Breaking the Stigma: Borderline Personality Disorder in Men

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental health condition that affects how people view themselves and others, making it difficult to function in daily life. It is characterized by intense mood swings, unstable self-image, and difficulty maintaining relationships.¹ Despite wanting stable, loving relationships, a deep fear of abandonment often triggers anger, self-harm, or suicidal tendencies, making it harder to maintain those connections.²

Understanding Borderline Personality Disorder (BPD)

Individuals with BPD often have chronic feelings of emptiness and distorted perceptions of themselves and others, leading to emotional instability and impulsive behaviors. BPD usually develops by early adulthood² and is frequently complicated by co-occurring conditions like mood disorders, anxiety, post-traumatic stress disorder (PTSD), eating disorders, and substance use disorders (SUDs).

Prevalence of BPD in the general population

Studies estimate BPD affects 0.7% to 2.7% of the general population. In primary care settings, the prevalence is around 6%, increasing to 11-12% in outpatient psychiatric clinics and 22% among psychiatric inpatients. Historically, clinicians have diagnosed BPD more often in women than in men. However, research shows that women only have a slightly higher overall rate of BPD at 3% versus 2.4% for men.¹

Differences in BPD symptom expression between men and women

Although prevalence rates of BPD are similar between men and women, much of the research and clinical evaluation still focuses on female symptoms. 

It is crucial to understand that BPD symptoms in men are expressed differently than in women with BPD.

For example, recent studies that compare BPD between sexes indicate that men tend to exhibit more aggressiveness, impulsivity, and narcissistic behaviors. At the same time, women are more likely to show affective instability, suicidal or self-harming behaviors, and unstable relationships.³

It is important to note that several pre-established societal biases contribute to the higher diagnosis of BPD in women compared to men, including:

• Perception of women as more emotional – Societal norms often label women as more “emotional” than men, leading to a greater likelihood of BPD diagnosis.
• Help-seeking behavior – Women are generally more likely to seek mental health treatment. In contrast, men may face legal issues due to aggressive or violent behavior, which can divert attention away from mental health needs.
• Misdiagnosis of men – Men who express intense emotions are often misdiagnosed with other disorders, such as antisocial personality disorder, bipolar disorder, or psychosis.

Recognizing these differences is vital to accurate diagnosis and treatment, as diagnosing BPD can be challenging for all genders.

Common Symptoms of BPD and How They Manifest in Men

While BPD affects individuals regardless of gender, its symptoms can manifest differently in men. This can heavily influence how men experience — and express — the disorder. Here are some common symptoms⁴ of BPD and how they may present in men:

• Emotional instability – Men with BPD may display intense mood swings through outward expressions like anger and irritability, while women might show internalized emotions such as sadness and rumination.
• Impulsivity – Men are more likely to engage in harmful behaviors, such as substance abuse, reckless driving, gambling, or unsafe sex. They often seek new experiences that increase their adrenaline, reflecting a desire for excitement.
• Intense and unstable relationships – Individuals with BPD typically fear abandonment, leading to tumultuous relationships. Men may exhibit this through abrupt beginnings and endings to relationships or heightened separation anxiety.
• Identity disturbance – Those with BPD often struggle to develop a stable sense of self, resulting in frequent changes in their careers, values, and relationships.
• Difficulty regulating emotions – Men may express emotional distress more through anger and aggression than women, impacting their interactions and relationships.
• Chronic feelings of emptiness – Depression and feelings of emptiness are common in people with BPD, regardless of gender.
• Minimization of symptoms – Men are less likely than women to seek therapy or help for their BPD symptoms, often due to societal expectations and stigma surrounding mental health.

BPD in men may also be expressed through substance abuse and addiction, as well as other addictions to sex, shopping, or gambling. When individuals struggle with a mental health disorder — in this case, BPD — and substance abuse or addiction concurrently, this is known as a dual diagnosis.

Additional signs of BPD in men

In addition to the common symptoms of BPD, men may exhibit certain behaviors that further complicate their relationships and emotional well-being. Here are a few additional signs of BPD that are commonly observed in men:

• Blame shifting – Men with BPD may shift blame onto others — particularly loved ones — for feelings of failure, guilt, or deficiency. The person blamed may not be at fault or is unaware of the issue. This behavior can stem from an inability to cope with overwhelming guilt and despair, making it hard for them to accept responsibility.
• Emotional sensitivity – Men with BPD can be highly sensitive emotionally, perceiving even neutral comments as personal attacks or criticism. This heightened sensitivity often leads to strained relationships and feelings of being misunderstood.
• Narcissistic and controlling behaviors – To compensate for feelings of a lack of control, many men with BPD may exhibit controlling behaviors in relationships. This can manifest through extreme threats or attention-seeking behaviors, such as acting out sexually, as a way to maintain control.
• Boundary issues – Men with BPD may struggle to respect boundaries set by others, often acting impulsively or forcefully when faced with limits. Their difficulty in self-regulation can lead to challenging interpersonal dynamics.

The Challenges of Identifying BPD in Men

Early on, many men are often misdiagnosed with conditions like oppositional defiant disorder (ODD), attention deficit disorder (ADD), intermittent explosive disorder (IED), or even bipolar depression.⁵ A red flag for BPD could be a history of multiple diagnoses, as the symptoms overlap with many other disorders. One of the closest conditions in terms of shared symptoms is post-traumatic stress disorder (PTSD). Both BPD and PTSD share common traits such as:

• Intense mood swings
• Difficulty regulating emotions
• Fear of abandonment
• Outbursts of anger or rage
• Episodes of dissociation

Due to these similarities, it is easy to see how men with BPD can be misunderstood or incorrectly diagnosed. The cultural expectation that men should suppress emotions can also contribute to the misdiagnosis, as symptoms like emotional dysregulation and fear of abandonment may manifest differently in men than in women.

Accurately diagnosing BPD requires a deeper exploration of these recurring symptoms and a keen understanding of the patient’s emotional history. This thorough assessment can lead to better treatment and management, ensuring that men with BPD receive the proper care they need.

Treatment for BPD in Men

Living with BPD can feel overwhelming, but it is possible to manage the condition with the proper support. Psychotherapy, skills groups, and medication are effective tools for managing BPD symptoms.

Although medications like mood stabilizers and antidepressants can help alleviate some symptoms of BPD, there is no specific medication that directly treats the disorder. Instead, combining therapy and skills-building can provide more comprehensive, long-term management.

Research shows that residential treatment for BPD can significantly reduce anxiety, depression, and suicide attempts while also enhancing interpersonal relationships and emotional regulation.

Begin your journey to long-lasting recovery
At Clearview, we offer specialized, individualized, evidence-based treatment programs for men experiencing BPD. Our compassionate staff utilizes world-renowned treatment methods, such as dialectical behavior therapy (DBT), to help clients develop the skills needed for long-term health and well-being.

If you or a loved one is struggling with BPD, it is critical to seek a proper diagnosis and appropriate treatment. Call us today or fill out our online contact form — we are here to help.

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Resources

¹ Chapman, J., Jamil, R. T., & Fleisher, C. (2024, April 20). Borderline Personality Disorder. National Library of Medicine; StatPearls Publishing.

² Mayo Clinic. (2024, January 31). Borderline personality disorder – Symptoms and causes. Mayo Clinic.

³ Qian, X., Townsend, M. L., Tan, W. J., & Grenyer, B. F. S. (2022). Sex differences in borderline personality disorder: A scoping review. PLOS ONE, 17(12).

⁴ Health. (2024). This Is What Borderline Personality Disorder Could Look Like in Men. Health.

⁵ An Interesting Mix: Male Borderline Personality Disorder. (2017, February 4). Psych Central.