Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
Borderline Personal Disord Emot Dysregul. 2015 Apr 9;2:7. doi: 10.1186/s40479-015-0028-7. eCollection 2015.
Aggression is a core feature of borderline personality disorder (BPD). Well-replicated results from the general population indicate that men engage in aggression more frequently than women. This article addresses the question of whether gender also influences aggression in BPD, and whether the neurobiological mechanisms underlying aggressive behavior differ between male and female BPD patients. Data show that most self-reports, interviews and behavioral tasks investigating samples of BPD patients do not find enhanced aggressiveness in male patients, suggesting that BPD attenuates rather than aggravates gender differences usually present in the general population. Neurobiological studies comparing BPD patients with gender-matched healthy controls, however, reveal a number of interesting gender differences: On the one hand, there are well-replicated findings of reduced amygdala and hippocampal gray matter volumes in female BPD patients, while these findings are not shared by male patients with BPD. On the other hand, only male BPD patients exhibit reduced gray matter volume of the anterior cingulate cortex, increased gray matter volume of the putamen, reduced striatal activity during an aggression task, and a more pronounced deficit in central serotonergic responsivity. These neurobiological findings point to a particular importance of impulsivity for the aggression of male BPD patients. Limitations include the need to control for confounding influences of comorbidities, particularly as male BPD patients have been consistently found to show higher percentages of aggression-predisposing comorbid disorders, such as antisocial personality disorder, than female BPD patients. In the future, studies which include systematic comparisons between females and males are warranted in order to disentangle gender differences in aggression of BPD patients with the aim of establishing gender-sensitive treatments where needed.
攻击性是边缘型人格障碍（BPD）的核心特征。来自普通人群的大量复制结果表明，男性比女性更频繁地表现出攻击性。本文探讨了性别是否也会影响 BPD 中的攻击性，以及男性和女性 BPD 患者的攻击性行为的神经生物学机制是否存在差异。研究数据表明，大多数自我报告、访谈和行为任务调查 BPD 患者样本时，并未发现男性患者的攻击性增强，这表明 BPD 减轻了而不是加剧了普通人群中通常存在的性别差异。然而，将 BPD 患者与性别匹配的健康对照组进行比较的神经生物学研究揭示了一些有趣的性别差异：一方面，有大量研究结果表明，女性 BPD 患者的杏仁核和海马灰质体积减少，而男性 BPD 患者则没有这种情况。另一方面，只有男性 BPD 患者表现出前扣带回皮质灰质体积减少、纹状体灰质体积增加、攻击性任务期间纹状体活动减少以及中枢 5-羟色胺反应性更明显缺陷。这些神经生物学发现表明，冲动性对男性 BPD 患者的攻击性特别重要。局限性包括需要控制合并症的混杂影响，特别是因为男性 BPD 患者一直被发现比女性 BPD 患者表现出更高比例的攻击性倾向合并症，如反社会人格障碍。未来，有必要进行系统比较女性和男性的研究，以厘清 BPD 患者攻击性的性别差异，以便在需要时建立性别敏感的治疗方法。
