Borderline Personality Disorder In Men
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Why Is Borderline Personality Disorder Under-Diagnosed in Men?
Borderline personality disorder (BPD) is a condition that is characterized by:
- Changing mood patterns
- Difficulty regulating emotions
- Difficulty maintaining healthy, stable relationships
BPD was thought to be more prevalent in women than men. Recent studies have found this to be inaccurate. This is due to a number of factors. Most likely this is because men are less likely to seek out psychotherapy services. Instead, they find themselves incarcerated or in substance abuse rehabilitation facilities due to their underlying and untreated BPD. Studies have also shown that gender bias regarding BPD may also over-represent women. Likewise, there is a common bias towards diagnosing men with substance abuse disorders.
Currently, it is believed that BPD affects 1.6% of the general population and 20% of psychiatric patients. There is a lifetime prevalence of BPD at 5.9%. BPD is caused by both genetic and environmental factors. Almost 70% of people with BPD have a history of childhood maltreatment whether physical, sexual, or emotional. Most people seek initial treatment for BPD around the age of 18, but symptoms typically present at a much earlier age. Patients under 18 are not often given a formal BPD diagnosis unless they seek treatment through psychotherapy with symptoms that present themselves for longer than a year. The earlier BPD is diagnosed, the earlier treatment can begin and the more likely remission is reached and maintained.
What Does BPD Look Like in Men?
Though there is no difference in men and women with regards to the prevalence of BPD, women are over-diagnosed compared to men at a rate of 3:1. This over-diagnosis is due to the fact that BPD in women is often associated with eating disorders and anxiety disorders which will direct them to psychological services focused on cognitive therapies. Men with BPD commonly exhibit signs that point them to correctional facilities or substance abuse rehabilitation centers.
Although most symptoms of BPD are consistent in both men and women, symptoms that are more prevalent in men include:
- Explosive Temperament
- Self-Harm: Specifically head-banging and losing jobs on purpose
- Other forms of self-harm are consistent in both men and women
- Approximately 60-80% of people with BPD participate in some form of non-suicidal self-harm
- Problems maintaining healthy relationships due to an inability to commit to a romantic partner, blame-shifting, or hypersensitivity to rejection
- Narcissistic or controlling behaviors
- Boundary Issues
- High levels of novelty
- Impulsivity and engaging in harmful or high-risk behaviors
Borderline personality disorder in men is often accompanied by several different co-occurring disorders and conditions, including:
- Substance Abuse. Men with BPD are more likely to engage in some form of substance or alcohol abuse, sex addiction, or gambling disorder. Additionally, 75% of men with BPD show signs of alcohol dependency.
- Personality Disorders. Co-occurring paranoid, passive-aggressive, narcissistic, sadistic, or antisocial personality disorder are common among men with BPD. One study found that 57% of men with BPD also struggle with an antisocial personality disorder.
- Suicide. Unfortunately, the rate of death by suicide in people with BPD is around 10%. It is often related to failed treatment and/or late treatment in older patients.
Treatment for Men with BPD
Because men with BPD are more likely to end up within the prison system or substance abuse treatment centers, it is important to recognize that the root cause of the problems is borderline personality disorder. Seeking treatment will ensure that both the BPD and the co-occurring conditions are treated. This can lead to a longer-term period of remission. The most effective treatments for BPD are:
- Mentalization-Based Therapy (MBT)
- Dialectical Behavior Therapy (DBT)
- Transference-Focused Therapy (TFP)
Though some psychiatrists may recommend mood stabilizers or antidepressants, most patients see remission in their BPD with behavioral therapies. There is currently no medication specifically for treating BPD.
MBT focuses on the treatment of emotional regulation. This process helps men with BPD:
- Make sense of themselves and others in a more positive way
- Improve emotional stability, mood swings, and relationships
- Reduce explosive temperment
- Minimize impulsivity or risk-taking behaviors
A study done on MBT treatments showed that eight years after the initial treatment, only 14% of the participants still met diagnostic criteria for BPD.
Dialectical Behavior Therapy
DBT uses mindfulness and interpersonal/emotional regulation skills and therapies to help men with BPD learn to:
- Control intense emotions
- Reduce self-destructive behaviors
- Improve relationships
- Improve overall quality of life
The four components of DBT are:
- Skills training groups target the patient’s unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity. This takes place through core mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
- Weekly individual psychotherapy focuses on:
- Parasuicidal behaviors
- Therapy-interfering behaviors
- Behaviors that interfere with the quality of life
- Behavioral skills acquisition
- Post-traumatic stress behaviors
- Self-respect behaviors
- Telephone consultation teaches people with BPD to ask for help and to apply newly learned skills in crisis situations.
- Weekly meetings with a therapist boosts motivation among DBT providers and their patients.
Currently, DBT is the most effective form of treatment for people struggling with BPD. It is a multi-faceted program that targets multiple symptoms of BPD. Each plan targets the individual patient’s specific needs.
Cognitive Behavioral Therapy
Like other personality disorders, men struggling with BPD may struggle with:
- Negative beliefs about the self or others
- Problem behaviors made worse by environment
- Skill deficits that often result in abnormal responses to situations
Cognitive behavioral therapies address a variety of problem behaviors. Therapists can work with their client to reframe these maladaptive thoughts and actions through:
- Cognitive Restructuring
- Behavior Modification
- Skills Training
The best combination of CBT skills is going to depend on each specific client and their needs.
TFP allows patients with BPD to establish a relationship with their therapist. This can help point out the problems that a specific patient may have with interpersonal relationships. This type of therapy can also:
- Reduce impulsivity, irritability, anger, and self-harm
- Improve emotional regulation
- Decrease anxiety and depression
- Improve social interactions
- Reduces suicidal ideation
Seeking psychotherapy or other behavioral health services is crucial for the management and treatment of borderline personality disorder in men. Those who received an official diagnosis and obtained professional treatment saw 35% remission after 2 years and 91% remission after 10 years. Behavioral treatments helped to improve the standard of living for men with BPD across all areas. Most people with BPD will improve with treatment over time. Symptoms and relapses can be unpredictable and continued therapy is often needed.
It is crucial that men who are experiencing co-morbid conditions of BPD and substance abuse seek dual diagnosis treatment rather than relying solely on substance abuse treatment. Relapse is more likely when the root cause is left unaddressed. According to SAMHSA, in people with co-occurring mental health and substance abuse issues, receiving integrated, professional care is the most effective way for someone to achieve long-term recovery and live a happy and healthy life. Entering a dual diagnosis IOP or PHP program can enable someone to make a very solid start at recovery.
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