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.Electronic supplementary materialThe online version of this article (doi:10.1186/s40479-015-0028-7) contains supplementary material, which is available to authorized users.
Highlights
Aggression may be defined as any behavior directed toward another individual with the intention to cause harm [1]
Several findings emphasize the high prevalence of aggression in borderline personality disorder (BPD): 73% of BPD patients have engaged in aggressive behavior over the course of a year [3], 58% are “occasionally or often” involved in physical fights, and 25% have used a weapon against others ([2], p.154)
Men engage in aggression more frequently than women, with effect sizes ranging between 0.14 – 0.84 depending on the method of data collection and the form of aggressive behavior: The effect size is stronger in real-world settings and varies as a function of the seriousness of the aggressive act, i.e., the more dangerous the behavior, the stronger the male preponderance [14,15]
Summary
Aggression may be defined as any behavior directed toward another individual with the intention to cause harm [1]. Scott and colleagues [31] performed a prospective study in a mixed clinical and community sample and used the Revised Conflict Tactics Scale as a measure for aggressiveness They demonstrated that the relationship between BPD traits and aggression was not influenced by gender. Another study found a positive relationship between BPD traits and intimate partner aggression in female, but not in male participants of a late-middle-aged community sample [35]. The latter finding might have been due to the form of aggressive
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