Barriers to gender affirming healthcare for transgender and non-binary people with endometriosis.

BPD is a mental disorder characterized by pervasive instability in emotions, interpersonal relationships and self-image as well as impulsive behavior (for symptoms, see ). BPD has a prevalence of 0.92–1.90% in Western countries, with symptom onset typically occurring during adolescence. Women are more frequently diagnosed with BPD than men by a ratio of ~3:1, for which a substantial contribution of diagnostic as well as selection bias has been postulated. Individuals with BPD display high rates of self-harm, suicidal ideation and suicide attempts. BPD shows substantial symptom overlap and comorbidity with other mental disorders, and comorbidity with neurological and somatic health conditions. Although some psychotherapies are effective in treating BPD, no psychopharmacological treatments have been approved by the US Food and Drug Administration specifically for BPD. In addition to environmental risk factors such as early interpersonal trauma, genetic factors contribute substantially to disorder risk. Twin and family studies estimate the heritability of BPD to be 46–69% and demonstrate that the genetic risk for BPD is partially shared with other mental disorders but also with continuous traits; for example, the Big Five personality traits. However, a systematic assessment of shared genetic risk with a broad range of disorders and traits is missing. For many mental disorders, GWAS meta-analyses of genetic data from tens or hundreds of thousands of cases and controls have successfully identified hundreds of genetic risk loci. By contrast, genetic research on BPD lags behind. In the only GWAS of BPD conducted so far, encompassing 998 cases and 1,545 controls, no single genome-wide significant variants were identified, but significant genetic correlations () of BPD were observed with bipolar disorder (BIP), schizophrenia (SCZ) and major depressive disorder. Although these findings indicate the potential of using genetic approaches to investigate BPD, research based on those results is limited by large uncertainties in the estimated effect sizes. Additionally, the extent to which sex-specific genetic effects contribute to the observed sex differences in the prevalence and clinical characteristics of BPD remains unclear.