Borderline Personality Disorder Diagnoses in Men and Women: a differential

Borderline Personality Disorder (hereafter referred to as “BPD”) is one of the most difficult psychiatric afflictions to treat, and clinicians who are faced with a BPD-diagnosed patient often abandon them precisely because of its intransigence. BPD is a personality disorder that falls within the “Cluster B” category of personality disorders, and is characterized by rapidly fluctuating mood, self-destructive behaviors, and interpersonal manipulation. Researchers have estimated that approximately 3 percent of the general population in the United States fit the diagnostic criteria of BPD. Until recently, the overarching presumption has been that BPD is a disorder largely isolated to women. However, as this paper argues, BPD afflicts both men and women in a relatively equal manner, and many men who are in actuality, Borderline-disordered are misdiagnosed with Antisocial Personality Disorder. (Conversely, many women who present symptoms of Antisocial Personality Disorder are misdiagnosed with BPD). As Borderline Personality Disorder is a psychiatric illness that not only causes great suffering for afflicted individuals, but inflicts incredible social costs, it is imperative that a more subjective diagnostic criterion that includes parameters for both men and women is developed. As difficult as BPD is to treat, and as explosive as individuals with this disorder can be toward therapists and social workers, BPD individuals are just as deserving of mental health intervention as anyone with any other mental disorder, no matter what their gender.

It has only been in recent years that psychological scholarship has turned its attention to the prevalence of Borderline Personality Disorder among male patients. As a 2011 article by Sansone et al observes, BPD symptoms manifest themselves among male and female patients in markedly different ways. Women with BPD have a tendency to engage in self-directed destructive behaviors, such as self-mutilation and unprotected sex with multiple partners, whereas men with the affliction tend to direct their destructive impulses toward others. As Sansone et al relate, men with BPD exhibit greater “explosive temperament and novelty seeking”. Not only does this intimidating behavior confuse therapists and other clinicians who are charged with treating these men in the diagnostic process, often leading to a misdiagnosis of Antisocial Personality Disorder or Bipolar Disorder, but also presents a wider social dilemma. Clearly, a man with an explosive temperament and violent tendencies places an imminent threat to the general public if left untreated and unchecked, but men who exhibit these behaviors often find themselves in trouble with the criminal justice system. Thusly, if men with BPD continue to be misdiagnosed, untreated, or generally ignored, the costs associated with incarceration and the varied technicalities of criminal justice administration can be staggering. More investment in research into the prevalence of BPD among males and in resulting effective treatments for this disorder may initially be expensive, however the long-term savings will clearly justify any short-term expenses.

With regard to the creation of appropriate diagnostic procedures for Borderline Personality disorder in men and in women, certain aspects of the disorder can sometimes make it unclear as to whether the clinician is dealing with an individual who has true BPD or a closely related affliction, such as Antisocial Personality Disorder or Narcissistic Personality Disorder. BPD, along with other “Cluster B” personality disorders, is often characterized by a weak sense of identity on the part of the afflicted individual, and a marked failure to adhere to commonly accepted social norms, such as gendered behaviors. As RC Howard states in a 2015 article relating to his research into individuals with Borderline Personality Disorder and Antisocial Personality Disorder, proposes that “psychological androgyny is particularly applicable to those who, manifesting a combination of antisocial and borderline PDs, lie at the extreme of the severity dimension of Personality Disorder.” This “psychological androgyny” that Howard speaks of, lies at the heart of the potential to misdiagnose BPD-afflicted males with Antisocial Personality Disorder and other psychiatric illnesses. This problem is extremely profound; should a male with BPD be misdiagnosed with Antisocial Personality Disorder, many therapists will refuse help outright, as they feel extremely threatened by Antisocial personality-disordered individuals. Again, the United States, as a society, has a great deal of motivation to be pro-active in the proper assessment and treatment of Borderline Personality Disorder afflicted individuals as such. The issue with treating individuals with Antisocial Personality Disorder is that they often do not “care” about their respective diagnoses, and, as such, are “untreatable.” Individuals with BPD, on the other hand, being afflicted with an “excess” of emotion, rather then a profound lack thereof, are often extremely motivated to try to help themselves. Thus, again, “sorting out the wheat from the chaff” is of profound importance when it comes to identifying males who are diagnosable with BPD.

When it comes to the effective treatment of BPD-afflicted individuals, most of the relevant, current research has been centered around women, as the concept of the possibility of men being prone to BPD has been, well, admittedly slow to come around among mainstream therapists, social workers, and other clinicians. One of the major issues in the effective treatment of BPD has been the qualification of Borderline Personality Disorder as a clinically-treatable illness among patients, as a 2015 research study by Larivière et al shows: “...patients associated recovery with ‘healing from personal disease,’ which didn’t fit with their experience with BPD.” While the subjects in this particular study were entirely female, they nonetheless provided the basis for definitive conclusions about the appropriate treatments for Borderline Personality Disorder.

As it seems, effective treatment for Borderline Personality Disorder revolves around intensive intrapersonal therapy, as well as the occasional psycho-pharmaceutical intervention, and while these individuals can be quite difficult, it is nonetheless well worth the risk, as this paper has shown. Men who have Borderline Personality Disorder, as well as the classic “co-morbid” diagnoses of Antisocial Personality Disorder and Narcissistic Personality Disorder, can provide a great deal of trouble to therapists and other clinicians, as well as individuals employed within the criminal justice system, and can ultimately inflict great tolls upon our larger society. It is thus imperative that the United States, as a society, invests more in the research into the proper diagnosis of Borderline Personality Disorder among males, and among females, as well. Males with BPD, however, should be placed as a much greater priority. Because of their physical size, and greater proven propensity to engage in forceful attacks and retaliation, the men who are diagnosed with Borderline Personality Disorder are much more likely to inflict greater societal costs due to their admittedly “explosive” behavior. All in all, Borderline Personality Disorder, while being a very difficult disorder to treat, warrants a great deal of attention of the behalf of psychologists, social workers, and other clinicians, and thus requires a great deal of investment. From what this paper has demonstrated, however, that while gender issues cloud much of the issue of the proper diagnosis of Borderline Personality Disorder, these issues can be fairly sorted out. Male patients with Borderline Personality Disorder can often falsely present as “psychopaths,” or as individuals diagnosable with Antisocial Personality Disorder. However, it is imperative that we, as a society, find a way to properly treat male BPD-diagnosed individuals. The costs are far less than the risks involved.

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