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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\u2009=\u2009145) and naturally cycling (N\u2009=\u2009203). 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\u2009=\u20090.04). 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\u2009=\u20090.004), difficulties in daily living (p\u2009=\u20090.01), and depression\/anxiety symptoms (p\u2009=\u20090.004). 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.<\/jats:p>","DOI":"10.1038\/s41386-024-02045-4","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T10:57:19Z","timestamp":1736593039000},"page":"841-848","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The impact of ovulation-suppressing contraceptives on behavioral and functional difficulties in borderline personality disorder"],"prefix":"10.1038","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1575-8642","authenticated-orcid":false,"given":"Seyma","family":"Katrinli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex O.","family":"Rothbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raneeka","family":"DeMoss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Hunter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3197-7415","authenticated-orcid":false,"given":"Abigail","family":"Powers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2531-923X","authenticated-orcid":false,"given":"Vasiliki","family":"Michopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8537-5156","authenticated-orcid":false,"given":"Alicia K.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"key":"2045_CR1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. 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Compr Psychiatry. 1999;40:245\u201352.","journal-title":"Compr Psychiatry"},{"key":"2045_CR4","doi-asserted-by":"publisher","first-page":"e0279015","DOI":"10.1371\/journal.pone.0279015","volume":"17","author":"X Qian","year":"2022","unstructured":"Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLoS One. 2022;17:e0279015.","journal-title":"PLoS One"},{"key":"2045_CR5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/S0165-0327(02)00432-9","volume":"74","author":"M Steiner","year":"2003","unstructured":"Steiner M, Dunn E, Born L. Hormones and mood: from menarche to menopause and beyond. J Affect Disord. 2003;74:67\u201383.","journal-title":"J Affect Disord"},{"key":"2045_CR6","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/S2215-0366(16)30358-3","volume":"4","author":"SH Li","year":"2017","unstructured":"Li SH, Graham BM. Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? the potential role of sex hormones. Lancet Psychiatry. 2017;4:73\u201382.","journal-title":"Lancet Psychiatry"},{"key":"2045_CR7","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.yfrne.2014.05.004","volume":"35","author":"M Altemus","year":"2014","unstructured":"Altemus M, Sarvaiya N, Neill Epperson C. Sex differences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014;35:320\u201330.","journal-title":"Front Neuroendocrinol"},{"key":"2045_CR8","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.biopsycho.2015.03.016","volume":"109","author":"TA Eisenlohr-Moul","year":"2015","unstructured":"Eisenlohr-Moul TA, DeWall CN, Girdler SS, Segerstrom SC. Ovarian hormones and borderline personality disorder features: preliminary evidence for interactive effects of estradiol and progesterone. Biol Psychol. 2015;109:37\u201352.","journal-title":"Biol Psychol"},{"key":"2045_CR9","doi-asserted-by":"publisher","first-page":"2085","DOI":"10.1017\/S0033291718001253","volume":"48","author":"TA Eisenlohr-Moul","year":"2018","unstructured":"Eisenlohr-Moul TA, Schmalenberger KM, Owens SA, Peters JR, Dawson DN, Girdler SS. Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System. Psychol Med. 2018;48:2085\u201395.","journal-title":"Psychol Med"},{"key":"2045_CR10","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1002\/ab.21877","volume":"46","author":"JR Peters","year":"2020","unstructured":"Peters JR, Owens SA, Schmalenberger KM, Eisenlohr-Moul TA. Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder. 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Mol Psychiatry. 2024.","DOI":"10.31219\/osf.io\/hp7mn"}],"container-title":["Neuropsychopharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41386-024-02045-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41386-024-02045-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41386-024-02045-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T09:21:10Z","timestamp":1742203270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41386-024-02045-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,11]]},"references-count":34,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["2045"],"URL":"https:\/\/doi.org\/10.1038\/s41386-024-02045-4","relation":{},"ISSN":["0893-133X","1740-634X"],"issn-type":[{"value":"0893-133X","type":"print"},{"value":"1740-634X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,11]]},"assertion":[{"value":"4 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 December 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"BH is a paid promotional speaker for Axsome Therapeutics, Inc. and Alkermes, Inc.\u00a0The remaining\u00a0authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}