Impact of Social Exclusion on salivary Progesterone and Estradiol in Women with Borderline Personality Disorder

Abstract

Background Borderline personality disorder (BPD) is characterized by instability in interpersonal relationships and fear of abandonment, which intensify during stress. Social stressors seem to activate the hypothalamic–pituitary–gonadal (HPG) axis in healthy controls (HC), but this has not been investigated in patients with BPD. This study aimed to investigate the effects of social stress, i.e. social exclusion on progesterone and estradiol levels in women with BPD compared to HC. Methods 82 women with BPD and 82 HC were randomly assigned to either an exclusion or overinclusion condition of the Cyberball paradigm. Saliva samples were collected at baseline and 15 minutes after the task to measure progesterone and estradiol. Two 2 × 2 factorial ANOVAs were conducted with group and condition as the independent variables and Δ-progesterone and Δ-estradiol as dependent variables. Results On progesterone, the analysis revealed no significant main effects of group or condition, but a significant group × condition interaction. Post-hoc tests showed that progesterone responses within the BPD group significantly differed between exclusion and overinclusion, while no significant differences were observed in HC. Descriptively, progesterone levels increased following social exclusion, whereas they decreased after overinclusion in BPD. For estradiol levels no significant main effects for group, condition, or their interaction were found. Discussion This study provides initial evidence that women with BPD exhibit distinct progesterone responses to social exclusion versus overinclusion. BPD participants showed a descriptive decrease in progesterone after overinclusion and a small increase after exclusion. These findings might be interpreted as perhaps a lack of assumed protective effects of progesterone (e.g. calming). Further research is needed to better understand this hormonal pattern and its implications for social functioning in BPD.