Borderline Personality Disorder is generally thought of as a “female” disorder. But men can be borders, too. This article if from Dr Fischer who is an Executive Director of the Optimum Performance Institute in Woodland Hills, CA. He specialises in treating young adults with Borderline Personality Disorder or certain traits of it.
When people think of a person with a diagnosis of borderline personality disorder, they think of it being a woman’s illness. However, men can also have BPD. How many borderline men and what percentage of all BPD patients are men?
Years ago, doctors were reluctant to make the diagnosis of BPD, in part because the treatments available were not producing favourable results and therefore there was little hope for a full recovery.
With the advent of Dialectical Behavioral Therapy and other therapeutic modalities, it is clear that we can do a lot to help people with Borderline to improve the quality of their lives. We have made great strides in de-stigmatizing the diagnosis of BPD in women. Finally, we are taking the next step and doing the same for men.
Previous research has shown that men account for about 25% of BPD cases. Today we know it’s a remarkable 50/50.
How does BPD in men differ from BPD in women?
The scientific literature indicates that women with BPD are more prone to eating disorders, mood, anxiety, and PTSD (Post Traumatic Stress Disorder), while men demonstrate paranoia, passive/aggressive tendencies, narcissism, and personality disorders. anti-social. Men with BPD appear to be more likely to abuse their spouses rather than direct their anger at themselves. They demonstrate personalities characterized by quick tempers, substance abuse, and a need to seek out exciting experiences.
While this can be supported by the data, I believe it gives a very pejorative impression of men. In fact, there is no difference between women and men in terms of their psychological stress levels. Both are human beings who suffer tremendous anxiety. Both men and women are subject to their genetics and possibly abusive social exposure, as everyone has a need to be validated.
Certainly, in the Roanne Program, we see men with BPD who do not have antisocial personality disorder. They are not paranoid. They are very different from this stereotypical labelling.
How we look at someone in difficulty determines, in part, how we treat them.
There is always some truth to generalizations about behaviour, but every person is unique. Caution is important when placing a person in statistically calculated boxes. Nobody deserves to be stereotyped.
Are the causes of BPD different for men vs. women?
The specific causes or antecedents may be different. But men and women with BPD share an underlying difficulty managing stress and anxiety. There may be neurological or genetic causes and there may be differences in the ways of dealing with the feeling of invalidation. This leads the border to become distracted and find it difficult to complete his goals. Not being able to do that causes problems with self-esteem. This cycle of feelings and behaviours can make it difficult to establish consistent and caring relationships with others.
Both men and women suffer equally.
We sometimes see men with some of the characteristics of BPD sufferers, but they have other markers of personality disorder as well. For example, antisocial personality disorder and BPD sometimes appear to overlap. Narcissistic Personality Disorder, in some cases, too. Can you comment on this?
There are certainly many men with BPD who also have antisocial and narcissistic personalities.
For this group, help should be delivered in a comprehensive way, addressing aggressive and anti-social behaviour and providing restraint as well as compassion and understanding. It can be extremely difficult to provide meaningful and appropriate care for men (or women) who engage in antisocial behaviour.
However, the young people we’ve been working with don’t generally seem antisocial. This leads me to believe that there are many men who could benefit and who are deserving of care but may be reluctant to come forward for help because they feel they don’t fit the current diagnosis of BPD.
The young people we see for treatment for BPD clearly demonstrate the underlying thought processes, namely rigid black-or-white thinking styles and perfectionism. They find it difficult to commit, which makes their ability to form intimate relationships more difficult. Seeing the world this way too much in black or white also makes it difficult for them to master the ups and downs that come with achieving complex goals because the downs are experienced as catastrophic and overwhelming.
Of course, this way of seeing the world is common. We all do this sometimes. But when it becomes the predominant way of dealing with stress and anxiety, it becomes problematic, especially in people who are prone to intense emotional swings.
The association of narcissism and antisocial behaviours with BPD, I believe, maybe in part an artefact of the group of people on whom the studies were based. A diagnostic system that is based on statistically valid behavioural observations but does not address the inner life produces a system that may have verifiability but often bears little resemblance to the individual sitting in an office.
The picture gets even more confusing when you look at how many other diagnoses, such as depression, anxiety, bipolar, and ADHD, and ADHD are also a part of the reality in men and women diagnosed with BPD. But when you boil down to the basics of things there really isn’t much difference in the core symptoms at all, it’s just they show up differently in men than women.
