Personality Disorders in Women, an Overview

  • Poornima BholaEmail author
  • K Dharani Devi
Living reference work entry
Part of the Mental Health and Illness Worldwide book series (MHIW)


Personality disorders represent enduring patterns of difficulties in ways of thinking, feeling, and behaving that deviate from cultural expectations, and typically emerge in adolescence or early adulthood. The associated distress and impairment associated with these complex vulnerabilities impact relationships, work, and the sense of self and present significant treatment challenges. Using a gendered lens can provide a more nuanced view of the interface between gender and personality vulnerabilities. This perspective can reveal the ways in which content and approaches are “gendered”; informed by, shaped by, or biased toward men’s or women’s perspectives or experiences. In this chapter, we use a critical reflective stance to unpack and interrogate the meaning of gender, spanning the process from diagnosis to treatment of personality disorders. The gender inequalities in rates and diagnoses of personality disorders are critically examined. The expressions of personality vulnerabilities and the therapeutic process are viewed through the lens of culture. The importance of understanding developmental psychopathology pathways and intergenerational transmission of personality dysfunction among women is emphasized. Contemporary, and sometimes divergent, perspectives on the diagnostic models and approaches for personality disorders are explored. These include the changes in diagnostic nomenclature and positioning, the pulls between categorical and dimensional approaches, and the emergence of transdiagnostic frameworks. Although the debate on the intersections between PTSD, complex PTSD, and borderline pathology continues, the centrality of trauma in working with these vulnerable women is evident. In thinking about all these questions, we examine the implications for sensitive and informed assessment and intervention frameworks.


Personality disorder Women Gender Dimensional personality Culture Developmental psychopathology 


  1. Afifi TO, Mather A, Boman J, Fleisher W, Enns MW, MacMillan H, Sareen J (2011) Childhood adversity and personality disorders: results from a nationally representative population-based study. J Psychiatr Res 40:814–822. Scholar
  2. Alarcon RD, Leetz KL (1998) Cultural intersections in the psychotherapy of borderline personality disorder. Am J Psychother 52:176–190Google Scholar
  3. Aviram RB, Brodsky BS, Stanley B (2006) Borderline personality disorder, stigma, and treatment implications. Harv Rev Psychiatry 14:249–256. Scholar
  4. Bach B, Markon K, Simonsen E, Krueger RF (2015) Clinical utility of the DSM-5 alternative model of personality disorders: six cases from practice. J Psychiatr Pract 21:3–25Google Scholar
  5. Bandelow B, Krause J, Wedekind D, Broocks A, Hajak G, Ruther E (2005) Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatr Res 134:169–179Google Scholar
  6. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich-May J (2011) Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. Oxford University Press, New YorkGoogle Scholar
  7. Barrett LF, Bliss-Moreau E (2009) She’s emotional. He’s having a bad day: attributional explanations for emotion stereotypes. Emotion 9:649–658. Scholar
  8. Bartsch DR, Roberts RM, Davies M, Proeve M (2015) Borderline personality disorder and parenting: clinician perspectives. Adv Ment Health 13:113–126. Scholar
  9. Beauchaine TP, Klein DN, Crowell SE, Derbidge C, Gatzke-Kopp L (2009) Multifinality in the development of personality disorders: a biology x sex x environment interaction model of antisocial and borderline traits. Dev Psychopathol 21:735–770. Scholar
  10. Bem SL (1993) The lenses of gender: transforming the debate on sexual inequality. Yale University Press, New HavenGoogle Scholar
  11. Blashfield RK, Davis RT (1993) Dependent and histrionic personality disorders. In: Sutker PB, Adams HE (eds) Comprehensive handbook of psychopathology. Springer, BostonGoogle Scholar
  12. Blashfield RK, Reynolds SM, Stennett B (2012) The death of histrionic personality disorder. In: Widiger TA (ed) The Oxford handbook of personality disorders. Oxford University Press, New York, pp 603–627Google Scholar
  13. Bornstein RF (2011) Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes. J Personal Disord 25:235–247. Scholar
  14. Braamhorst W, Lobbestael J, Emons WHM, Arntz A, Witteman CLM, Bekker MHJ (2015) Sex bias in classifying borderline- and narcissistic personality disorder. J Nerv Ment Dis 203:804–808. Scholar
  15. Bradley R, Zittel Conklin C, Westen D (2005) The borderline personality diagnosis in adolescents: gender differences and subtypes. J Child Psychol Psychiatry 46:1006–1019Google Scholar
  16. Chen Y, Nettles ME, Chen SW (2009) Rethinking dependent personality disorder: comparing different human relatedness in cultural contexts. J Nerv Ment Dis 197:793–800. Scholar
  17. Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA (2014) Distinguishing PTSD, complex PTSD, and borderline personality disorder: a latent class analysis. Eur J Psychotraumatol 5.
  18. Conway CC, Hammen C, Brennan PA (2015) Optimizing prediction of psychosocial and clinical outcomes with a transdiagnostic model of personality disorder. J Personal Disord 30:545–566. Scholar
  19. Corbitt EM, Widiger TA (1995) Sex differences among the personality disorders: an exploration of data. Clin Psychol Sci Pract 2:225–238Google Scholar
  20. Crawford TN, Cohen P, Brook JS (2001) Dramatic-erratic personality disorder symptoms:1 continuity from early adolescence into adulthood. J Personal Disord 15:319–335Google Scholar
  21. Florange JG, Herpertz SC (2019) Parenting in patients with borderline personality disorder, sequelae for the offspring and approaches to treatment and prevention. Curr Psychiatry Rep 21:9. Scholar
  22. Fonagy P, Bateman AW (2008) The development of borderline personality disorder – a mentalizing model. J Personal Disord 22:4–21Google Scholar
  23. Ford JD, Courtois CA (2014) Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Pers Disord Emot Dysregulation 1:9Google Scholar
  24. Ford MR, Widiger TA (1989) Sex bias in the diagnosis of histrionic and antisocial personality disorders. J Consult Clin Psychol 57:301–305Google Scholar
  25. Fraiberg S, Adelson E, Shapiro V (1975) Ghosts in the nursery: a psychoanalytic approach to the problem of impaired infant–mother relationships. J Am Acad Child Adolesc Psychiatry 14:387–422Google Scholar
  26. Gawda B (2018) Cross-cultural studies on the prevalence of personality disorders. Curr Issues Pers Psychol 6:318–329. Scholar
  27. Gilligan C (1982) In a different voice: psychological theory and women’s development. Harvard University Press, Cambridge, MAGoogle Scholar
  28. Godbout N, Daspe MÈ, Runtz M, Cyr G, Briere J (2019) Childhood maltreatment, attachment, and borderline personality–related symptoms: gender-specific structural equation models. Psychol Trauma 11:90–98. Scholar
  29. Golier JA, Yehuda R, Bierer LM, Mitropoulou V, New AS, Schmeidler J, Silverman JM, Siever LJ (2003) The relationship of borderline personality disorder to post traumatic stress disorder and traumatic events. Am J Psychiatry 160:2018–2024Google Scholar
  30. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD et al (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. J Clin Psychiatry 69:533–545Google Scholar
  31. Gray J (1992) Men are from Mars, women are from Venus: a practical guide for improving communication and getting what you want in your relationships. Harper Collins, New YorkGoogle Scholar
  32. Gunderson JG (2013) Seeking clarity for future revisions of the personality disorders in DSM-5. Pers Disord: Theory Res Treat 4:368–376Google Scholar
  33. Herman JL (1992) Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. J Trauma Stress 5:377–391Google Scholar
  34. Herpertz SC, Nagy K, Ueltzhöffer K, Schmitt R, Mancke F, Schmahl C, Bertsch K (2017) Brain mechanisms underlying reactive aggression in borderline personality disorder – sex matters. Biol Psychiatry 4:257–266. Scholar
  35. Hobson RP, Patrick M, Crandell L, García-Pérez R, Lee A (2005) Personal relatedness and attachment in infants of mothers with borderline personality disorder. Dev Psychopathol 17:329–347. Scholar
  36. Hoertel N, Peyre H, Wall M, Limosin F, Blanco C (2014) Examining gender differences in DSM-IV borderline personality disorder symptom expression using item response theory (IRT). J Psychiatr Res 59:213–219. Scholar
  37. Holthausen BS, Habel U (2018) Sex differences in personality disorders. Curr Psychiatry Rep 20:1–7. Scholar
  38. Jani S, Johnson RS, Banu S, Shah A (2016) Cross-cultural bias in the diagnosis of borderline personality disorder. Bull Menn Clin 80:146–165. Scholar
  39. Johnson DM, Shea MT, Yen S et al (2003) Gender differences in borderline personality disorder: findings from a collaborative longitudinal personality disorders study. Compr Psychiatry 44:284–292Google Scholar
  40. Johnson JG, Cohen P, Kasen S, Ehrensaft MK, Crawford TN (2006) Associations of parental personality disorders and axis I disorders with childrearing behavior. Psychiatry 69:336–350Google Scholar
  41. Judd PH, McGlashan TH (2003) A developmental model of borderline personality disorder: understanding variations in course and outcome, 1st edn. American Psychiatric, Washington, DCGoogle Scholar
  42. Kaplan M (1983) A woman’s view of DSM-III. Am Psychol 38:786–792Google Scholar
  43. Keuroghlian AS, Palmer BA, Choi-Kain LW, Borba CPC, Links PS, Gunderson JG (2016) The effect of attending good psychiatric management (gpm) workshops on attitudes toward patients with borderline personality disorder. J Personal Disord 30:567–576. Scholar
  44. Krueger RF, Eaton NR (2015) Transdiagnostic factors of mental disorders. World J Psychiatry 14:27–29. Scholar
  45. Kulkarni J (2017) Complex PTSD – a better description for borderline personality disorder? Australas Psychiatry 1–3.
  46. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007) DSM-IV personality disorders in the national comorbidity survey replication. Biol Psychiatry 62:553–564Google Scholar
  47. Lequesne ER, Hersh RG (2003) Disclosure of a diagnosis of borderline personality disorder. J Psychiatr Pract 10:170–176. Scholar
  48. Linehan MM (1993) Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press, New YorkGoogle Scholar
  49. Löffler-Stastka H, Ponocny-Seliger E, Meissel T, Springer-Kremser M (2006) Gender aspects in the planning of psychotherapy for borderline personality disorder. Wien Klin Wochenschr 118:160–169Google Scholar
  50. MacIntosh HB, Godbout N, Dubash N (2015) Borderline personality disorder: disorder of trauma or personality, a review of the empirical literature. Can Psychol 56:227–241Google Scholar
  51. Morey LC, Hopwood CJ (2019) Expert preferences for categorical, dimensional, and mixed/hybrid approaches to personality disorder diagnosis. J Personal Disord 6:1–8. Scholar
  52. Narayanan G, Rao K (2018) Personality disorders in the Indian culture: reconsidering self-perceptions, traditional society and values. Psychol Stud 1–10.
  53. New AS, Triebwasser J, Charney DS (2008) The case for shifting borderline personality disorder to Axis I. Biol Psychiatry 64:653–659Google Scholar
  54. Newman LK, Stevenson CS, Bergman LR, Boyce P (2007) Borderline personality disorder, mother-infant interaction and parenting perceptions: preliminary findings. Aust N Z J Psychiatry 41:598–605Google Scholar
  55. Nolen-Hoeksema S, Watkins ER (2011) A heuristic for developing transdiagnostic models of psychopathology: explaining multifinality and divergent trajectories. Perspect Psychol Sci 6:589–609. Scholar
  56. Nolen-Hoeksema S (2012) Emotion Regulation and Psychopathology: The Role of Gender. Annu Rev Clin Psychol 8:161–87.
  57. Paris J (1997) Antisocial and borderline personality disorders: two separate diagnoses or two aspects of the same psychopathology? Compr Psychiatry 38:237–242. Scholar
  58. Paris J (1998) Personality disorders in sociocultural perspective. J Personal Disord 12:289–301. Scholar
  59. Paris J (2004) Gender differences in personality traits and disorders. Curr Psychiatry Rep 6:71–74Google Scholar
  60. Paris J (2014) A history of research on borderline personality disorder in childhood and adolescence. In: Sharp C, Tackett JL (eds) Handbook of borderline personality disorder in children and adolescents. Springer, New York, pp 9–17Google Scholar
  61. Pull CB, Janca A (2018) Personality disorders: three classifications with a fly in the ointment. Curr Opin Psychiatry 31:40–42. Scholar
  62. Putnam FW (2003) Ten-year research update review; child sexual abuse. J Am Acad Child Adolesc Psychiatry 4:269–278Google Scholar
  63. Quirk SE, Berk M, Pasco JA, Brennan-Olsen SL, Chanen AM, Koivumaa-Honkanen H, Burke LM, Jackson HJ, Hulbert C, Olsson CA, Moran P, Stuart AL, Williams LJ (2017) The prevalence, age distribution and comorbidity of personality disorders in Australian women. Aust N Z J Psychiatry 51:141–150. Scholar
  64. Reichl C, Brunner R, Fuchs A, Holz B, Parzer P, Fischer-Waldschmidt G, Resch F, Kaess M (2017) Mind the fathers: associations of parental childhood adversities with borderline personality disorder pathology in female adolescents. J Personal Disord 31:827–843. Scholar
  65. Reinelt E, Stopsack M, Aldinger M, Ulrich I, Grabe HJ, Barnow S (2014) Longitudinal transmission pathways of borderline personality disorder symptoms: from mother to child? Psychopathology 47:10–16Google Scholar
  66. Ring D, Lawn S (2019) Stigma perpetuation at the interface of mental health care: a review to compare patient and clinician perspectives of stigma and borderline personality disorder. J Ment Health.
  67. Ronningstam EF, Keng S-L, Ridolfi ME, Arbabi M, Grenyer BFS (2018) Cultural aspects in symptomatology, assessment, and treatment of personality disorders. Curr Psychiatry Rep 20:22. Scholar
  68. Ruocco AC (2005) Reevaluating the distinction between Axis I and Axis II disorders: the case of borderline personality disorder. J Clin Psychol 61:1509–1523Google Scholar
  69. Ryder AG, Sunohara M, Kirmayer LJ (2015) Culture and personality disorder: from a fragmented literature to a contextually grounded alternative. Curr Opin Psychiatry 28:40–45. Scholar
  70. Samuel DB, Widiger TA (2009) Comparative gender biases in models of personality disorder. Personal Ment Health 3:12–25Google Scholar
  71. Sansone RA, Sansone LA (2011) Gender patterns in borderline personality disorder. Innov Clin Neurosci 8:16–20Google Scholar
  72. Sharp C, Fonagy P (2015) Practitioner review: borderline personality disorder in adolescence: recent conceptualization, intervention, and implications for clinical practice. J Child Psychol Psychiatry 56:1266–1288. Scholar
  73. Silberschmidt A, Lee S, Zanarini M, Schulz SC (2015) Gender differences in borderline personality disorder: results from a multinational, clinical trial sample. J Personal Disord 29:828–838Google Scholar
  74. Skodol AE, Bender DS (2003) Why are women diagnosed borderline more than men? Psychiatry Q 74:349–360. Scholar
  75. Sprock J, Crosby JP, Nielsen BA (2001) Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms. J Personal Disord 15:41–59Google Scholar
  76. Stepp SD, Whalen DJ, Pilkonis PA, Hipwell AE, Levine MD (2011) Children of mothers with borderline personality disorder: identifying parenting behaviors as potential targets for intervention. Pers Disord 3:76–91. Scholar
  77. Tan YM, Lee CW, Averbeck LE, Brand-de Wilde O, Farrell J, Fassbinder E, Jacob GA, Martius D, Wastiaux S, Zarbock G, Arntz A (2018) Schema therapy for borderline personality disorder: a qualitative study of patients’ perceptions. PLoS One 13.
  78. Torgersen S, Kringlen E, Cramer V (2001) The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 58:590–596. Scholar
  79. Trull TJ, Widiger TA (2013) Dimensional models of personality: the five-factor model and the DSM-5. Dialogues Clin Neurosci 15:135–146Google Scholar
  80. Ussher JM (2013) Diagnosing difficult women and pathologising femininity: gender bias in psychiatric nosology. Fem Psychol 23:63–69Google Scholar
  81. van de Water T, Suliman S, Seedat S (2016) Gender and cultural issues in psychiatric nosological classification systems. CNS Spectr 21:334–340. Scholar
  82. Viljoen S, Cook AN, Lim YL, Layden BK, Bousfield NK, Hart SD (2015) Are psychopathic and borderline personality disorder distinct, or differently gendered expressions of the same disorder? An exploration using concept maps. Int J Forensic Ment Health 14:267–279. Scholar
  83. Wang L, Xiao Z (2012) The need to establish diagnostic criteria for borderline personality disorder in China. Shanghai Arch Psychiatry 24:231–232. Scholar
  84. Widiger TA, Clark LA (2000) Toward DSM-V and the classification of psychopathology. Psychol Bull 126:946–963Google Scholar
  85. Widiger TA, Trull TJ (1993) Borderline and narcissistic personality disorders. In: Sutker PB, Adams HE (eds) Comprehensive handbook of psychopathology, 2nd edn. Plenum, New York, pp 371–394Google Scholar
  86. Widom CS, Czaja SJ, Paris J (2009) A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. J Personal Disord 23:433–446Google Scholar
  87. Yen S, Shea MT, Battle C, Johnson DM, Zlotnick C, Dolan-Sewell R, Skodol AE, Grilo CM, Gunderson JG, Sansilow CA, Zanarini MC, Bender DS, Rettew JB, McGlashan TH (2002) Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study. J Nerv Ment Dis 190:510–518Google Scholar
  88. Zahn-Waxler C, Shirtcliff EA, Marceau C (2008) Disorders of childhood and adolescence: gender and psychopathology. Annu Rev Clin Psychol 4:275–303Google Scholar
  89. Zalewski M, Stepp SD, Scott LN, Whalen DJ, Beeney JF, Hipwell AE (2014) Maternal borderline personality disorder symptoms and parenting of adolescent daughters. J Personal Disord 28:541–554. Scholar
  90. Zanarini MC (2000) Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin N Am 23:89–101. Scholar
  91. Zhong J, Leung F (2007) Should borderline personality disorder be included in the fourth edition of the Chinese classification of mental disorders? Chin Med J 120:77–82. Scholar
  92. Zlotnick C, Rothschild L, Zimmerman M (2002) The role of gender in clinical presentation of patients with borderline personality disorder. J Personal Disord 16:277–282Google Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Clinical PsychologyNational Institute of Mental Health and Neurosciences (NIMHANS)BangaloreIndia

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