(PS7-78) Sex Differences in Borderline Personality Symptoms: Results from Veteran and Civilian Samples Receiving DBT

Background: Features of borderline personality disorder (BPD) include extreme affective and identity instability, and alarmingly high (75%) lifetime suicide attempt (SA) rates. Males with BPD are understudied, despite notable sex differences in symptom presentation. Findings show higher aggression, impulsivity, and substance use (SU) in males with BPD, relative to higher affective instability, self-injury (NSSI), suicide behaviors, and disordered eating (DE) in females. Understanding the effects of these differences on treatment is critical; males with BPD are less likely to find treatment helpful and more likely to drop out. This study examined sex differences (specifically, biological sex) in problem behaviors (PB) related to borderline personality symptoms in Veterans and civilians receiving Dialectical Behavior Therapy (DBT).

Methods: Veterans (N=126; 76 F; age M=43) were patients in a comprehensive outpatient DBT program. Civilians (N=105; 85 F; age M=32) were patients in an 8-week DBT intensive outpatient program (IOP). The Borderline Symptom List Supplement was administered at baseline to assess PB over the past week (e.g., SU, DE, SA, high-risk behavior (HRB), NSSI). Logistic and ordinal regressions examined sex differences in each sample.

Results: In Veterans, PB ranged from 2.6% (purging) to 27.4% (bingeing). 48.8% reported at least one PB, with no differences between males (53.3%) and females (43.4%). Males reported more SU (p=.029) and HRB (p=.017) than females. 26.1% of males reported SU, and 14.1% reported HRB, relative to 11.8% and 5.3% of females. No other PB differed significantly. In civilians, PB ranged from 2.6% (SA) to 41.2% (bingeing). 81% reported at least one PB, with no differences between males (72.2%) and females (82.4%). Males tended to report more drug use (p=.057) than females. 27.8% of males reported SU relative to 11.8% of females. Females reported more uncontrolled anger (p=.046) than males, with 36.5% of females reporting this PB relative to 11.1% of males. Notably, while overall PB percentages were greater in civilians, past week SA percentages were greater in Veterans (6.5% vs. 2.6%).

Discussion: Consistent with past research on males with BPD, male Veterans reported more SU and HRB. Male civilians tended to report more drug use; surprisingly, female civilians reported more uncontrolled anger. The latter is inconsistent with findings of lower externalization in females. Despite past findings showing more eating pathology in females, there were no differences in DE, and bingeing was the most frequent PB in both samples. This finding suggests the relevance of DE in BPD across sex and treatment contexts. Critically, civilians reported higher percentages of PB (81% vs. 48.8%), but recent SA were higher in Veterans (6.5% vs. 2.6%). Suicide risk may remain higher among Veterans, even when overall PB rates appear less severe. Limitations include the small number of male civilians (n=12), and that only biological sex was examined. Future research should consider examining gender identity differences, which are equally, and crucially, relevant. Findings highlight the importance of considering treatment context and patient population as well as sex differences, for optimizing DBT and improving outcomes.