Wednesday, September 18, 2013

Study: Precursors to BPD in Females and Males

Since we’re talking about gender in Borderline Personality Disorder let’s take a look at the precursors that indicate BPD and the potential differences in this so called battle of the sexes.

Study: Precursors to BPD in Females and Males

Borderline Personality Disorder (BPD) doesn’t just suddenly appear. While the symptoms of BPD may become magnified and intensify with age, signs of Borderline Personality Disorder can start appearing as early as infancy.

A new study conducted by Marianne Goodman, M.D., assistant professor of psychiatry at The Mount Sinai School of Medicine in New York, explores the trajectory of Borderline Personality Disorder in females and males. The study shows precursors for Borderline Personality Disorder developing as early as infancy, through childhood and adolescence.

Goodman’s study, done in collaboration with the National Education Alliance for Borderline Personality Disorder (NEA.BPD), is one of the few that looks at Borderline Personality Disorder and its development in both males and females. The study compares the emotional, cognitive, and social development of people officially diagnosed with BPD to that of their non-affected siblings.

“So what do we know about developmental precursors in Borderline Personality Disorder?” asked Goodman during an NEA BPD call-in lecture. “When I went to literature, I was surprised to find not much.”

Childhood Indicators of BPD

Before Goodman’s study, little was known about the childhood precursors to Borderline Personality Disorder, especially in the case of males. Goodman pointed out that Nicki Crick, a developmental psychologist, proposed a theoretical model for five childhood indicators of BPD:

  • A hostile, paranoid world view
  • Intense, unstable, and inappropriate emotions
  • Overly close relationships
  • Impulsivity
  • Lack of sense of self

Goodman was impressed, finding that this looks similar to BPD symptoms seen in adults. But what about males? What is known about their developmental indicators when it comes to BPD?

Prior studies identified profiles of males with BPD as including precursors such as aggressive, disruptive, and antisocial behavior. But Goodman adds that adolescent males were not included in this model due to the small number of males in the sample.

Precursors to BPD

With the collaboration of nearly 2,000 parents, Goodman was able to compile information on this subject. What she discovered was that the trajectory of Borderline Personality Disorder doesn’t differ much between females and males in early development.

In infancy, the only precursor that shows a major difference is that of “unusual temperament,” at 9.8 percent in female infants and only 2.7 percent in males. The second notable precursor was “extreme separation anxiety,” being 8.7 percent in males and less than half that in females.

I know I had pretty extreme separation anxiety starting as early as 2.5 and that never really went away. Maybe earlier, but I haven’t asked.

Other precursors found in infancy, such as inability to self-soothe, sensitivity, social delay, and occurrence of sexual abuse, were similar in occurrence between males and females in the study. Similarly, those precursors and other BPD symptoms that begin to make an appearance in childhood, such as impulsivity and lying, remain relatively level between males and females.

So, not much difference. I don’t find this surprising but outside of my BPD blog I do a lot of sociological and neurobiological studies and frankly, socioeconomic environments have a lot more influence on the expression of male and female differences than biological ones.  Anyone that tells you differently has their own agenda.
BPD in Adolescence

“The diversion between male and female development of the disorder really begins in adolescence,” says Goodman.

            Not shocking at all.

One stand-out symptom that was overwhelmingly identified by parents of male children diagnosed with Borderline Personality Disorder as having prevalence in adolescence was “odd or unusual thinking.” More than half of the respondents with male children agreed that their child fell into that category. Zero respondents felt their female children diagnosed with BPD experienced “odd or unusual thinking.”
This I have to question. I don’t like that parents were asked without input from their kids. Also, zero respondents felt female children had “odd or unusual thinking”. Without clarification of what this means exactly I can’t say for sure, but I bet if you asked my parents this question they would have answered a big “yes” in that box. But then again, I was always an imaginative and creative child and this was never stifled in me. I was also a solitary child. I had friends, but I was no less likely to simply play on my own without the other children.

As these were yes and no questions, no data was gathered regarding what “odd or unusual thinking” looked like to the parents of these male adolescents, noted Goodman.
“The point is, these parents noticed something was ‘off,’” she said.
Another surprising find was the experience of body image issues among male adolescents with Borderline Personality Disorder. Nearly 16 percent of male adolescents displayed a proclivity to body image issues, as compared with 6.6 percent of females.

This is fascinating. Men are often overlooked in terms of body image issues but our society puts no less pressure on them. It often displays differently but it’s definitely an issue.

The aim of Goodman’s study was to discern children at risk for developing Borderline Personality Disorder so that BPD treatments and medications can be designed for prevention, or a change in the trajectory of the disorder, rather than letting the disorder fully manifest.

“The whole notion of intervening earlier has got to be higher on the priority scale,” said Goodman.


It’s a start. It’s incomplete, but it’s a start. I definitely think that learning the signs to look for in children and adolescents in order to help them get treatment sooner is incredibly important. However if these are the main differences that they were seeing, it seems to me that both boys and girls typically have very similar profiles growing up when it comes to the display of Borderline Personality Disorder.

One big issue that they didn’t cover at all that they surely should have: Home environment. Severity of Borderline Personality Disorder is at least partially dependent on a person’s immediate environment and the challenges they are faced with and surrounded by in their everyday life. So perhaps in future studies they should look at environmental stressors. 


  1. It's so difficult to identify and be able to help children with this because, just like you said, the environment factor. The factor that complicates it (environment) is probably the same factor that leads the child to fear opening up to their parents about their internal world, and their parents might not know a thing about validating them to begin with (tautology?) My parents would have been so "inconvenienced" to ask me to open up, or had I opened up, and had we done this undertaking as a child/adolescent. Thus, I'm doing the hard work now as adult.

    Plus, it's unfortunate that so many professionals are not keeping current on their research and they will just flat out say "No one gets diagnosed BPD as a child." and simply dismisses the conversation. It's as if they are not willing to entertain a different way to approach things.

    Another great post. Keep up the great work.

  2. Hi Haven - thanks for this. I really love and appreciate your blog. However I wondered of you could provide more info and research on recovery (research on what works/what doesn't. ie DBT etc). There is a lot of emphasis on the pathology and causes but would be great to have more info on how to help overcome it? Anyway just my thoughts! Take good care and good luck with the new relationship. :)

  3. You can also complete a home-based program at your own pace with book-based curriculum and study. In our modern world, however Psychotherapie


Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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