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. BPD is diagnosed predominantly in females (approximately 75%), however, recent research suggests that this condition may actually be underdiagnosed in men. Gender plays a role in BPD in that men and women with this mental condition can exhibit different traits, may have different comorbidities, and tend to 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% of 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 exhibit splitting, which is viewing things in extremes—such as seeing people 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 suicide
  • Suicidal behaviors or threats
  • Intense and highly changeable moods, with each episode lasting between a few hours to a few days
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or problems controlling anger
  • Difficulty trusting, sometimes accompanied by irrational fears about 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 BPD with regard to personality traits, comorbidities, and treatment utilization between men and women. Men with BPD are more likely to demonstrate an explosive temperament and higher levels of novelty seeking than women who have BPD.

Comorbidities and Complications

Men with BPD are more likely to have substance use disorders while women with this condition are more likely to exhibit eating disorders, mood conditions, anxiety, and posttraumatic stress disorder.

This may explain why women seek treatment more often, contributing to sampling bias in studies, whereas men are more likely to wind up in prison settings and remain underrepresented in mental health settings.

Substance Abuse

Substance abuse disorders are more common in men with BPD, especially alcohol dependency. One review found a lifetime diagnosis of substance abuse in BPD at around 75%.

Self-Harm 

It's approximated that between 60 to 85% of people with BDP engage in non-suicidal self-injury (NSSI).

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 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 a co-morbid paranoid, passive-aggressive, narcissistic, sadistic, or antisocial personality disorder. This association with antisocial personality disorder contributes to more men landing in the correctional system rather than mental healthcare settings. One review noted that men more often displayed intensive anger, whereas women more frequently showed affective instability.

Treatment

Men who have BPD less frequently seek pharmacotherapy and psychotherapy services, compared with women who have the disorder.

Men with BPD are more likely to have treatment histories relating to substance abuse whereas women are more likely to have treatment histories characterized by pharmacotherapy and psychotherapy.

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 plays role in the misdiagnosis and underdiagnosis of BPD in men, resulting in the misconception that it occurs less frequently in men than it actually does. BPD has been viewed as a disorder full of emotional extremes. However, it is more than that, and symptoms are different for men and women. This means men and women have different needs when it comes to treatment for their BPD.

The first step towards getting help for BPD is recognizing that there is a problem, If you or 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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