615950
letter2015
ANP0010.1177/0004867415615950ANZJP CorrespondenceANZJP Correspondence
Letter
Letter
Borderline personality
disorder and polycystic
ovary syndrome
Roth Trisno, Roisin
Worsley and
Jayashri Kulkarni
 he Monash Alfred Psychiatry Research
T
Centre (MAPrc), Melbourne, VIC, Australia
Corresponding author:
Jayashri Kulkarni, The Monash Alfred
Psychiatry Research Centre (MAPrc), Level
4, 607 St Kilda Road, Melbourne, VIC 3004,
Australia.
Email: j.kulkarni@alfred.org.au
DOI: 10.1177/0004867415615950
To the Editor
Polycystic ovary syndrome (PCOS) is
diagnosed when any two of the follow-
ing are present: oligo-ovulation, hyper-
androgenism or polycystic ovaries on
ultrasound. It affects 12–18% of
Australian women of reproductive age.
The pathogenesis of PCOS is unclear,
but is contributed to multiple genetic
and environmental factors such as obe-
sity. PCOS has been associated with
personality disorders, with PCOS suf-
ferers noted to have chronic emotional
stress and dissatisfaction, to avoid inter-
personal relations and to be frustrated
and afraid of intimate relationships
(Scaruffi et al., 2014).
Further research has suggested a cor-
relation between PCOS and borderline
Downloaded from anp.sagepub.com at Gazi University on February 6, 2016
personality disorder (BPD). Roepke
et al. (2010) found that 30.4% of patients
with BPD had PCO compared to 6.9%
in healthy controls. Another study
demonstrated that oestrogen and pro-
gesterone exerted significant effects on
several BPD symptoms, especially feel-
ings of social rejection, negative and
positive urgency, anger rumination and
lack of premeditation (Eisenlohr-Moul
et al., 2015).
Emma is a 22-year-old woman with a
history of sexual abuse by her stepfather
from age 10 years until she ran away
from home at age 15 years. Since then,
Emma had multiple psychiatric hospitali-
sations for suicide attempts, ongoing
self-harm (lacerating her arms and legs),
rapid mood swings, very poor self-
esteem, episodic outbursts of rage and
poor concentration. She has a diagnosis
of ‘BPD’. Emma weighs 105 kg, is 162 cm
in height, has hirsutism and severe acne.
She described her mood and self-harm
worse premenstrually. Emma had been
treated with many combinations of
antipsychotics, mood stabilisers and
antidepressants. Currently, she is taking
lamotrigine (350  mg/day), sertraline
(150 mg/day) and quetiapine XR (400 mg/
day). She had completed a dialectical
behaviour therapy (DBT) programme in
the past month – with little improve-
ment. We diagnosed PCOS in Emma,
with raised serum testosterone, low-
ered sex hormone–binding globulin and
low oestradiol. She also had a fasting
blood glucose suggesting pre-diabetes.
Emma received PCOS treatment
of metformin (1000  mg twice daily
Australian & New Zealand Journal of Psychiatry
Australian & New Zealand Journal of Psychiatry
1
© The Royal Australian and
New Zealand College of Psychiatrists 2015
Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
anp.sagepub.com
[BD]), transdermal oestradiol (100 µg
patch) and cyclical progesterone. She
described great improvements in her
mood and self-harming thoughts and
behaviours.
The case above and recent work
indicate that ovarian hormones might
have significant effects on psychologi-
cal functioning of women with BPD.
Additional work is needed to ascer-
tain whether there exists a causal
relationship between altered hypotha-
lamic–pituitary–gonadal (HPG) axis
hormone levels and BPD.
Declaration of interest
The author(s) declared no potential con-
flicts of interest with respect to the
research, authorship and/or publication of
this article.
Funding
The author(s) received no financial sup-
port for the research, authorship and/or
publication of this article.
References
Eisenlohr-Moul TA, DeWall CN, Girdler SS, et al.
(2015) Ovarian hormones and borderline
personality disorder features: Preliminary evi-
dence for interactive effects of estradiol and
progesterone. Biological Psychology 109: 37–52.
Roepke S, Ziegenhorn A, Kronsbein J, et al. (2010)
Incidence of polycystic ovaries and androgen
serum levels in women with borderline per-
sonality disorder. Journal of Psychiatric Research
44: 847–852.
Scaruffi E, Gambineri A, Cattaneo S, et al. (2014)
Personality and psychiatric disorders in
women affected by polycystic ovary syn-
drome. Frontiers in Endocrinology 5: Article 185.