Borderline Personality Disorder (BPD) in men is a condition which is rarely talked about.

BPD is characterised by emotional instability and relationship difficulties, which has traditionally been viewed as a female disorder, even though mental health conditions are not gender specific.

They can affect anyone in any age group, in any race, and in any culture.

But what actually leads to a diagnosis of BPD in men?

It quite often can be rooted in childhood trauma and inconsistent caregiving, as with the female presentation and other personality disorders.

Some men with BPD may have experienced emotional distance from their mothers during childhood, potentially contributing to their condition.

However, sexual abuse rates are reported to be much higher in men who are diagnosed with BPD than in women who present with the condition.

Then, there are also biological, psychological, and environmental factors to take into account.

Neurobiological research has identified dysfunctions in frontolimbic circuits, particularly involving the amygdala and prefrontal cortex, as being associated with BPD in both men and women.

These neural alterations may contribute to the emotional instability and impaired impulse control characteristic of the disorder.

There is also a hereditary component to consider, as well.

While genetics likely play a role in BPD development, the exact heritability remains unclear. Studies have produced widely varying results, with heritability estimates ranging from 0% to 76%.

So while it is a factor, the figures are extremely skewed.

Understanding BPD in Men: Breaking the Stereotypes

Breaking stereotyping means breaking stigma.

And that can only come by bringing greater awareness to the nuances of BPD in men. While the signs of BPD can be similar across genders, their manifestation in men often differ quite significantly.

Understanding that men with BPD may present differently can not only lead to more accurate diagnosis and effective treatment, but also create a more inclusivity.

By challenging the notion that BPD is a “female disorder,” we can remove some of the clinical type-casting, which can be extremely unhelpful, and in fact, be quite regressive and limit potential for proper recovery.

What does BPD look like in Males?

Men with BPD often display more externalising behaviours, which can often result in some of the symptoms of emotional instability of the disorder being obscured – preventing a proper diagnosis.

This can partially be attributed to genetics in some instances.

The MAOA gene, in particular, has been linked to externalising behaviours in men with BPD, while in women it’s associated with more internalised struggles.

Research from 2017 indicates that men with BPD are more prone to explosive temperaments and higher levels of novelty-seeking behaviour compared to their female counterparts.

How Common is BPD in Men?

There’s been ongoing debate around the prevalence of BPD across the gender divide for many years now.

And contrary to earlier beliefs that BPD was predominantly a female condition, there’s actually significant evidence to suggest that the distribution between genders is far more even than previously thought.

A 2008 study found that BPD was almost equally prevalent across men and women.

Previously the research had suggested that there was a 3:1 ratio of male to female reported in a lot of clinical settings. (This information came from the DSM-V)

We can only assume that this misconception surrounding the prevalence of BPD in men came from clinician bias and the sampling bias in research, which has led to some skewed figures of prevalence, which have become commonly accepted.

And whilst those figures might have been somewhat accurate in the context of the studies themselves, they haven’t actually been accurate in terms of the broader representation of how the condition presents.

Mental health conditions don’t express favouritism.

BPD in Men vs Women: Differences in Symptom Presentation

• Externalising vs. Internalising Behaviours: Men with BPD have been shown to exhibit more externalising behaviours such as impulsivity and physical aggression. While women are more prone to internalising behaviours like mood and anxiety disorders.
• Substance Use Disorders: Men with BPD show significantly higher rates of substance use disorders, particularly alcohol dependence (65.3% vs. 42.7% in women).
• Affective and Anxiety Disorders: Women with BPD exhibit higher rates of affective disorders (93.6% vs. 81.6% in men) and anxiety disorders (91.8% vs. 79.6% in men).
• Eating Disorders: Women with BPD have a higher prevalence of eating disorders (35.5% vs. 18.4% in men).
• Antisocial Traits: Men with BPD are more likely to display antisocial personality traits compared to women.

Recognising the Signs: Unique Symptoms and Traits of BPD in Men

Really, the biggest reason for picking up on the early signs of BPD in men comes down to improved outcomes, which will ultimately lead to an improved quality of life.

The misdiagnosis and under diagnosis of the condition, which often go hand in hand can present real deep issues in terms of recovery that might not be immediately apparent.

For example, if a man is diagnosed with antisocial personality disorder, and hence treated in the incorrect way, the root cause – and symptoms – of BPD aren’t being addressed.

But, in addition, this may also create its own form of stigma.

If a man is wrongly cast as being anti-social, it might feed into the shame complex that can be characteristic of BPD. It might create the narrative that they are a bad person.

When in fact there’s deep trauma at play, informing their choices.

As well as providing an undercurrent of shaming, this might lead to them adopting the language and labelling as a way of rationalising their condition, and their life.

Overly identifying.

It can create a false belief system about who they are and the way they act.

This is why greater awareness and acceptance is so important. So we can offer a proper and complete diagnosis.

Externalising Behaviours: Aggression and Substance Abuse

Here are some externalising behaviours that are prevalent in men with BPD:

• Heightened Aggression: Men with BPD demonstrate higher levels of impulsivity and physical aggression compared to women. This often manifests as explosive anger outbursts, causing significant challenges in relationships and professional settings.
• Substance Abuse Prevalence: Multiple studies consistently show higher rates of substance use disorders in men with BPD, particularly alcohol dependence. This may be an attempt to self-medicate or conform to societal expectations of masculinity.
• Diagnostic Challenges: The prevalence of externalising behaviours in men can lead to under diagnosis of BPD, as they may not present in typical mental health treatment contexts.
• Conflict with Authority: The tendency towards intense anger and difficulty regulating emotions can lead to frequent conflicts with supervisors or coworkers. This may result in disciplinary actions or job loss.

Emotional Instability and Impulsivity

While emotional instability is a core symptom of BPD across the gender divide, it can actually look quite different between men and women. And so, learning to identify and manage triggers is vitally important for men with BPD to maintain good emotional health.

This should come as no surprise given the potential for more externalising behaviours on the part of the male.

But what does this look like and how does it play out in real-world terms?

Firstly, the impulsivity that men experience can often be overlooked by the casual observer, due to the masculine dominant (patriarchal) culture that predominates most of the world.

It can be seen as men being men.

And perhaps even see them celebrated as a rebel.

Recklessness is a currency in the eyes of some.

But there is a big difference between calculated risk, which is a challenge we’re all faced with at certain points in our life and being chronically reckless…

There are two ways this recklessness can play out in men with BPD:

Motoric Impulsiveness: This refers to acting without thinking about consequences. It involves quick, unplanned reactions before fully processing information. In BPD, it may manifest as sudden anger outbursts, risky behaviours, or abrupt decisions with significant impacts.

Non-planning Impulsiveness: This relates to a lack of future planning and forethought. It involves a present-focused mindset with difficulty considering long-term consequences. For those with BPD, this could lead to problems setting and achieving long-term goals, frequent life plan changes, or disregard for future outcomes.

Some of the behaviours most associated with men with BPD include:

• Reckless driving
• Gambling
• Unsafe sex or risky sexual behaviours

Men with BPD may also struggle with the same chronic feelings of emptiness and identity disturbance, similar to women with the disorder.

However, due to the closeted nature of most typical males, there is far less willingness to express their feelings.

This can then result in further internal struggles, which could present as irritability, restlessness, or a constant search for new experiences to fill the void.

The externalising symptom of seeking novelty at play again…

Relationship Patterns and Fear of Abandonment

Here are some relationship patterns that are common within men with BPD:

• Fear of Abandonment: Men with BPD often experience intense and unstable relationships, marked by a profound fear of abandonment. These unstable relationship patterns can significantly impact how BPD affects relationships.
• Idealisation and Devaluation Cycle: The relationship patterns of men with BPD are often characterised by a cycle of idealisation and devaluation. Many individuals with BPD experience distinct stages in their relationships, often cycling through idealisation and devaluation. They may initially put their partners on a pedestal, only to quickly become disillusioned and critical.
• Antisocial Traits Comorbidity: A 2009 study revealed that 57% of men with BPD met criteria for antisocial personality disorder, compared to only 26% of women. This higher prevalence of antisocial traits can result in manipulative behaviours or lack of empathy in relationships.

The Hidden Struggles: Comorbidities and Challenges Specific to Men with BPD

The irony with the symptom set of men with BPD is that the behaviours are often hidden in plain sight. Men with BPD often face various co-occurring conditions, which can complicate diagnosis and treatment.

Due to the externalising nature of BPD in men, society often fails to recognise these behaviours as symptoms of a mental health condition.

Instead, men with BPD might often be viewed as troublemakers or as having anger management issues. And so, this misperception can again lead to delayed diagnosis and treatment, exacerbating the challenges these individuals face.

This societal blindspot can leave men with BPD feeling misunderstood and unsupported.

Substance Use Disorders and BPD

Then, there’s yet another layer to the externalising vs internalising of symptoms between men and women with BPD.

Studies show men with BPD are more likely to struggle with substance abuse disorders (SUDs) than women with the disorder. In fact, a 2009 study found that 65.3% of men with BPD had alcohol dependence, compared to 42.7% of women.

That’s a significant difference.

But why is this happening?

In truth, there is no real fixed answer here.

The higher prevalence of SUDs in men with BPD may be attributed to attempts at self-medication, with those substances being used to manage intense emotions and impulsivity characteristic of BPD.

However, there is a flip side to this coin.

Substance use can exacerbate BPD symptoms, while BPD traits themselves can equally make someone more vulnerable to addiction.

It’s a difficult cycle… Both to recognise and to break.

A partial answer to this comorbidity might be found in fact that both disorders involve problems with emotional regulation and impulse control.

This overlap in symptoms might explain why they often occur together.

The combination often leads to more severe symptoms, poorer treatment outcomes, and a higher risk of suicidal behaviour.

But there’s something else…

Men with BPD and substance use disorders might not show up in mental health settings as often as you’d expect.

They’re actually more likely to end up in substance abuse facilities, potentially facing legal action as a result of their perceived anti-social behaviour.

Men with BPD are historically more likely to receive substance abuse treatment, while women are more likely to have received psychotherapy or medication.

What does this mean for recovery? It’s clear we need an integrated approach. We can’t treat BPD and substance use disorders separately in men.

They’re too intertwined. We need to address both issues simultaneously.

It’s challenging, but it’s necessary for effective treatment.