Borderline Personality Disorder in Men

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Borderline personality disorder (BPD) is a mental disorder characterized by ongoing patterns of varying moods, self-image, and behaviors. Research in the 1980s showed that BPD is three times more prevalent in women, but more recent research suggests that this condition actually affects men and women equally. BPD is less frequently diagnosed in men because they are often misdiagnosed with depression or post-traumatic stress disorder. Gender plays a role in BPD in that men and women with this mental condition exhibit different traits, have different comorbidities, and utilize different kinds of treatment.

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What Is BPD?

People with BPD have trouble regulating their emotions, controlling their behavior and maintaining stable relationships. They’re likely to engage in dangerous or harmful behavior, such as reckless driving or risky sex. They may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

BPD affects 1.6% in the general population and 20% of the psychiatric inpatient population. 

Symptoms

People with BPD may experience mood swings and feel uncertain about how they see themselves and their role in the world. As a result, their interests and values can change quickly. They also tend to view things in extremes, such as all good or all bad.

Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy the next. This contributes to unstable relationships.

Other symptoms of BPD include:

  • Impulsive and dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Self-harming behavior, such as cutting
  • Recurring thoughts of suicidal behaviors or threats
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or problems controlling anger
  • Difficulty trusting, sometimes accompanied by irrational fear of other people’s intentions
  • Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality

Signs of BPD in Men

There are notable gender differences in borderline personality disorder with regard to personality traits, comorbidities, and treatment utilization between men and women. Men with borderline personality disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking than women with borderline personality disorder.

Comorbidities and Complications

Men with borderline personality disorder are more likely to have substance use disorders while women with this condition are more likely to exhibit eating, mood, anxiety, and posttraumatic stress disorders. This may explain why women seek treatment more often, contributing to sampling bias in studies, whereas men are more likely wind up in prison settings and remain underrepresented in mental health settings.

Substance Abuse

Substance abuse disorders are more common in men with BPD, and they are especially likely to have alcohol dependency. One study estimated the rate of current substance use for those with BPD is 14%, and the rate for lifetime substance use is 78%. About 14.3% of people with BDP abuse alcohol; opioid and cocaine abuse are prominent as well.

Self-Harm 

It's approximated that between 60% and 85% of people with BDP self-harm, with a range of lethality. Men and women are equally likely to engage in self-harm. One study looked at 22 self-harm behaviors in men and women with BPD, and found only two self-harm behaviors are found to be more prevalent in men: head-banging and losing a job on purpose. The authors concluded that there may be some genuine gender differences with regard to specific self-harm behaviors, but the majority of self-harm behaviors overlap between the sexes.

Know the Signs of Self-Harm

Someone you know may be engaging in self-harm if they have the following:

  • Scars
  • Scratches, bruises, burns
  • Sharp objects around
  • Wearing long sleeves or pants
  • Avoiding showing skin

Anti-Social Behaviors

Men with BPD are also more likely than women to have paranoid, passive-aggressive, narcissistic, and sadistic, and antisocial personality disorder. One study found that men with BPD were more like to have antisocial personality disorder. BPD, with and without comorbid ASPD, was also associated with convictions for violent crime more strongly than ASPD, especially in adulthood. This contributes to more men landing in the correctional system rather than mental health care settings. Men more often displayed intensive anger, whereas women more frequently showed affective instability.

Treatment

As for treatment utilization, men with borderline personality disorder are more likely to have treatment histories relating to substance abuse whereas women are more likely to have treatment histories characterized by more pharmacotherapy and psychotherapy. Men less frequently seek pharmacotherapy and psychotherapy services, compared with women.

How to Seek Help

If you or someone you know is in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone.

A Word From Verywell

Social bias played a large and unfortunate role in the misdiagnosis and underdiagnosis of BPD in men in the past, resulting in the misconception that BPD less frequently occurs in men. BPD is viewed as a disorder full of emotional extremes, it is more than that and symptoms are different for men and women. This means men have different needs when it comes to treatment for their BPD.

The first step towards getting help for BPD is recognizing that someone has a problem, If your loved one is showing signs of BPD, it's important to see a mental health professional for proper diagnosis and prompt treatment.

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