Borderline personality disorder: what the research says

What is premenstrual exacerbation and how does it affect different psychiatric illnesses?

Premenstrual exacerbation is when psychiatric symptoms worsen during the premenstrual phase. Hormonal changes during the menstrual cycle create a vulnerable period for many psychiatric conditions, but premenstrual exacerbation remains poorly defined.

Do mental health disorders get worse during the menstrual cycle?

Yes, several mental health disorders like depression, panic attacks, eating disorders and borderline personality disorder clearly worsen around menstruation. The evidence is less clear for anxiety or bipolar disorder.

What is healthcare like for women with PMDD in Australia?

Most women see many doctors before getting diagnosed, more than half experience medical gaslighting and misdiagnosis, and only 19% receive the proper diagnostic tests. Getting a correct diagnosis helps women feel less confused about themselves.

What are premenstrual syndrome and premenstrual dysphoric disorder?

Between 5% and 8% of women have moderate-to-severe symptoms that cause significant problems with work, relationships, and daily life. These are called PMS or PMDD. PMDD is the most severe form.

Does the menstrual cycle affect how often women have suicidal thoughts?

Yes. Women with recent suicidal thoughts reported significantly more severe ideation during the perimenstrual phase (around their period) compared to other cycle phases. The cycle explained 25% of the change in suicidal thoughts.

How common are suicidal thoughts and self-harm in people with PMDD?

Suicidal thoughts, planning, and attempts are very common in people with PMDD. About 72% report lifetime suicidal thoughts, 49% report planning, and 34% report attempts.

Does the menstrual cycle affect anger and aggression in women with borderline personality disorder?

Yes, the menstrual cycle affects how anger is expressed as aggression. Reactive aggression (responding aggressively to others) peaked during the midluteal phase, while planned aggression was highest during earlier phases when mood was more stable.

Do menstrual cycle hormones affect symptoms in women with borderline personality disorder?

This review found that menstrual cycle hormones do appear to affect symptoms in borderline personality disorder, with most symptoms worsening around menstruation and improving around ovulation. However, more research is needed to understand how and develop treatments.

Does psychopathic personality affect how women's cortisol responds to stress?

Women with psychopathic personality traits showed lower stress-induced cortisol at 20 minutes after a performance task compared to controls. However, this study is not specifically about PMS, so it's unclear how directly it applies to women with PMS.

Do women with PMDD have depression symptoms outside the luteal phase?

Yes. Even women with minor or moderate depression symptoms when not premenstrual were about 1.9 times more likely to have PMDD, suggesting PMDD is a variant of depression that becomes worse premenstrually rather than appearing only premenstrually.

How do work and time off affect women's moods during different phases of their menstrual cycle?

Work days made women feel more anxious, stressed, and tired compared to days off. Menstrual cycle phase also affected mood, but the effect depended on whether it was a work or off day and on the woman's personality traits.

Do women with PMS show personality changes during their menstrual cycle?

Yes. Women with PMS showed significantly increased personality disorder traits during the luteal phase (before menstruation) compared to the follicular phase. This pattern did not happen in women without PMS.

What conditions beyond depression can antidepressants treat?

Newer antidepressants including SSRIs have FDA approval for several conditions including anxiety, obsessive-compulsive disorder, and panic disorder. Controlled studies also show they help premenstrual dysphoric disorder.

Are depression and personality disorders linked to PMDD?

Yes. Women with depression are about 9 times more likely to have PMDD, and avoidant personality disorder is also linked to PMDD (mainly in women over 30). However, the study cannot show whether depression causes PMDD, PMDD causes depression, or if both are caused by something else.

How does mood change throughout 2 weeks in women with PMS compared to women without PMS?

Women with PMS experienced significantly greater mood changes over 2 weeks compared to women without PMS, showing much larger ups and downs in mood from day to day.

Can one questionnaire help doctors tell the difference between PMS, PMDD, and other mood disorders?

Researchers created a new questionnaire called COMPASS designed to help doctors distinguish PMS, PMDD, and perimenopause from conditions like depression, personality disorders, and trauma disorders that cause similar symptoms.

Could early stress or past trauma make PMDD symptoms worse later in the cycle?

This research offers a possible explanation for why PMDD symptoms vary so much, and why related conditions can worsen before a period. It is only a theory, not tested on patients, so we don't yet know if it is true.

Does borderline personality disorder get worse at certain times in the menstrual cycle?

Yes. Most emotional symptoms in women with borderline personality disorder worsen in the midluteal phase and around menstruation. The majority showed at least 30% worsening of symptoms.

Does stress affect the menstrual cycle in college students?

Yes, there is a significant relationship between stress level and menstrual cycle in this study. However, this is cross-sectional so we cannot be sure stress causes menstrual changes rather than the reverse.

How does the menstrual cycle affect mood and seizures in women with epilepsy?

Women with epilepsy experienced mood changes and more seizures during the early follicular phase, not the typical late luteal phase. This suggests they have a different menstrual-related symptom pattern.

How common are suicidal thoughts and self-harm in people with PMDD?

Very high: 72% reported lifetime suicidal thoughts, 49% reported planning, 42% reported intent, 40% preparing for an attempt, 34% attempted suicide, and 51% reported self-harm. Most also had other mental health diagnoses.

Does aggression change during the menstrual cycle in borderline personality disorder?

Yes, different types of aggression change at different times in the cycle. Reactive aggression was highest during the days around the period, while a different type of aggression (proactive) was highest during other parts of the cycle.

Do emotional and behavioral symptoms of borderline personality disorder get worse before menstruation?

Most emotional symptoms appeared to get worse in the middle-to-late luteal phase and around menstruation, then improved in the follicular phase. However, the study was very small and included only unmedicated women without painful periods.

Can a combined oral contraceptive pill help PMDD in women who also have depression or anxiety?

One 34-year-old woman with PMDD along with depression, anxiety, and other psychiatric conditions improved on a combined oral contraceptive pill. Her mood, anxiety, menstrual cramps, and ability to handle stress all got better.

Is borderline personality disorder more common in women with PMS?

Yes, women with PMS had significantly more borderline personality disorder traits than those without PMS (p=0.001), and this relationship was stronger with more severe PMS.

Do women with severe PMS have more personality disorders?

Yes. 27% of women with severe PMS had a personality disorder compared to 0% of women without PMS. The most common was obsessive-compulsive personality disorder.

What is dysphoria, and how is it different from other mood problems?

Dysphoria is a complex emotional state combining intense unhappiness and discontent with irritability. It is related to but distinct from other mental health conditions like depression.

Are suicidal attempts more likely during certain phases of the menstrual cycle?

Yes. Suicidal attempts were most frequent during the menstrual phase. However, this study only looked at women already hospitalized for attempts, so it cannot tell us the true risk in the general population.

Do women with bipolar disorder experience mood changes across their menstrual cycle?

Yes. Most women with bipolar disorder taking medication reported significant mood changes linked to their menstrual cycle, and most also had unusually long menstrual cycles. However, the study was very small.

Do women with PMDD have other mental health conditions or personality traits?

Most women with PMDD (77%) had experienced other mood or anxiety disorders in their past, compared with only 17% of women without PMDD. Two-thirds of women with PMDD who had children experienced postpartum depression.

Do psychiatric hospital admissions happen more often at certain menstrual cycle phases?

57% of admissions happened during the pre-menstrual or menstrual phase, but this link was only statistically significant for cycloid psychoses, a rare type of psychosis. For most other psychiatric conditions, the menstrual cycle did not affect admission timing.

Do menstrual cycle phases affect mood and impulsive behavior in women with borderline personality disorder?

No clear connection was found between menstrual cycle phase and mood or behavior when women tracked their symptoms daily. However, all women reported premenstrual worsening when asked afterward. None met criteria for severe premenstrual disorder.

Are certain personality traits linked to PMS?

Women with PMS have higher scores on harm avoidance and novelty seeking compared to the general population. These traits are modestly linked to specific symptom patterns.

Is PMS a psychiatric disorder or a gynecological disorder?

PMS is a gynecological disorder tied to ovulation and the corpus luteum, since symptoms stop when ovulation stops. Women with 'pure PMS' have less psychiatric history than other groups.

Do women with PMDD have a history of depression or other mental health problems?

Yes. 78% of women with PMDD had a lifetime history of other mental disorders, most commonly depression. 29% of those who had given birth reported postpartum depression.

Do mental health professionals support adding premenstrual dysphoric disorder to the psychiatric manual?

Most social workers surveyed did not support adding premenstrual dysphoric disorder to the manual, though many were undecided. This reflects professional debate about whether PMDD should be classified as a psychiatric diagnosis.

Does personality dysfunction change during the menstrual cycle in women with PMS?

No. Personality issues were reported equally in both the follicular and luteal phases, even in women with PMS.

Is premenstrual syndrome more common in women with low sexual desire?

Yes. Significantly more women with low sexual desire had severe premenstrual syndrome than women without sexual dysfunction. These women also had higher rates of depression.

Does the menstrual cycle cause mental health problems?

The menstrual cycle likely does not cause mental health problems on its own. The authors argue that mood and mental health are affected by a combination of hormonal changes, personality, stress, and life circumstances.

Is premenstrual affective syndrome linked to sexual trauma in psychiatric patients?

In psychiatric inpatients, women with premenstrual affective syndrome were much more likely to have abnormal sexual histories, including trauma, compared to women without premenstrual affective syndrome.

Are mood changes before your period linked to personality type?

Psychological symptoms like irritability, depression, and tension before the period are linked to personality traits. But painful periods are not.