While BPD is more commonly diagnosed in females, this may represent a gender difference in those who seek treatment. Since the 1980s, the DSM has indicated that this disorder is more common in women than men. However, a recent study called the National Epidemiologic Survey on Alcohol and Related Conditions found that BPD is equally as common among men and women.
Currently, most researchers in the field agree with this finding. The over-diagnosing of females by clinicians represents a gender bias with regards to BPD. Sampling bias may also be responsible for the gender discrepancy with this disorder. For example, if females display more self-harming behaviors than men, and use mental health services more frequently because of this, it follows that studies conducted in this setting would report more females than males.
In addition, the way that BPD expresses itself may be different between males and females due to cultural norms, parenting styles or natural gender differences in behavior. One study found that men with BPD had more explosive temperaments than females with BPD. They also had higher levels of novelty-seeking behaviors coupled with harm avoidance. Women with BPD, on the other hand were characterized by high levels of harm avoidance but not novelty seeking. In other words, explosive elements and novelty seeking represent two major distinctions between men and women with borderline personality disorder.
Studies have found that substance abuse is more common in men than women with BPD. Men with this disorder are also more likely to have other co-occurring Axis II disorders such as paranoid, passive-aggressive, narcissistic, sadistic and antisocial personality disorders. Compared to women with BPD, men with BPD display more antisocial features. While men with BPD are more likely to abuse substances, women are more likely to have co-occurring eating disorders. Women are also more likely to have mood, anxiety and posttraumatic stress disorders in addition to their BPD diagnosis.
One study conducted in England found that both men and women were equally likely to participate in skin-cutting. Self-harming behaviors such as skin-cutting do not appear to vary by gender. Other impulse patterns emerge in equal proportions in both sexes. In addition, no differences between the genders have been found in the degree of overall impairment.
Both genders display equal levels of emotional distress when presented for treatment. However, there are distinct gender differences in terms of treatment utilization. Over the course of a lifetime, BPD patients of both genders utilize treatment equally. Men are more likely to utilize treatment services for drug and alcohol rehabilitation and are less likely to use pharmacotherapy and psychotherapy services than women with BPD.