Psychiatric Quarterly [psaq] PH196-465931-04 May 24, 2003 9:44 Style ﬁle version June 4th, 2002
Psychiatric Quarterly, Vol. 74, No. 4, Winter 2003 (
WHY ARE WOMEN DIAGNOSED
BORDERLINE MORE THAN MEN?
Andrew E. Skodol, M.D., and Donna S. Bender, Ph.D.
DSM-IV-TR states that borderline personality disorder (BPD) is “diagnosed
predominantly (about 75%) in females.” A 3:1 female to male gender ratio is
quite pronounced for a mental disorder and, consequently, has led to specula-
tion about its cause and to some empirical research. The essential question is
whether the higher rate of BPD observed in women is a result of a sampling
or diagnostic bias, or is it a reﬂection of biological or sociocultural differences
between women and men? Data to address these issues are reviewed. The dif-
ferential gender prevalence of BPD in clinical settings appears to be largely a
function of sampling bias. True prevalence by gender is unknown. The modest
empirical support for diagnostic biases of various kinds would not account for a
wide difference in prevalence between the genders. Biological and sociocultural
factors provide potentially illuminating hypotheses, should the true prevalence
of BPD differ by gender.
KEY WORDS: borderline personality disorder; gender ratio; gender bias; gender-related
Andrew E. Skodol, M.D., is Deputy Director and Director of the Department of Person-
ality Studies, New York State Psychiatric Institute; and Professor of Clinical Psychiatry,
Donna S. Bender, Ph.D., is Research Scientist, Department of Personality Studies,
New York State Psychiatric Institute; and Assistant Professor of Medical Psychology in
Psychiatry, Columbia University.
Address correspondence to Andrew E. Skodol, M.D., New York State Psychiatric Insti-
tute, Box 121, 1051 Riverside Drive, New York, NY 10032; e-mail: firstname.lastname@example.org.
2003 Human Sciences Press, Inc.