Perimenstrual Symptom Exacerbation Observed in Borderline Personality Disorder

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Symptom resolution was typically observed in the follicular or ovulatory stages.
Symptom resolution was typically observed in the follicular or ovulatory stages.

Study data published in Psychological Medicine identified a potential risk for perimenstrual worsening of emotional symptoms in women with borderline personality disorder (BPD).

A cohort of 15 healthy women with BPD who were not taking medication and did not have dysmenorrhea reported daily symptoms for 35 days. All participants met the emotional instability criterion for BPD, and none had premenstrual dysphoric disorder. Cyclic symptom worsening was assessed using the Carolina Premenstrual Assessment System. Ovulation and cycle phases were confirmed through urine luteinizing hormone and salivary progesterone measures. Between-phase comparisons were performed to isolate the exacerbation effects of each cycle phase.   

Most symptoms displayed a midluteal worsening and a perimenstrual peak. Relative to the ovulatory phase, the midluteal phase was associated with worsening anxiety (P <.05), anger/irritability (P <.05), interpersonal conflict (P <.05), and physical symptoms (P <.05). Relative to the ovulatory and midluteal phases, the perimenstrual phase demonstrated worsening of all emotional symptoms of BPD. Symptom resolution was typically observed in the follicular or ovulatory stages. Generally, the ovulatory phase demonstrated the lowest symptoms, and relative to the follicular phase showed lower levels of depression (P <.01), hopelessness (P <.001), shame (P <.01), and physical symptoms (P <.05). Post-hoc analyses highlighted negative correlations of person-centered progesterone with most symptoms, including depression (P =.042), hopelessness (P =.012), anger/irritability (P =.042), and physical symptoms (P =.018). The majority (93%) of participants met the Carolina Premenstrual Assessment System threshold for clinically significant symptom exacerbation.

These data highlight potential risk periods for emotional symptom worsening in BPD. Longitudinal studies with “fine-grained” hormonal measurement are needed to elucidate the specific pathophysiology of perimenstrual symptom worsening in this disorder. 

Reference

Eisenlohr-Moul TA, Schmalenberger KM, Owens SA, Peters JR, Dawson DN, Girdler SS. Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System [published online May 28, 2018]. Psychol Med. doi: 10.1017.S0033291718001253

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