ArticlePsychological medicine2018
Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System.
Article in Psychological medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 35 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- A scoping review of hormonal clinical trials in menstrual cycle-related brain disorders: Studies in premenstrual mood disorder, menstrual migraine, and catamenial epilepsy.Frontiers in neuroendocrinology · 2023Pooled it
- Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies.Archives of women's mental health · 2022Pooled it
- Effects of acute estradiol and progesterone on perimenstrual exacerbation of suicidal ideation and related symptoms: a crossover randomized controlled trial.Translational psychiatry · 2022Trial
- Affective Sensitivity to Ovarian Steroid Hormone Flux Across the Menstrual Cycle: Manifestations and Biopsychosocial Risk Factors.Annual review of clinical psychology · 2026Review
- Within-person associations between daily ovarian steroid levels and mood-related symptoms in ovulatory and anovulatory early adolescents.Psychoneuroendocrinology · 2026Article
- Measuring emotion dysregulation in pregnancy using smartphone activity: a prospective research study in the United States.BMC pregnancy and childbirth · 2026Article
- Article
- Toward Precision Reproductive Psychiatry: A Call for Targeted, Transdiagnostic Approaches to Premenstrual Disorders.The American journal of psychiatry · 2025Article
- The impact of ovulation-suppressing contraceptives on behavioral and functional difficulties in borderline personality disorder.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2025Article
- Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology.Molecular psychiatry · 2025Review
- The Impact of Estrogen-Suppressing Contraceptives on Behavioral and Functional Difficulties in Borderline Personality Disorder.medRxiv : the preprint server for health sciences · 2024Article
- Understanding premenstrual exacerbation: navigating the intersection of the menstrual cycle and psychiatric illnesses.Frontiers in psychiatry · 2024Review
- Salivary testosterone is associated with feelings of senselessness and self-dislike in women with borderline personality disorder.European journal of psychotraumatology · 2024Article
- A call to integrate menstrual cycle influences into just-in-time adaptive interventions for suicide prevention.Frontiers in psychiatry · 2024Article
- Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality.The American journal of psychiatry · 2024Article
- A case series of premenstrual disorders presenting to the UK's National Female Hormone Clinic.BJPsych bulletin · 2023Article
- Cyclical exacerbation of suicidal ideation in female outpatients: Prospective evidence from daily ratings in a transdiagnostic sample.Journal of psychopathology and clinical science · 2023Article
- Daily ovarian hormone exposure and loss of control eating in adolescent girls: A registered report.The International journal of eating disorders · 2023Article
- Affective Risk Associated With Menstrual Cycle Symptom Change.Frontiers in global women's health · 2022Article
- Menstrual Cycle in Trauma-Related Disorders: A Mini-Review.Frontiers in global women's health · 2022Review
Corrections and comments
- Erratum issued
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundIndividuals with a borderline personality disorder (BPD) suffer from a constellation of rapidly shifting emotional, interpersonal, and behavioral symptoms. The menstrual cycle may contribute to symptom instability among females with this disorder.
methodsFifteen healthy, unmedicated females with BPD and without dysmenorrhea reported daily symptoms across 35 days. Urine luteinizing hormone and salivary progesterone (P4) were used to confirm ovulation and cycle phase. Cyclical worsening of symptoms was evaluated using (1) phase contrasts in multilevel models and (2) the Carolina Premenstrual Assessment Scoring System (C-PASS), a protocol for evaluating clinically significant cycle effects on symptoms.
resultsMost symptoms demonstrated midluteal worsening, a perimenstrual peak, and resolution of symptoms in the follicular or ovulatory phase. Post-hoc correlations with person-centered progesterone revealed negative correlations with most symptoms. Depressive symptoms showed an unexpected delayed pattern in which baseline levels of symptoms were observed in the ovulatory and midluteal phases, and exacerbations were observed during both the perimenstrual and follicular phases. The majority of participants met C-PASS criteria for clinically significant (⩾30%) symptom exacerbation. All participants met the emotional instability criterion of BPD, and no participant met DSM-5 criteria for premenstrual dysphoric disorder (PMDD).
conclusionsFemales with BPD may be at elevated risk for perimenstrual worsening of emotional symptoms. Longitudinal studies with fine-grained hormonal measurement as well as hormonal experiments are needed to determine the pathophysiology of perimenstrual exacerbation in BPD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.