# Gender differences in aggression of borderline personality disorder

## TL;DR

This paper explores how gender influences aggression in borderline personality disorder and finds that BPD reduces typical gender differences in aggression while revealing distinct neurobiological patterns in men and women with BPD.

## Contribution

The study identifies gender-specific neurobiological differences in aggression among BPD patients, suggesting the need for gender-sensitive treatment approaches.

## Key findings

- BPD appears to attenuate typical gender differences in aggression seen in the general population.
- Female BPD patients show reduced amygdala and hippocampal gray matter volumes, while male BPD patients show reduced anterior cingulate cortex volume and altered striatal activity.
- Male BPD patients exhibit more pronounced impulsivity-related aggression and deficits in serotonergic responsivity.

## Abstract

Aggression is a core feature of borderline personality disorder (BPD). Well-replicated results from the general population indicate that men engage in aggression more frequently than women. This article addresses the question of whether gender also influences aggression in BPD, and whether the neurobiological mechanisms underlying aggressive behavior differ between male and female BPD patients. Data show that most self-reports, interviews and behavioral tasks investigating samples of BPD patients do not find enhanced aggressiveness in male patients, suggesting that BPD attenuates rather than aggravates gender differences usually present in the general population. Neurobiological studies comparing BPD patients with gender-matched healthy controls, however, reveal a number of interesting gender differences: On the one hand, there are well-replicated findings of reduced amygdala and hippocampal gray matter volumes in female BPD patients, while these findings are not shared by male patients with BPD. On the other hand, only male BPD patients exhibit reduced gray matter volume of the anterior cingulate cortex, increased gray matter volume of the putamen, reduced striatal activity during an aggression task, and a more pronounced deficit in central serotonergic responsivity. These neurobiological findings point to a particular importance of impulsivity for the aggression of male BPD patients. Limitations include the need to control for confounding influences of comorbidities, particularly as male BPD patients have been consistently found to show higher percentages of aggression-predisposing comorbid disorders, such as antisocial personality disorder, than female BPD patients. In the future, studies which include systematic comparisons between females and males are warranted in order to disentangle gender differences in aggression of BPD patients with the aim of establishing gender-sensitive treatments where needed.

The online version of this article (doi:10.1186/s40479-015-0028-7) contains supplementary material, which is available to authorized users.