Incidence of polycystic ovaries and androgen serum levels in women with borderline personality disorder

Abstract

Obesity, increased visceral fat and disturbed glucose metabolism have been found in borderline personality disorder (BPD) patients. These conditions are often associated with disturbed androgen metabolism. Elevated androgens in women are related to polycystic ovaries (PCO) and might have an impact on psychopathology. Thus, higher prevalence of PCO and elevated androgen levels are suspected in BPD. In the study, we examined 31 BPD patients and 30 healthy controls ultrasonographically for PCO and measured their serum levels of androgens and interacting hormones. Furthermore, influence on psychopathology of free testosterone (FT) serum level was assessed. PCO was significantly more prevalent in BPD patients (30.4%) compared to healthy controls (6.9%). Testosterone, FT, androstenedione (A), and 17α-hydroxyprogesterone (17-OHP) were significantly elevated in the BPD group independently of BMI. FT serum level significantly correlated with depressive symptoms. In summary, our data suggest a disturbed androgen metabolism in BPD patients.

Introduction

Recent research on borderline personality disorder (BPD) has focused on comorbid medical conditions, especially obesity and obesity-related chronic medical disorders (Kahl et al., 2006, Frankenburg and Zanarini, 2006). Obesity and associated metabolic alterations appear to be linked to BPD as indicated by increased visceral fat and reduced insulin sensitivity in BPD patients (Kahl et al., 2005). Female obesity is often associated with profound alterations in androgen metabolism (Pasquali, 2006), which might have corresponding psychopathological effects (Archer, 2006). Women with central obesity have lower sex hormone-binding globulin (SHBG) than women with peripheral obesity or normal weight (Pasquali et al., 1990). Reduction of circulating SHBG increases metabolic clearance and production of SHBG-bound steroids, e.g. testosterone (Kirschner et al., 1990). Also, production rates and metabolic clearance rates of other androgens, such as dehydroandrosterone (DHEA) and androstenedione, are increased in obesity (Pasquali, 2006). Hyperandrogenemia in women is often related to polycystic ovary syndrome (PCOS) Norman, 2002 and PCOS is linked to obesity in women (Gambineri et al., 2002). The exact causality of these associations remains unknown. Thus, some data argue for a primary abdominal fat deposition with hyperinsulinemia and secondary hyperandrogenemia and cyst formation, whereas more recent data suggest a primary androgen excess with secondary visceral fat deposition (Escobar-Morreale and San Millán, 2007).

There is also evidence that some of the psychopathological symptoms frequently found in BPD are linked to altered serum androgen levels (Archer, 2006, Hermans et al., 2008). A number of studies, but not all, have demonstrated a positive correlation of serum testosterone (T) and aggressive behavior in animals and, to a lesser degree, in humans within both sexes (Rubinow and Schmidt, 1996, Archer, 2006). Thus, adolescent girls with aggressive conduct disorders showed higher level of FT and lower level of SHBG compared to healthy controls (Pajer et al., 2006). Among female prisoners, higher levels of T corresponded to increased levels of aggressive dominance and violent behavior (Dabbs and Hargrove, 1997). Finally, endogenous T was higher in bulimic women compared to controls (Sundblad et al., 1994, Cotrufo et al., 2000, Naessén et al., 2006). In one of the latter studies, plasma T correlated positively with aggression (Cotrufo et al., 2000). In summary, these findings suggest a role of elevated T in the symptomatology of disorders with impaired impulse control in women. Nevertheless, the data on aggression and testosterone are conflicting. With respect to the effect of exogenous T, some researchers conclude that an effect of T on human aggression is evident only at pharmacological (i.e., unphysiologically high), rather than at physiological (i.e., replacement), dose levels of the hormone (e.g. Rubinow and Schmidt, 1996). Also, androgen serum levels seem to be associated with mood. Although there are few studies at present, increased and decreased testosterone levels were associated with depressive symptoms in women (Rohr, 2002, Weiner et al., 2004).