Symptoms of borderline personality disorder may worsen for women during or before their time of menstruation.
That’s according to a study in Psychological Medicine, undertaken by researchers at the University of Illinois at Chicago. It is the first ever study to provide evidence that women with borderline personality disorder, a mood disorder that makes it difficult to manage strong emotions, are more at risk of worsened symptoms during the week leading up to and during their menstrual period.
Borderline personality disorder is a serious mental illness often characterised by severe difficulties in regulating emotions. Those with the condition may experience intense and unstable relationships, impulsive behaviour, poor self-esteem, self-sabotaging behaviours and extreme emotions.
Those with borderline personality disorder can often go through intense periods of anxiety, depression and anger that can last days. They are also at an increased risk of suicide and recurrent thoughts related to self-harm or suicide or common.
Assistant Professor of psychiatry at the University of Illinois at Chicago and lead author of the study Tory Eisenlohr-Moul says her findings may help clinicians anticipate possible changes for their female patients in the lead up to menses.
“This is particularly important since people with borderline personality disorder are at a high risk of suicide, so anything that can help patients and clinicians reliably predict changes in their symptoms is very useful,” she said.
In undertaking her research, Eisenlohr-Moul and her colleagues at the University of Chicago at Illinois engaged women between the ages of 18 and 45 who were healthy, with normal menstrual cycles, and who were not taking psychiatric medications or birth control. Out of the 310 females who were recruited, 17 had borderline personality disorder and 15 completed the study. This represented the largest ever study that examined cyclical mood changes in women with borderline personality disorder.
The women undertaking the study were asked to complete questionnaires relating to their symptoms from borderline personality disorder, the symptoms of their menstrual cycle, any past traumas, whether they experienced anxiety and depression and their demographics.
The women were also asked to keep a daily log of their borderline personality disorder symptoms and their menstrual symptoms for 35 days. Urine and saliva sampled were taken to confirm the women were ovulating and to track the progression of their menstrual cycle.
Eisenlohr-Moul said the researchers didn’t expect women with borderline personality disorder to have different or higher hormone levels during their menstrual cycle when compared to those without the condition. However they anticipated that women experiencing borderline personality disorder may have a greater sensitivity to hormonal changes, which can impact mood.
The Carolina Premenstrual Assessment Scoring System (which is used to assess the impact of menstrual cycle on emotions) was used to determine whether the women experienced mood changes related to their menstruation that were significant enough to impact their everyday functioning.
They found that many symptoms of borderline personality disorder were aggravated in the week leading up to and during menstruation. During the perimenstrual phase, symptoms worsened by 30 per cent or more. Eisenlohr-Moul says this would be equivalent to progressing from moderate to extreme depression.
Those with borderline personality disorder can find everyday life a struggle. The disorder impacts how a person feels about themselves, their behaviour and how they relate to others. People may experience an extreme fear of abandonment, a rapid shift in their own self-identity, image, goals or personal values, paranoia, mood swings, a feeling of emptiness, risky or impulsive behaviours like unsafe sex, reckless driving, gambling, drug abuse, binge eating or quitting a job suddenly.
Relationships for people with borderline personality disorder can also be difficult and unstable, with a person with the condition idolizing a person one day and resenting them the next. Problems controlling emotions such as anger can also lead to outbursts, being sarcastic or making bitter comments and even physical fights.
Given women experiencing borderline personality disorder are already at such high risk for suicide in everyday life, being able to predict when their symptoms may worsen based on their period may be helpful.
Eisenlohr-Moul says that knowing that women may experience a worsening of their symptoms in the lead up to their period, clinicians can help prepare them for the possibility that their symptoms may get worse, and give them coping strategies.
Having stable levels of estrogen and progesterone can have anti-anxiety effects and help improve mood. This may explain why the perimenstrual phase of the menstrual cycle, when these levels drop rapidly, may make those with borderline personality disorder more at risk to mood and emotional changes.
Eisenlohr-Moul is hoping to explore whether hormone-stabilizing treatments will positively impact those with borderline personality disorder. She says that by regulating the hormonal peaks experienced during the menstrual cycle, doctors may be able to eliminate such hormonal triggers.
Elizabeth Pratt is a medical journalist and producer. Her work has appeared on Healthline, The Huffington Post, Fox News, The Australian Broadcasting Corporation, The Sydney Morning Herald, News.com.au, Escape, The Cusp and Skyscanner. You can read more of her articles here. Or learn more about Elizabeth and contact her via her LinkedIn and Twitter profiles.