The impact of ovulation-suppressing contraceptives on behavioral and functional difficulties in borderline personality disorder

Abstract

Borderline Personality Disorder (BPD) is characterized by rapidly shifting emotional, interpersonal, and behavioral symptoms, often co-morbid with mood and anxiety disorders. Females are more likely to be diagnosed with BPD than males and exhibit greater functional impairment. Hormonal fluctuations may influence the manifestation of BPD symptoms. Here, we investigated the influence of ovulation-suppressing contraceptives on behavioral and functional difficulties in BPD. The sample included 348 females ages 18-50 undergoing residential treatment for psychiatric disorders, with 131 having a BPD diagnosis. Patients were categorized by their contraceptive method: Ovulation-suppressing contraceptives (N = 145) and naturally cycling (N = 203). Interaction models tested the impact of ovulation-suppressing contraceptives on the relationship between BPD diagnosis and behavioral and functional difficulties at admission and discharge, assessed by the four Behavior and Symptom Identification Scale (BASIS-32) domains: difficulties in relationships, daily living, depression/anxiety, and impulsivity. Females with a BPD diagnosis were more likely to use ovulation-suppressing contraceptives compared to those without BPD (p = 0.04). However, ovulation-suppressing contraceptive use was not associated with behavioral and functional difficulties at admission, discharge, or over time. Ovulation-suppressing contraceptives moderated the association between BPD diagnosis and difficulties in relationships (p = 0.004), difficulties in daily living (p = 0.01), and depression/anxiety symptoms (p = 0.004). Specifically, patients with BPD experienced more behavioral and functional difficulties only if naturally cycling, whereas patients without BPD showed higher symptom severity only if using ovulation-suppressing contraceptives. Our findings suggest that the impact of ovulation-suppressing contraceptives on behavioral and functional difficulties varies depending on BPD diagnosis and underscores the need for further clinical studies.

Fig. 1. Interactions between BPD diagnosis and ovulation-suppressing contraceptive use on behavioral and functional difficulties.

The associations between ovulation-suppressing contraceptive use and A Difficulties in relationships, B Difficulties in daily living, C Depression and anxiety symptoms, and D Impulsivity in females with and without BPD diagnosis at admission and discharge. The associations between BPD diagnosis and E Difficulties in relationships, F Difficulties in daily living, G Depression and anxiety symptoms, and H Impulsivity in ovulation-suppressing contraceptive users (OS) and naturally cycling (NC) females at admission and discharge. The y-axis shows estimated marginal means and standard errors for psychiatric symptoms. Statistical significance is indicated by asterisks (*p < 0.05, **p < 0.01, ***p < 0.001). Significant interactions between ovulation-suppressing contraceptives and BPD diagnosis were observed for difficulties in relationships at admission and discharge A,E, difficulties in daily living at admission B,F, and depression and anxiety symptoms C,G. ns: Not significant (p > 0.05).