Elevated salivary testosterone levels in women with borderline personality disorder are linked to a cluster of internalizing symptoms, including self-dislike and feelings of senselessness, rather than externalizing behaviors like aggression, according to a study published in the European Journal of Psychotraumatology.
In the study, researchers investigated the association between salivary testosterone levels and symptoms of borderline personality disorder (BPD) in women. The study included 98 women with BPD (mean age 28 years, range 18-46) who provided saliva samples between 1:00 PM and 2:00 PM as part of a larger research project. Participants were excluded if they had acute major depressive episodes, current substance abuse, psychotic disorders, or were taking more than three different psychotropic substances or benzodiazepines. All participants received monetary compensation (minimum 60€).
Salivary samples were collected using SaliCap devices and analyzed using a competitive immunoassay. Of the 98 participants, four had missing testosterone values due to measurement errors. Among the 94 analyzed samples, testosterone levels ranged from 1 to 149 pg/mL, with an average of 30 pg/mL (standard deviation [SD] = 28). The study controlled for body mass index (BMI) in their analyses and applied Bonferroni correction for multiple comparisons.
Notably, neither hormonal contraception (reported by 16 women) nor menstrual cycle phase affected average testosterone levels. The study population included 42 smokers, and 50 women reported taking at least one psychotropic substance, while 48 were medication-free.
Regression analyses revealed that higher testosterone levels were significantly associated with greater overall symptom burden, as indicated by increased scores on both the Borderline Symptom List (BSL-23) (mean = 45, SD = 20) and Beck Depression Inventory-II (BDI-II) (mean = 27, SD = 12). Specifically, by-item analyses showed that elevated testosterone correlated with internalizing symptoms, including increased feelings of self-dislike, senselessness, pessimism, and the perception of being a failure. These associations were particularly found for internalizing symptoms, suggesting a link between testosterone levels and a negative self-view, rather than externalizing behaviors such as aggression or impulsivity.
Further analysis of the DSM-V criteria for BPD revealed a non-significant trend toward higher testosterone being associated with self-destructiveness, but a negative correlation with uncontrollable anger. These results suggest that, contrary to previous assumptions, elevated testosterone in women with BPD is not primarily linked to externalizing behaviors, but rather to internal emotional distress. The study emphasizes the need for further research.
Full disclosures can be found in the published study.
