Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2024 Nov 24;19(1):e1642. doi: 10.1002/pmh.1642

Gender differences in treatment effectiveness for borderline personality disorder

Xinyu Qian 1, Michelle L Townsend 1, Brin F S Grenyer 1,✉
PMCID: PMC11586321  PMID: 39582081

Abstract

Borderline personality disorder (BPD) is a psychological disorder that is diagnosed predominantly in females yet is equally as prevalent in males. Many empirical research studies on the treatment of BPD have been conducted with only female participants. We aimed to investigate the impact of current treatments for BPD on men compared to women. Using data from a larger ongoing longitudinal study, we matched 48 males with 48 females in treatment on age, overall functioning and psychological distress at intake and then accessed their progress in treatment after 12 months. Controlling for the initial scores at baseline, analysis of covariance (ANCOVA) analysis found significant differences in outcome measures at 12‐months follow‐up. Females had significantly greater improvements in BPD severity and greater improvements in internalizing symptoms such as chronic feelings of emptiness. Females also reported significantly greater satisfaction and ratings of health at follow‐up. These findings suggest that current treatment as usual for BPD could be more effective for women compared to men. Results from the study highlight the need for future studies to investigate the experience of males in current BPD treatment and to identify potential areas for modification to better cater to this population.

INTRODUCTION

Borderline personality disorder (BPD) is a complex personality disorder marked by internalizing symptoms such as strong, unstable emotions, and externalizing symptoms such as self‐harm and explosive anger (American Psychiatric Association, 2013). Epidemiology research estimates that between 0.5% and 5.9% of the adult population in the world have BPD (Leichsenring et al., 2011; Lenzenweger et al., 2007; ten Have et al., 2016). Since the introduction of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the 1980s, it has been thought to be a female predominant disorder (Skodol & Bender, 2003). According to the DSM‐5, BPD is diagnosed predominantly in females, with a 3:1 female to male sex ratio (American Psychiatric Association, 2013).

Genetics and different gender socialization processes can also account for differences in BPD symptoms between males and females. According to the biopsychosocial model by Leichsenring et al. (2011), the development of BPD is related to a combination of biological and environmental factors. Findings from twin studies indicated heritable components in the development of BPD, especially around impulsivity and instability (Al‐Alem & Omar, 2008). Furthermore, males and females appear to develop cognitive schemas regarding gender‐appropriate behaviours based on their environments (Starr & Zurbriggen, 2017). The impacts of these differences on treatment have seldom been studied hence the need for further research (Qian et al., 2022).

Despite the indication of female preponderance of BPD, research reports the prevalence of BPD is similar between sexes (Grant et al., 2008; Sansone & Sansone, 2011). Furthermore, research suggests that there could be notable differences in BPD symptoms between males and females. A recent scoping review suggests that males appear to display more externalizing symptoms (e.g., aggressiveness), while females appear to display more internalizing symptoms (e.g., affective instability) (Qian et al., 2022). This raises the question as to why BPD is more likely to be recognized in females (Sansone & Sansone, 2011). Difference in BPD conceptualization might contribute to this difficulty, with some theories even positing that affective instability is primary in understanding the disorder (Linehan, 1993). Clinician bias could also be contributing to the misconception of BPD as a female‐specific disorder, with practitioners overlooking these symptoms in men.

There is currently an underrepresentation of males in studies of BPD, and most literature on treatment has focused on female participants (Qian et al., 2022). Due to the postulation that males are more likely to exhibit different BPD symptoms compared with females, it is unclear whether current treatments that were validated with female participants are as effective for males. For instance, the original studies on dialectical behaviour therapy (DBT), one of the most empirically supported treatment for BPD, excluded males (Linehan et al., 1991). Associated with this absence of males in research is the finding from a large‐scale study (n = 5,530) regarding sex differences in the treatment of BPD, which suggests that males were less likely to seek treatment compared to females (Dehlbom et al., 2022). This raises the question of whether the low utilization and high withdrawal rates of males in BPD treatment may be partly due to treatment being more female‐specific in its design (Larivière et al., 2022). Given these factors, we aimed to contribute new data to the issue by comparing a matched sample of individuals identifying as males versus females in treatment.

METHODS

Participants

Adult participants diagnosed with BPD who presented to mental health services for treatment were recruited into an ongoing longitudinal study (Grenyer et al., 2022). Clinical diagnosis of BPD was made by a trained mental health practitioner using a structured interview protocol of mental health outcomes and assessment (NSW Department of Health, 2003). Other inclusion criteria included the completion of both the intake and follow‐up interview after 12 months and having undergone treatment as usual (TAU) in this period. Exclusion criteria were evidence of psychosis, alcohol or other drug disorders as the primary presenting problem, and/or imminent level of risk determined by the relevant Mental Health Triage Policy. All consenting participants gave written informed consent following approval from the institutional review board.

Procedure

During intake, participants completed a broad set of measures relevant to prognostic factors, including demographic information. Gender as assigned at birth (male or female) was collected, and there was no independent biological verification of sex or further information available about gender identity or diversity. Following intake, a brief intervention was offered as the initiation phase of a stepped care model between acute crisis presentation and long‐term treatment. The brief intervention included 4 weeks of outpatient symptom stabilization and relationship improvement with the participant's family or carer where applicable (Grenyer et al., 2018; Huxley et al., 2019; Project Air Strategy for Personality Disorders, 2015). After the brief intervention, participants continued TAU in the community supported by evidence‐based psychological recommendations from clinical guidelines (Grenyer, 2013). The study was for 1 year, with the follow‐up assessment of TAU being 12 months after intake. The follow‐up interviewed all participants by trained research psychologists independent of their treating clinician. At follow‐up, participants completed the same self‐report measures that were administered during intake. The research team had no role in the community treatment received, and thus, it was allowed to vary as ‘treatment as usual’.

Measures

BPD severity

The severity of all nine DSM‐5 BPD symptoms were rated from 1 = ‘none of the time’ to 6 = ‘all of the time’ for a dimensional understanding of symptoms as used in previous studies (e.g., Miller et al., 2018; Woodbridge et al., 2021). The reliability of the nine items were acceptable at baseline (α = .73) and 12 months follow‐up (α = .75).

Psychological distress

Psychological distress (anxiety and depression) was assessed by the Mental Health Inventory 5 (MHI‐5) (Berwick et al., 1991). It consists of five items measured on a 6‐point Likert scale from 1 = ‘none of the time’ to 6 = ‘all of the time’. Total MHI‐5 score is calculated by summing up the scores of each item. A higher score translates to greater psychological distress. The MHI‐5 was found to be excellent in detecting mood and anxiety disorders comparable to longer measures. It also displayed construct validity with the Zung Self‐rating Depression Scale (Yamazaki et al., 2005) and demonstrated acceptable reliability (α > .74) (McCabe et al., 1996; McHorney & Ware, 1995; Rumpf et al., 2001). In the current study, the MHI‐5 had acceptable and good reliability at baseline (α = .76) and 12 months follow‐up (α = .87).

Quality of life

Two global items from the World Health Organization Quality of Life (WHO‐QOL) were used to access quality of life and health measured on scale from 0, Very bad to 100, Very good. The two global items include ‘How would you rate your quality of life?’, and ‘How satisfied are you with your health?’. An additional item ‘How would you rate your overall health?’ from the Hospital Consumer Assessment of Health‐care Providers and Systems (HCAHPS) survey was also included (Giordano et al., 2010). Global measures have been shown to have good validity (de Boer et al., 2004) and have been used extensively in health research (Fayers & Sprangers, 2002).

Overall functioning

Two global items from the World Health Organization Disability Assessment Scale (WHO‐DAS) were used to access vocational impairment. The two global items were ‘in the past 14 days, how many days were you totally unable to carry out your usual activities or work because of any health conditions?’, and ‘not counting the days that you were totally unable, how many days did you cut back or reduce your usual activities or work?’. These items are commonly employed in research focused on the examination of vocational functioning (Keeley et al., 2014).

Data analysis

Analyses were conducted using IBM SPSS Statistics, Version 28.0 software. Tests were two‐tailed with significance level of α = .05. Controlling for the initial score at baseline, an analysis of covariance (ANCOVA) analysis was used to determine if outcome measures at 12‐month follow‐up significantly differ by gender. The chi‐square analysis was used to determine differences in demographic information between the sexes.

Matching of participants

The initial sample included 194 participants (53 males and 141 females). This difference in sample sizes between groups could lead to reduced statistical power and decrease the likelihood of detecting true differences, resulting in biased results in analyses (Roberts & Torgerson, 1999). In addition, it was also found that the female participants reported significantly higher MHI‐5 scores at intake than males (p < .05). To counter the issue of an unbalanced sample of female participants who reported higher severity scores, a matched pairs design was employed in the current study (Ivers et al., 2012). Participants from both groups (identifying as male vs. female) were matched based on age, overall functioning (WHO‐DAS) and psychological distress (MHI‐5). Participants were not matched on BPD symptom severity to reduce the risk of masking potential sex differences.

The matching process resulted in a final sample size of 96 participants (48 males and 48 females). Independent‐samples t‐tests were conducted with the 48 matched pairs to ensure that there were no significant differences between the groups for the matching variables. Table 1 illustrates the results of the matching variables between the matched participants.

TABLE 1.

Intake mean (sd) of matched male and female cohort by age, overall functioning (World Health Organization Disability Assessment Scale [WHO‐DAS]) and psychological distress (Mental Health Inventory 5 [MHI‐5]).

Total N = 96 Male n = 48 Female n = 48 t df p
M SD M SD M SD
Age (M, SD) 34.17 14.20 33.98 14.44 34.35 14.10 −0.13 94 .898
WHO‐DAS a 6.16 5.50 6.02 5.62 6.29 5.42 −0.24 94 .811
Total MHI b 20.93 4.49 20.58 4.19 21.27 4.80 −0.75 94 .456
Open in a new tab
a

Day range 0 to 14.

b

Score range 6 to 30.

RESULTS

The demographic information of the participants is shown in Table 2. There was no significant difference in the collected demographic information between the sexes except for relationship status.

TABLE 2.

Demographic information of participants (n = 96).

Total Male Female χ2
n n n Value p
Relationship status 4.98 0.026
Single 43 27 16
In a relationship 46 18 28
Employment status 0.20 0.658
Full/part time employment 41 22 19
Stipend 35 17 18
Housing 0.00 0.986
Rented 56 27 29
Own house/flat 25 12 13
Living arrangement 4.54 0.337
Alone 9 4 5
Spouse and/or children 24 10 14
Parents 28 18 10
Extended relatives and/or friends 21 8 13
Others/did not answer 14 8 6
Open in a new tab

Tables 3 and 4 show sex differences in treatment outcomes between both groups. Despite the matching of participants, the mean score at baseline suggests that participants identifying as females reported greater BPD symptom severity, lower quality of life and poorer self‐rated health. This trend, however, was reversed at follow‐up, with participants identifying as females reporting better clinical results than those identifying as males for most of the outcome measures. Based on the self‐reported BPD symptoms, a total of 41 (85%) participants identifying as males and 47 (98%) identifying as females met the criteria (i.e., five of nine symptoms) for BPD diagnosis at baseline, and 25 (52%) participants identifying as males and 20 (42%) identifying as females met the criteria for BPD diagnosis at follow‐up X 2 (1) = 0.96, p = .328. Although there were no differences between groups, both improved over the year with about half no longer meeting diagnostic criteria at follow‐up suggesting the treatments received were helpful.

TABLE 3.

Analysis of covariance (ANCOVA) for follow‐up changes in borderline personality disorder (BPD) symptom severity (range 1–6) as a function of gender (assigned male/female at birth), using baseline BPD symptom severity scores as a covariate (n = 96).

Baseline Follow‐up F p d 95%CI
Total Male Female Total Male Female
M SD M SD M SD M SD M SD M SD
BPD symptom severity (Total) 3.41 0.89 3.17 0.96 3.66 0.76 2.05 0.79 2.22 0.89 1.89 0.64 5.74 0.019 0.065 0.07, 0.76
Unstable relationships 3.71 1.72 3.54 1.81 3.88 1.62 2.03 1.40 2.00 1.35 2.06 1.45 0.00 0.961 0.00 −0.54, −0.57
Impulsivity 3.69 1.60 3.60 1.75 3.77 1.45 2.27 1.40 2.38 1.51 2.17 1.29 0.58 .449 0.01 −0.35, 0.79
Mood dysregulation 4.27 1.44 3.45 1.44 4.27 1.44 2.41 1.46 2.48 1.49 2.33 1.43 0.38 0.538 0.00 −0.41, 0.79
Anger 3.45 1.44 3.10 1.55 3.79 1.24 2.08 1.25 2.25 1.35 1.92 1.13 2.04 0.156 0.02 −0.15, 0.89
Chronic emptiness 4.05 1.30 3.76 1.40 4.33 1.14 2.40 1.51 2.85 1.65 1.98 1.25 9.33 0.003 0.09 0.33, 1.55
Identity disturbance 3.38 1.74 3.08 1.69 3.67 1.77 2.29 1.60 2.46 1.74 2.13 1.45 2.49 0.118 0.03 −0.13, 1.13
Real/imagined abandonment 3.23 1.84 3.00 1.77 3.47 1.89 1.83 1.43 1.90 1.45 1.77 1.43 0.35 .554 0.00 −0.41, 0.77
Self‐harm or suicide 1.61 1.08 1.36 0.61 1.87 1.38 1.19 0.73 1.24 0.82 1.13 0.63 1.00 0.320 0.01 −0.15, 0.46
Paranoid ideation 3.50 1.29 3.30 1.39 3.71 1.16 2.35 1.28 2.58 1.40 2.13 1.13 4.74 0.032 0.05 0.05, 1.09
Open in a new tab

Note: Total symptom severity is average of the sum of all nine BPD criteria.

TABLE 4.

Analysis of covariance (ANCOVA) for changes in World Health Organization Quality of Life (WHO‐QOL) and overall health as a function of gender (assigned male/female at birth), using baseline symptom scores as a covariate (n = 96).

Baseline Follow‐up F p d 95%CI
Total Male Female Total Male Female
M SD M SD M SD M SD M SD M SD
WHO‐QOL
How would you rate your quality of life? 38.32 22.91 40.00 23.31 36.67 22.63 63.11 27.55 58.51 27.29 67.60 27.35 3.30 0.072 0.04 −21.03, 0.94
How satisfied are you with your health? 37.79 24.76 42.98 23.67 32.71 24.99 60.11 24.89 58.30 22.94 61.88 26.79 1.79 0.008 0.07 −17.04, 3.30
Overall health
How do you rate your overall health? 43.58 24.79 47.02 22.06 40.21 27.01 60.32 22.99 56.81 22.66 63.75 23.03 4.63 0.034 0.05 −18.54, −0.07
Open in a new tab

ANCOVA analyses found that participants identifying as female reported significantly greater improvements in total BPD symptom severity and severity in two out of the nine BPD symptoms (chronic emptiness and paranoid ideation; Table 3), as well as perception of overall health, and satisfaction with health (Table 4).

DISCUSSION

The present study compared a matched sample of individuals identifying as males or females with BPD and followed them over 12 months. Participants were matched based on their intake score on age, overall functioning and psychological distress. In general, about half the sample no longer met criteria for BPD after 12 months, suggesting treatment was moderately successful for both participants identifying as males (48% no longer meeting criteria) and those identifying as females (58% no longer meeting criteria). Findings observed an overall trend for participants identifying as females to show greater initial severity at intake yet greater improvements than those identifying as males across several domains (Tables 3 and 4).

Regarding specific BPD symptoms, results indicated that participants identifying as females reported greater improvements in internalizing symptoms, such as chronic emptiness and paranoid ideation. It may be that the current TAU offered to these participants was more helpful for females with these internalizing symptoms, consistent with previous reviews (Qian et al., 2022).

While participants identifying as males in the current sample reported lower feeling of emptiness than those identifying as females at baseline, this could suggest that the individual threshold for the feeling of emptiness and related symptoms between both groups could differ as individuals identifying as males may be socialized to be less sensitive (Siegel & Meunier, 2019) and more suppressive of emotions (Cai et al., 2016). Other research has found individuals identifying as females to be more likely to report chronic feeling of emptiness than individuals identifying as males (Hoertel et al., 2014). The definition for ‘chronic emptiness’ has been an issue in the research of BPD due to reasons such as overlaps with other similar constructs such as ‘hopelessness’ (Miller et al., 2020) and depression (Hudson et al., 2024). It would be beneficial for future research to have consensus in the definition of ‘chronic emptiness’, its relationship to depression and further exploration of these impacts at the level of gender.

Previous studies have reported that individuals identifying as males have also reported higher levels of suspiciousness/paranoia than individual identifying as females (Kring & Gordon, 1998; Lang et al., 1993), which may be associated with differences in emotional processing and recognition (Boden & Berenbaum, 2007). In contrast, participants identifying as males in the current sample reported lower paranoid ideation at baseline compared to those identifying as females but achieved significantly weaker improvements at follow‐up. It is unclear if these differences were due to the therapies helping women more than men reduce their suspiciousness or if men perhaps downplayed their emotional fears (to ‘play tough’) (Affleck et al., 2018). An alternative possibility is these differences are a statistical artefact, that is, those who have higher scores at baseline have a greater margin to show reductions, than those already starting with lower scores. Replication in future research with larger sample sizes and matching on specific BPD symptoms might provide additional insight into this issue. Alternatively, there could be fundamental differences in how the same symptom could manifest between genders; meaning, more research is required to explore this possibility.

The change in other internalizing symptoms, such as affective instability due to a marked reactivity of mood, was not significantly different between genders at baseline and follow‐up. This could be due to current BPD interventions incorporating multiple components and skills (Barnicot et al., 2015), which benefited all in the study. Mood‐related issues have been shown to require a substantial amount of time to see observable outcome (Picardi & Gaetano, 2014). Alternatively, this could also be an indication that current treatment targeting these symptoms does not differ in outcome between genders. Participants identifying as females reported significantly greater improvements in perceived overall health and happiness compared to those identifying as males. This further suggests that the current interventions available in the community may confer greater benefits for women than men.

The observed disparity in treatment effectiveness could also have been due to different treatment preferences and needs. For example, some men are more likely to exhibit high novelty seeking (Barnow et al., 2007; Staniloiu & Markowitsch, 2012) compared to women (Barnow et al., 2007; Deng et al., 2016). Some women may also be more likely to express and talk about their emotions (Liddon et al., 2018). It is possible that men may find it difficult to benefit from regular treatment that involves deep discussions around emotions. These factors are unlikely to be represented in the current body of BPD literature especially given the known low treatment utilization and retention rates of participants identifying as males. These kinds of issues require further research to explore the possible issues affecting men receiving psychological therapy.

What is not known is the extent that men were more likely to under‐report mental health symptoms than women (Call & Shafer, 2018; Shi et al., 2021; Sigmon et al., 2005). The clinical characteristics of participants in the present study could suggest that the participants identifying as males may be either under‐reporting their symptoms or that those with more severe symptoms were less likely to seek treatment or drop out.

Limitations

A limitation of the present study is that the treatment received was unable to be studied in detail (e.g., video recording or transcripts). This made it challenging to investigate the effectiveness of specific treatments for participants identifying as males and those identifying as females or any possible influences of therapy differences on the outcomes shown here. However, not standardizing treatment was necessary for the present study as it was part of a naturalistic longitudinal follow‐up meaning therapies were allowed to vary naturalistically. Although there was a careful attempt to match the participants in this study, slight mismatches between participants identifying as male–female pairs could influence findings from the data analyses. Another limitation was that only participants identifying as males who were engaged in treatment at follow‐up were included in the present study. This could mean that a proportion of participants identifying as males who dropped out before the follow‐up interview were not included. As participants identifying as males in the present study had a trend towards somewhat less severe BPD symptoms, it is unknown how these findings might generalize to individuals identifying as males with more severe presentations. A final limitation was the use of self‐report measures, and future studies may consider including more in‐depth quantitative and qualitative interview methods.

Future research

Given the limited knowledge on this topic, future research is required to replicate and extend these findings. In addition, work is needed to investigate the motivations and barriers that influence the treatment experience of individuals identifying as males with BPD, as well as the components which they find important. Our study intentionally did not investigate differences in drop out; thus, future studies are warranted exploring drop out and retention in treatment differences between genders. Further research may also further examine the treatment outcomes for internalizing and externalizing symptoms to determine if they are equally targeted in a clinical setting for both genders. Findings also highlighted that some of the participants did not self‐report meeting current criteria for BPD in the research assessment despite having a formal diagnosis of BPD. This could indicate potential biases in responding, such as minimization in self‐reports or exaggeration in a formal diagnostic interview. Hence, future studies could further explore possible issues in self‐report biases and fluctuations more broadly in BPD symptom reporting and also between gender effects (Hasler et al., 2014).

Conclusion

Recent studies suggest that BPD may manifest differently between genders and have found that the prevalence of BPD in men is just as high as in women. Despite this, most of the literature on treatment for BPD has been conducted predominantly with women. The present study found that participants identifying as males and those identifying as females both improved around multiple domains from psychological treatment. Women were found to show greater improvements in BPD symptom severity and perception of overall health, suggesting the TAU community therapies provided benefited them more than their male counterparts. More research is warranted in the area of gender differences in BPD, and it is imperative to investigate the treatment experience of men with BPD to facilitate beneficial outcomes in clinical settings.

CONFLICT OF INTEREST STATEMENT

Competing interests: The authors have declared that no competing interests exist.

ETHICS APPROVAL STATEMENT

Research has been approved by the University of Wollongong & Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee.

Qian, X. , Townsend, M. L. , & Grenyer, B. F. S. (2025). Gender differences in treatment effectiveness for borderline personality disorder. Personality and Mental Health, 19(1), e1642. 10.1002/pmh.1642

Funding information Project Air acknowledges New South Wales Ministry of Health.

DATA AVAILABILITY STATEMENT

The data is not available as participants only gave ethical consent for this project and not for further distribution outside the research team. The authors are under ethical obligations not to release the data to third parties. Access to the data would require the approval of the joint Human Research Ethics Committee of the University of Wollongong and NSW Health. Applications to access the data may be sent to Professor Grenyer, grenyer@uow.edu.au.

REFERENCES

  1. Affleck, W. , Carmichael, V. , & Whitley, R. (2018). Men's mental health: Social determinants and implications for services. Canadian Journal of Psychiatry, 63(9), 581–589. 10.1177/0706743718762388 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Al‐Alem, L. , & Omar, H. A. (2008). Borderline personality disorder: An overview of history, diagnosis and treatment in adolescents. International Journal of Adolescent Medicine and Health, 20(4), 395–404. http://europepmc.org/abstract/MED/19230440 [PubMed] [Google Scholar]
  3. American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders: DSM‐5 (5th ed.). American Psychiatric Publishing. 10.1176/appi.books.9780890425596 [DOI] [Google Scholar]
  4. Barnicot, K. , Couldrey, L. , Sandhu, S. , & Priebe, S. (2015). Overcoming barriers to skills training in borderline personality disorder: A qualitative interview study. PLoS ONE, 10(10), e0140635. 10.1371/journal.pone.0140635 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Barnow, S. , Herpertz, S. C. , Spitzer, C. , Stopsack, M. , Preuss, U. W. , Grabe, H. J. , Kessler, C. , & Freyberger, H. J. (2007). Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account. Psychopathology, 40(6), 369–378. 10.1159/000106467 [DOI] [PubMed] [Google Scholar]
  6. Berwick, D. M. , Murphy, J. M. , Goldman, P. A. , Ware, J. E. , Barsky, A. J. , & Weinstein, M. C. (1991). Performance of a five‐item mental health screening test. Medical Care, 29(2), 169–176. 10.1097/00005650-199102000-00008 [DOI] [PubMed] [Google Scholar]
  7. Boden, M. T. , & Berenbaum, H. (2007). Emotional awareness, gender, and suspiciousness. Cognition & Emotion, 21(2), 268–280. 10.1080/02699930600593412 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cai, A. , Lou, Y. , Long, Q. , & Yuan, J. (2016). The sex differences in regulating unpleasant emotion by expressive suppression: Extraversion matters. Frontiers in Psychology, 7, 1011. 10.3389/fpsyg.2016.01011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Call, J. B. , & Shafer, K. (2018). Gendered manifestations of depression and help seeking among men. American Journal of Men's Health, 12(1), 41–51. 10.1177/1557988315623993 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. de Boer, A. G. E. M. , van Lanschot, J. J. B. , Stalmeier, P. F. M. , van Sandick, J. W. , Hulscher, J. B. F. , de Haes, J. C. J. M. , & Sprangers, M. A. G. (2004). Is a single‐item visual analogue scale as valid, reliable and responsive as multi‐item scales in measuring quality of life? Quality of Life Research, 13(2), 311–320. 10.1023/B:QURE.0000018499.64574.1f [DOI] [PubMed] [Google Scholar]
  11. Dehlbom, P. , Wetterborg, D. , Lundqvist, D. , Maurex, L. , Dal, H. , Dalman, C. , & Kosidou, K. (2022). Gender differences in the treatment of patients with borderline personality disorder. Personality Disorders, 13(3), 277–287. 10.1037/per0000507 [DOI] [PubMed] [Google Scholar]
  12. Deng, Y. , Chang, L. , Yang, M. , Huo, M. , & Zhou, R. (2016). Gender differences in emotional response: Inconsistency between experience and expressivity. PLoS ONE, 11(6), e0158666. 10.1371/journal.pone.0158666 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Fayers, P. M. , & Sprangers, M. A. G. (2002). Understanding self‐rated health. The Lancet (British Edition), 359(9302), 187–188. 10.1016/S0140-6736(02)07466-4 [DOI] [PubMed] [Google Scholar]
  14. Giordano, L. A. , Elliott, M. N. , Goldstein, E. , Lehrman, W. G. , & Spencer, P. A. (2010). Development, implementation, and public reporting of the HCAHPS survey. Medical Care Research and Review, 67(1), 27–37. 10.1177/1077558709341065 [DOI] [PubMed] [Google Scholar]
  15. Grant, B. F. , Chou, S. P. , Ruan, W. J. , Goldstein, R. B. , Huang, B. , Stinson, F. S. , Saha, T. D. , Smith, S. M. , Dawson, D. A. , Pulay, A. J. , & Pickering, R. P. (2008). 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, 69(4), 533–545. 10.4088/JCP.v69n0404 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Grenyer, B. F. (2013). Improved prognosis for borderline personality disorder. The Medical Journal of Australia, 198(9), 464–465. 10.5694/mja13.10470 [DOI] [PubMed] [Google Scholar]
  17. Grenyer, B. F. S. , Lewis, K. L. , Fanaian, M. , & Kotze, B. (2018). Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial. PLoS ONE, 13(11), e0206472. 10.1371/journal.pone.0206472 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Grenyer, B. F. S. , Townsend, M. L. , Lewis, K. , & Day, N. (2022). To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder. Personality and Mental Health, 16(2), 138–154. 10.1002/pmh.1547 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hasler, G. , Hopwood, C. J. , Jacob, G. A. , Brändle, L. S. , & Schulte‐Vels, T. (2014). Patient‐reported outcomes in borderline personality disorder. Dialogues in Clinical Neuroscience, 16(2), 255–266. 10.31887/DCNS.2014.16.2/ghasler [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hoertel, N. , Peyre, H. , Wall, M. M. , Limosin, F. , & Blanco, C. (2014). Examining sex differences in DSM‐IV borderline personality disorder symptom expression using item response theory (IRT). Journal of Psychiatric Research, 59, 213–219. 10.1016/j.jpsychires.2014.08.019 [DOI] [PubMed] [Google Scholar]
  21. Hudson, C. C. , Ferguson, I. , Fan, K. , Björgvinsson, T. , & Beard, C. (2024). A general inductive approach to characterize transdiagnostic experiences of emptiness. Journal of Clinical Psychology, 80(8), 1726–1735. 10.1002/jclp.23689 [DOI] [PubMed] [Google Scholar]
  22. Huxley, E. , Lewis, K. L. , Coates, A. D. , Borg, W. M. , Miller, C. E. , Townsend, M. L. , & Grenyer, B. F. S. (2019). Evaluation of a brief intervention within a stepped care whole of service model for personality disorder. BMC Psychiatry, 19(1), 341. 10.1186/s12888-019-2308-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Ivers, N. M. , Halperin, I. J. , Barnsley, J. , Grimshaw, J. M. , Shah, B. R. , Tu, K. , Upshur, R. , & Zwarenstein, M. (2012). Allocation techniques for balance at baseline in cluster randomized trials: A methodological review. Trials, 13(1), 120. 10.1186/1745-6215-13-120 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Keeley, J. W. , Flanagan, E. H. , & McCluskey, D. L. (2014). Functional impairment and the DSM‐5 dimensional system for personality disorder. Journal of Personality Disorders, 28(5), 657–674. 10.1521/pedi_2014_28_133 [DOI] [PubMed] [Google Scholar]
  25. Kring, A. M. , & Gordon, A. H. (1998). Sex differences in emotion: Expression, experience, and physiology. Journal of Personality and Social Psychology, 74(3), 686–703. 10.1037//0022-3514.74.3.686 [DOI] [PubMed] [Google Scholar]
  26. Lang, P. J. , Greenwald, M. K. , Bradley, M. M. , & Hamm, A. O. (1993). Looking at pictures: Affective, facial, visceral, and behavioral reactions. Psychophysiology, 30(3), 261–273. 10.1111/j.1469-8986.1993.tb03352.x [DOI] [PubMed] [Google Scholar]
  27. Larivière, N. , Beauregard‐Laliberté, R. , Brière, A. , Fontaine, A. S. , Lamarre, A. , Tremblay‐Perreault, P. , & Corbière, M. (2022). Daily living functioning in men with borderline personality disorders: A scoping review. Journal of Psychosocial Rehabilitation and Mental Health, 10, 215–231. 10.1007/s40737-022-00313-4 [DOI] [Google Scholar]
  28. Leichsenring, F. , Leibing, E. , Kruse, J. , New, A. S. , & Leweke, F. (2011). Borderline personality disorder. Lancet, 377(9759), 74–84. 10.1016/s0140-6736(10)61422-5 [DOI] [PubMed] [Google Scholar]
  29. Lenzenweger, M. F. , Lane, M. C. , Loranger, A. W. , & Kessler, R. C. (2007). DSM‐IV personality disorders in the national comorbidity survey replication. Biological Psychiatry (1969), 62(6), 553–564. 10.1016/j.biopsych.2006.09.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Liddon, L. , Kingerlee, R. , & Barry, J. A. (2018). Gender differences in preferences for psychological treatment, coping strategies, and triggers to help‐seeking. British Journal of Clinical Psychology, 57(1), 42–58. 10.1111/bjc.12147 [DOI] [PubMed] [Google Scholar]
  31. Linehan, M. M. (1993). Cognitive‐behavioral treatment of borderline personality disorder (1st ed.). Guilford Publications. [Google Scholar]
  32. Linehan, M. M. , Armstrong, H. E. , Suarez, A. , Allmon, D. , & Heard, H. L. (1991). Cognitive‐behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064. 10.1001/archpsyc.1991.01810360024003 [DOI] [PubMed] [Google Scholar]
  33. McCabe, C. J. , Thomas, K. J. , Brazier, J. E. , & Coleman, P. (1996). Measuring the mental health status of a population: A comparison of the GHQ–12 and the SF–36 (MHI–5). British Journal of Psychiatry, 169(4), 517–521. 10.1192/bjp.169.4.516 [DOI] [PubMed] [Google Scholar]
  34. McHorney, C. A. , & Ware, J. J. E. (1995). Construction and validation of an alternate form general mental health scale for the medical outcomes study short‐form 36‐item health survey. Medical Care, 33(1), 15–28. 10.1097/00005650-199501000-00002 [DOI] [PubMed] [Google Scholar]
  35. Miller, C. E. , Lewis, K. L. , Huxley, E. , Townsend, M. L. , & Grenyer, B. F. S. (2018). A 1‐year follow‐up study of capacity to love and work: What components of borderline personality disorder most impair interpersonal and vocational functioning? Personality and Mental Health, 12(4), 334–344. 10.1002/pmh.1432 [DOI] [PubMed] [Google Scholar]
  36. Miller, C. E. , Townsend, M. L. , Day, N. J. S. , & Grenyer, B. F. S. (2020). Measuring the shadows: A systematic review of chronic emptiness in borderline personality disorder. PLoS ONE, 15(7), e0233970. 10.1371/journal.pone.0233970 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. NSW Department of Health . (2003). Your guide to MH‐OAT: Clinicians' reference guide to NSW mental health outcomes and assessment tools. NSW Department of Health. https://books.google.com.au/books?id=R7uGAAAACAAJ [Google Scholar]
  38. Picardi, A. , & Gaetano, P. (2014). Psychotherapy of mood disorders. Clinical Practice and Epidemiology in Mental Health, 10, 140–158. 10.2174/1745017901410010140 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Project Air Strategy for Personality Disorders . (2015). Brief intervention manual for personality disorders. University of Wollongong, Illawarra Health and Medical Research Institute. [Google Scholar]
  40. Qian, X. , Townsend, M. L. , Tan, W. J. , & Grenyer, B. F. S. (2022). Sex differences in borderline personality disorder: A scoping review. PLoS ONE, 17(12), e0279015. 10.1371/journal.pone.0279015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Roberts, C. , & Torgerson, D. J. (1999). Understanding controlled trials: Baseline imbalance in randomised controlled trials. BMJ, 319(7203), 185. 10.1136/bmj.319.7203.185 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Rumpf, H.‐J. , Meyer, C. , Hapke, U. , & John, U. (2001). Screening for mental health: Validity of the MHI‐5 using DSM‐IV Axis I psychiatric disorders as gold standard. Psychiatry Research, 105(3), 243–253. 10.1016/S0165-1781(01)00329-8 [DOI] [PubMed] [Google Scholar]
  43. Sansone, R. A. , & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in Clinical Neuroscience, 8(5), 16–20. [PMC free article] [PubMed] [Google Scholar]
  44. Shi, P. , Yang, A. , Zhao, Q. , Chen, Z. , Ren, X. , & Dai, Q. (2021). A hypothesis of gender differences in self‐reporting symptom of depression: Implications to solve under‐diagnosis and under‐treatment of depression in males. Frontiers in Psychiatry, 12, 589687. 10.3389/fpsyt.2021.589687 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Siegel, K. , & Meunier, É. (2019). Traditional sex and gender stereotypes in the relationships of non‐disclosing behaviorally bisexual men. Archives of Sexual Behavior, 48(1), 333–345. 10.1007/s10508-018-1226-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Sigmon, S. T. , Pells, J. J. , Boulard, N. E. , Whitcomb‐Smith, S. , Edenfield, T. M. , Hermann, B. A. , LaMattina, S. M. , Schartel, J. G. , & Kubik, E. (2005). Gender differences in self‐reports of depression: The response bias hypothesis revisited. Sex Roles, 53(5), 401–411. 10.1007/s11199-005-6762-3 [DOI] [Google Scholar]
  47. Skodol, A. E. , & Bender, D. S. (2003). Why are women diagnosed borderline more than men? The Psychiatric Quarterly, 74(4), 349–360. 10.1023/a:1026087410516 [DOI] [PubMed] [Google Scholar]
  48. Staniloiu, A. , & Markowitsch, H. (2012). Gender differences in violence and aggression – A neurobiological perspective. Procedia ‐ Social and Behavioral Sciences, 33, 1032–1036. 10.1016/j.sbspro.2012.01.279 [DOI] [Google Scholar]
  49. Starr, C. R. , & Zurbriggen, E. L. (2017). Sandra Bem's gender schema theory after 34 years: A review of its reach and impact. Sex Roles, 76(9), 566–578. 10.1007/s11199-016-0591-4 [DOI] [Google Scholar]
  50. ten Have, M. , Verheul, R. , Kaasenbrood, A. , van Dorsselaer, S. , Tuithof, M. , Kleinjan, M. , & de Graaf, R. (2016). Prevalence rates of borderline personality disorder symptoms: A study based on the Netherlands mental health survey and incidence Study‐2. BMC Psychiatry, 16(1), 249. 10.1186/s12888-016-0939-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Woodbridge, J. , Reis, S. , Townsend, M. L. , Hobby, L. , & Grenyer, B. F. S. (2021). Searching in the dark: Shining a light on some predictors of non‐response to psychotherapy for borderline personality disorder. PLoS ONE, 16(7), e0255055. 10.1371/journal.pone.0255055 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Yamazaki, S. , Fukuhara, S. , & Green, J. (2005). Usefulness of five‐item and three‐item mental health inventories to screen for depressive symptoms in the general population of Japan. Health and Quality of Life Outcomes, 3(1), 48–48. 10.1186/1477-7525-3-48 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data is not available as participants only gave ethical consent for this project and not for further distribution outside the research team. The authors are under ethical obligations not to release the data to third parties. Access to the data would require the approval of the joint Human Research Ethics Committee of the University of Wollongong and NSW Health. Applications to access the data may be sent to Professor Grenyer, grenyer@uow.edu.au.

Articles from Personality and Mental Health are provided here courtesy of Wiley

RESOURCES