The Most Surprising Symptoms of Borderline Personality Disorder in Men

AN UNSTABLE SENSE of self, anger, aggression, self-harm, and substance abuse are common symptoms for men with borderline personality disorder (BPD). The condition can also trigger intense mood shifts, impulsivity, and relationship problems.

While people commonly associate the condition with women, men experience BPD at similar rates.

“It’s important for people to know that it’s a condition that’s diagnosed in men,” says Christine Crawford, M.D., M.P.H., associate medical director at the National Alliance on Mental Illness (NAMI). However, she says men tend to experience different BPD symptoms.

BPD is a mental health condition where self-regulation of emotions is difficult. People “feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event,” according to NAMI.

“The disorder causes dysfunction in everyday living for individuals, as it impacts the way they think and feel about themselves, others, and the world,” says Atlanta-based licensed professional counselor Anna Claire Seanor, L.P.C. NCC.

Fortunately, BPD is treatable, which helps people feel better and enjoy meaningful relationships, Dr. Crawford says. Here’s what you should know about borderline personality disorder in men, including the common symptoms.

What is borderline personality disorder?

BPD CAN BE an “enigma,” says Elizabeth Keohan, LCSW-C, a licensed Talkspace therapist. “It’s often marked by an extreme fear of abandonment, intense anger, and a pronounced difficulty within relationships.”

Relationships are chaotic and unstable because people with BPD often suddenly and dramatically change their views of others, according to the Cleveland Clinic. They might idealize someone one day and despise them the next.

Also, people with BPD exhibit mood fluctuations and impulsive behaviors and routinely threaten self-harm.

Individuals tend to have an unstable, distorted, or unclear self-image. They regularly feel shame and often perceive themselves as “bad,” according to the Cleveland Clinic. So they might suddenly change their goals, careers, or friends and sabotage their own success, such as by getting fired from jobs or ruining relationships.

What causes BPD isn’t fully understood, but most experts agree that it’s likely a mix of factors, including genetics, brain function, and traumatic events like childhood physical or sexual abuse and neglect, separation, or poor boundaries with parents.

There’s also an overlap between BPD and narcissistic personality disorder, Dr. Crawford says. Narcissistic personality disorder tends to be more common in men, and so BPD can sometimes present as narcissism, especially if someone displays a sense of grandiosity or entitlement in their interaction with others.

Yes, Men Do Get BPD

WOMEN HAVE HISTORICALLY been diagnosed with BPD more frequently, but Keohan believes it’s a “diagnostic bias.”

Dr. Crawford says women tend to seek out mental health support more frequently, and so, statistically, they’re more likely to be diagnosed with BPD. But plenty of men have the condition, as well. Research actually suggests that all genders likely experience BPD equally.

The condition sometimes presents differently in men vs. women, though. Seanor says men with BPD may display a history of substance abuse, explosive temperaments, and antisocial behaviors. Women may show eating, mood, anxiety, and post-traumatic stress disorders.

“This distinction is important to recognize when examining gender discrepancies in the diagnosis of BPD,” she says.

Men might more commonly use rehab and addiction treatments for substance abuse and may be misdiagnosed as having post-traumatic stress disorder (PTSD), narcissism, or depression.

“It’s also significant to note that as a result of their explosive and antisocial tendencies, men are more likely to be incarcerated and not have access to mental health treatment, causing them to be more underrepresented,” Seanor says.

Signs of Borderline Personality Disorder

ACCORDING TO THE Diagnostic and Statistical Manual of Mental Disorders (DSM), classic signs of BPD include:

• Patterns of unstable or changing relationships—that alternate between idealization and devaluation of someone
• Fear of abandonment
• Unstable self-image
• Struggles with identity or sense of self
• Impulsive or self-damaging behaviors—like excessive spending, substance abuse, reckless driving, or unsafe sex
• Self-harm, including suicidal threats or attempts
• Mood swings—periods of intense anxiety, depressed moods, or irritability that last for hours or days
• Constant feelings of worthlessness or sadness
• Inappropriate, intense, or uncontrollable anger—sometimes followed by shame or guilt
• Paranoia or loss of grasp of reality caused by stress
• Persistent feelings of boredom, emptiness, or dissatisfaction
• Dissociative feelings, where someone disconnects from their thoughts or sense of identity

However, research suggests men are more likely to have substance abuse and display “external” behaviors, like antisocial personality traits, violent self-harm, and interpersonal aggression.

Impulsivity is a common BPD symptom for men, Dr. Crawford says. “Some of those impulsive behaviors could be physical aggression, getting into fights. It could be substance abuse. It could be reckless driving.”

This could also show up as binge eating, overspending, or having multiple sexual partners and not using protection.

Men with BPD also may be more likely to have thoughts and make claims about suicide, she adds. It may be a learned behavior—when they’re feeling abandoned by someone or a lack of connection, they make a suicidal statement to get the attention of others.

Why People with BPD Struggle With Relationships

PEOPLE WITH BPD have a serious fear of abandonment, struggle to regulate their emotions, and act impulsively and recklessly, according to the Cleveland Clinic. They’re prone to angry outbursts and rapid mood swings, too.

“They didn’t learn all of the appropriate tools and strategies for how to have meaningful and healthy relationships and connections to other people—while they also had difficulty forming their own self-identity,” Dr. Crawford says.

These feelings and behaviors can push others away, Seanor adds, “causing those with BPD to have more instability with increased sadness, worthlessness, and fear.”

The intense emotions and a strong sense of abandonment lead people with BPD to believe their partners or loved ones will leave them, so they often want a constant validation of their commitment, Keohan says.

Still, “Loving someone with BPD isn’t an impossible task,” she says. Informing yourself about the condition is essential in navigating the relationship and dealing with the challenges.

Is BPD treatable?

PEOPLE LIVING WITH BPD don’t always realize they have the condition or that healthier ways of handling emotions and relating to others exist.

Psychotherapy and medication are common treatments for BPD, according to NAMI. Another is dialectical behavior therapy, which educates people on life skills and emotional regulation, Keohan says.

However, seeking treatment may be difficult for people with BPD, she explains.

“Therapy can be a type of relationship, too, and still in modern times, feel and be perceived as stigmatic,” Keohan adds. “Discourse can be a challenge in terms of establishing rapport and trust.”

Trying to push a loved one into getting treatment might thrust them deeper into their illness, Seanor says. “It’s important for loved ones to point out signs in a caring, supportive, and nonjudgmental manner while also attuning to their own needs.”

What to Do When A Loved One Has BPD

RELATIONSHIPS AREN’T JUST difficult for people with BPD. The condition affects everyone around them.

Seanor says research shows that validating a person with BPD’s feelings and emotions—not agreeing with them—can help de-escalate, ground, and calm them down. “This can be difficult, as the emotional reaction often doesn’t make sense to those not affected by the disorder,” she adds.

Setting boundaries can help, too. Seanor says boundaries create structure and accountability. “Holding individuals accountable for their emotional reactions helps prevent close ones from enduring unacceptable and potentially harmful behaviors,” she says, and it creates room for growth and healing for everyone in the relationship.

Seek out a mental health professional if it all gets to be too much. Keohan says this will help you learn how to cope with your relationship and how best to move forward.

“BPD is treatable, and if your partner has been diagnosed with it, it doesn’t necessarily change who they are or why they love you,” she says. “Leaving prematurely can be damaging to both of you, but certainly, it can impact any future trust issues.”

But if the relationship is harmful to you—mentally, emotionally, or physically—Seanor says it’s usually best to end things.