Potential causes of BPD in females may include a genetic predisposition and past traumatic experiences. BPD may cause symptoms, such as emotional instability, impulsive behavior, and relationship difficulties.

Some research suggests that borderline personality disorder (BPD) affects females nearly three times more often than males, though other studies have found a minimal difference. While the exact causes of BPD in females are not fully understood yet, research suggests the likely involvement of multiple factors.

These include biological, psychological, and environmental components. Biological factors may include genetic predisposition or structural abnormalities in the brain, while environmental factors may include early childhood trauma or other stressful life events.

This article explores the potential causes of BPD, particularly in females, in more detail. It also covers its diagnosis and treatment options.

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Experts are unsure exactly what causes BPD in females or the increased rate of it. Older research from 2003 suggests that 75% of those with the disorder are female, meaning there could be some diagnostic gender bias involved. It could also reflect the biological and sociocultural differences between males and females.

It may mean that females are more likely to consult a doctor or mental health professional for help, leading to the high rates of females receiving a diagnosis.

Generally, BPD is more likely to develop in people who are more emotionally sensitive and reactive than others, meaning that feelings arise more immediately and intensely. Furthermore, once triggered, it takes them longer to return to their usual emotional state.

If someone emotionally vulnerable experiences an environment that does not acknowledge them and help them feel validated, they can develop BPD. It can develop in those who have experienced:

  • childhood abuse
  • neglect
  • had their emotions minimized or discounted
  • have other family members with BPD

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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BPD mostly runs in families, with studies showing 50% heritability. As a result, people with relatives with BPD may be more likely to develop it themselves. Because of this, experts believe that genetic factors contribute to BPD.

However, there could be an overlap with their environment, as families may share a home and experiences. Because early relationships and upbringing impact how people view themselves and the world, it is difficult for experts to unravel the role of genetics versus the environment in BPD development.

Various traumatic life events can increase the risk of someone developing BPD. These may include:

  • physical, sexual, or emotional abuse
  • domestic violence
  • bullying
  • neglect
  • family separation or divorce
  • abandonment

Researchers have identified a significant link between sexual abuse in childhood and the later development of BPD. It appears that sexual abuse is more likely to lead to BPD than other types of trauma. As females are more likely to endure sexual abuse, this could explain why BPD appears to be more common in females.

Moreover, female teenagers with BPD, who did not experience symptom remission within 4 years of their initial symptoms, were significantly more likely to have experienced childhood sexual abuse.

In comparison, BPD symptoms improved significantly in female teenagers with BPD who did not experience this abuse.

Researchers have used MRI scans to assess the brains of individuals with BPD. The scans show that in many people with BPD, certain parts of the brain were smaller than typical or had abnormal activity levels. These parts include:

  • The amygdala: This is an area that helps regulate emotions, particularly fear, aggression, and anxiety.
  • The hippocampus: This area regulates behavior and self-control.
  • The orbitofrontal cortex: This area helps with planning and decision-making.

Changes in these areas could contribute to BPD symptoms. As yet, no research has identified the role of gender in brain development and BPD.

The overall causes of BPD across the genders are likely a combination of factors, including:

  • genetic predisposition
  • environmental factors
  • childhood experiences
  • brain chemistry and function

The causes of BPD may vary from person to person, and it is important to note that not all individuals with BPD have experienced traumatic life events or have a genetic predisposition.

Mental health professionals may find it challenging to diagnose BPD as it can have symptoms that resemble other mental health conditions. It may take several sessions to make a diagnosis.

During these sessions, a doctor assesses the patient’s history and any patterns of behavior that might point to BPD. They may also use a variety of tests and assessment tools to help make the diagnosis, including:

  • the McClean screening instrument for borderline personality disorder
  • a structured clinical interview for DSM-5 personality disorders
  • the Minnesota borderline personality disorder scale
  • the personality assessment inventory-borderline features scale

Talk therapy is the preferred treatment for BPD. Specifically, doctors have success with dialectical behavioral therapy (DBT), which involves talking one-on-one with a therapist and with other individuals with BPD in a group setting.

DBT focuses on:

  • practicing mindfulness
  • accepting one’s feelings and emotions
  • identifying unhelpful thinking patterns
  • developing coping strategies and relationship skills
  • learning how to manage intense emotions

DBT helps people with BPD learn to express themselves and their emotions healthily and teaches them how to build positive relationships. Along with DBT, people with BPD may also benefit from other forms of therapy, such as cognitive behavioral therapy (CBT) or psychodynamic therapy.

Other treatments may include medications, such as antidepressants or antipsychotics to help regulate a person’s moods and reduce impulsiveness.

Learn more about DBT here.

Typically, BPD has a good outlook. Research suggests that with appropriate treatment, people experience reduced symptoms and improved functioning. Around 35% of people with BPD experience remission after 2 years, which jumps to about 91% after 10 years. After 16 years, almost everyone is symptom-free. Around 75% of people have sustained remission for more than 8 years.

However, people in remission may still have poor social relationships. They may continue to find it challenging to relate to people and regulate their emotions, so instead of developing better interpersonal skills, they might avoid relationships.

The causes of borderline personality disorder in females may include genetic predisposition, environmental factors, childhood experiences, and brain chemistry and function. There is a strong link between childhood sexual abuse and BPD. Because the rates of this type of abuse appear to be higher among females, this could explain the gender differences in BPD rates.

Doctors diagnose BPD through a clinical assessment with the help of specialized tests. Treatment includes talk therapy, such as dialectical behavioral therapy, and medication. Doctors diagnose BPD through a clinical assessment with the help of specialized tests. Treatment includes talk therapy, such as dialectical behavioral therapy, and medication.

Overall, BPD has a good outlook with the appropriate treatment. Although it can be a challenging condition, many people experience remission and improved functioning with the right support.