Sex differences in personality dysfunction in help-seeking adolescents: 2025 Cavelti et al

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Sex differences in personality dysfunction in help-seeking adolescents. borderline personality disorder emotional dysregulation 12 (2025) Cavelti, M., Schenk, J., Sele, S. et al

• University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Bern 60, 3000, Switzerland
• Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany

Abstract

Introduction

Understanding sex differences is crucial for improving diagnosis and treatment for personality disorders (PDs). This study aimed to investigate sex differences in personality dysfunction as per Criterion A of the DSM-5 Alternative Model of Personality Disorders in help-seeking adolescents.

Methods​

The sample comprised 706 adolescent patients (mean age = 15.4 years; 80.88% females). Personality dysfunction was assessed using the Semi-Structured Interview for Personality Functioning DSM-5 (STiP 5.1).

Results​

Females showed significantly higher overall personality dysfunction (Cohen’s d = 0.36) compared to males, particularly in the self-functioning domain (d = 0.50), including identity (d = 0.52) and self-direction (d = 0.38). Sex differences in interpersonal functioning, particularly empathy, were statistically not significant, but females demonstrated greater impairments in intimacy compared to males (d = 0.23). Age did not moderate sex differences in personality dysfunction. Higher levels of personality dysfunction were associated with an increased likelihood of an alcohol use disorder and more severe psychosocial impairments in females compared to males.

Discussion​

The findings indicate that female adolescent patients exhibit greater impairments in personality functioning than males, with the difference being more pronounced in self-functioning than in interpersonal functioning. Results highlight the need for further investigation of the biological, psychological, and social factors driving these differences and call for the development of sex-sensitive diagnostic and interventional approaches to PDs.

In addition, the primary manifestation of sex differences in the self functioning domain is consistent with prior findings showing that: (a) women are more likely to be diagnosed with internalizing disorders (e.g., affective, anxiety, and eating disorders) compared to men who are more often diagnosed with externalizing disorders (e.g., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder) [51]; and (b) women with PD show more internalizing symptoms than men with PD [27, 29]. The observed sex differences in personality dysfunction may reflect the higher likelihood of females seeking professional help for mental health problems compared to males [52]. In addition, they may reflect diagnostic bias due to social and gender stereotypes [53, 54]. For instance, females are traditionally expected to display a keen interest in close relationships and exhibit a higher degree of prosocial behavior. Against this backdrop, even minor deviations from these normative expectations could lead to disproportionately higher scores in assessments of interpersonal functioning impairments for females, as demonstrated in the case of closeness in the current study. Furthermore, as Criterion A was developed based on research primarily conducted with individuals with BPD (the most extensively studied PD), who are predominantly female, there may be an inherent bias in the AMPD, which could potentially account for the observed sex differences in the current study. However, assuming that the sex differences in personality functioning impairment found in the current study reflect “true” disparities, the greater impairments observed in self functioning among females might be explained through an interaction of biological vulnerability (e.g., for increased emotional liability [55]) and environmental influences (e.g., sexual abuse [56], relational or social bullying experiences [57] or greater thinness-oriented body dissatisfaction due to social norms [58]) that may compromise identity formation during adolescence [59]. It could be hypothesized that the greater identity impairments among females contribute to the mental health crisis observed in female teenagers, which is characterized by an increase in depression, self-harm, and suicide attempts within this group [60,61,62].

Link https://bpded.biomedcentral.com/articles/10.1186/s40479-025-00287-2