What Research Suggests About Borderline Personality Disorder In Men

Borderline personality disorder (BPD) is a personality disorder characterized by impulsive behavior, a shaky sense of self and self-esteem, unstable interpersonal relationships, and extreme difficulties in managing one’s emotions and mood. Like with other mental health conditions, BPD can be expressed differently in people of different genders. 

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How do borderline personality disorder (BPD) symptoms show up in men?

A higher number of women receive a BPD diagnosis than men. As a result, the true prevalence of the condition in men is unclear. Instead of women being more likely to have BPD, it may be possible that differences in how symptoms present and resulting discrepancies in mental health treatment and accessing mental health services for men and women may contribute to the lower rates of diagnosing borderline personality disorder in men.  

Men with borderline personality disorder may be more likely to demonstrate the following symptoms: 

• Aggressiveness
• Intense anger
• Impulsivity bordering on recklessness, including gambling, promiscuous sex without taking proper safety measures, binge eating, dangerous driving, and excessive substance use 
• Passive-aggressiveness
• Novelty-seeking behavior, or the desire to constantly see, do, and experience new situations 
• Rapidly changing interests
• Sadism (enjoying seeing pain inflicted on others, whether emotionally or physically) 
• A glib attitude, seeming unconcerned about other people’s perception of them
• Unstable sense of values
• Grandiosity
• A flexible moral code
• Entitlement
• A sense of arrogance
• Paranoia and suspiciousness
• Superficiality and difficulty caring about topics under surface-level concerns
• Social withdrawal
• Egocentrism and selfishness
• Exploitation of other people
• A lack of empathy
• Irritability
• A significant desire for admiration
• Envy

Gender differences in borderline personality disorder and co-occurring conditions

Some people with borderline personality disorder develop additional mental health conditions. However, the most common conditions that co-occur can vary by gender. Women with BPD can be more likely to develop anxiety disorders, eating disorders, post-traumatic stress disorder (PTSD), and mood disorders like depression or bipolar disorder. Men with BPD are more likely to be diagnosed with an additional personality disorder like antisocial personality disorder or narcissistic personality disorder. Men are also more likely to be diagnosed with a substance use disorder. 

Substance use (sometimes incorrectly referred to as “substance abuse”) can be a particular concern for men with BPD. Research shows that 75% of men with BPD meet the diagnostic criteria for a substance use disorder, often alcohol use disorder, at some point in their lifetime. BPD and a substance use disorder can act as negative reinforcers. Substance use and intoxication can heighten the impulsivity and recklessness associated with BPD (and particularly with BPD in men). In turn, the emotional instability and turmoil of BPD may encourage the use of substances to numb negative emotions as an unhealthy coping mechanism.

Often, more women than men seek treatment for BPD. Some researchers believe this tendency is due to the unique co-occurring disorders men and women experience. Women may be more likely to pursue treatment for an additional mental health condition like depression or PTSD and receive a subsequent BPD diagnosis to begin treatment for BPD symptoms. 

Contrarily, men with BPD and a co-occurring substance use disorder are less likely to seek or receive treatment or care for either condition. This situation may be because the aggression associated with male BPD may heighten the likelihood of a person being expelled from substance use treatment programs, which may discourage men from seeking help. 

Gender differences in BPD “splitting”

“Splitting” is a behavioral defense mechanism that occurs in some interpersonal relationships of people with BPD. Difficulty with emotional intelligence and comprehension or dissociation due to traumatic or unhealthy childhood relationships can result in people with BPD, regardless of their gender identity, struggling to process certain levels of nuance or complexity in their relationships with others. 

Individuals living with BPD may use splitting behaviors, in which they perceive another person as either having only positive qualities or only negative ones (“splitting” the person into a reduced version of themselves, with no possibility for integrating both positive and negative aspects, which most people have). Splitting can contribute to some of the instability in interpersonal relationships that can be common in people with BPD. 

A pattern can emerge when a new relationship (romantic or otherwise) begins. A person with BPD may idealize the other person and think of them as perfect. Then, at the first sign of real or imagined conflict or misunderstanding, the person with BPD may immediately reclassify the relationship as “bad” in their mind and switch to demeaning and criticizing the other person. BPD splitting may be a form of defense mechanism to protect against the intense fear of rejection and abandonment that is a criterion for the disorder. 

Splitting in BPD can present differently in men and women. Men with the disorder are often described as “snapping” at the other person, having an explosive outburst, or becoming belligerent. In these situations, men with BPD may threaten to harm the other person or themselves. 

Often, it is more socially acceptable for men to express anger aggressively. Some of the discrepancies in BPD diagnosis numbers between men and women might be explained by men with BPD not seeing that explosive anger is a symptom and not a trait. In some cases, men may receive positive reinforcement for engaging in relationships this way, as they may be seen as more “manly.” 

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Support options for BPD

Regardless of gender identity, there are effective treatments for borderline personality disorder to manage daily life. Dialectical behavior therapy (DBT), delivered by a qualified mental health professional, has been shown to lead to positive results and symptom reduction.

One additional possible reason for more women than men seeking BPD treatment could be a persistent sense of shame and stigma associated with men who seek mental healthcare. Online therapy, which is typically more discreet than traditional in-person therapy, could be a way around this barrier. With online therapy through a platform like BetterHelp, men can speak to a counselor from the comfort of their own homes and choose between phone, video, or live chat sessions. In addition, they may choose to speak to a male therapist if they are more comfortable doing so. 

Research has indicated that online therapy can be as effective as in-person therapy at treating mental health conditions, including borderline personality disorder. One research review examined the effectiveness of a number of different online therapy treatments, the majority of which focused on BPD, and found that symptom reduction was common after completing online therapy sessions.