49:106–18. pmid:27664823