Therapy Soup welcomes Dr. Robert Fischer. Dr. Fischer is executive director of the Optimum Performance Institute in Woodland Hills, CA. OPI’s Roanne Program specializes in treating young adults with Borderline Personality Disorder or BPD traits.
When most people think of a person with a borderline personality disorder diagnosis, they think of it being a woman’s disorder. Yet, men can also have BPD. How many men have BPD and what percentage of all BPD sufferers are men?
Years ago, clinicians were reluctant to make the diagnosis of BPD partly because the treatments available were not yielding favorable results, and therefore, there was not a lot of hope for full recovery.
With the advent of Dialectic Behavioral Therapy (DBT) and other therapeutic modalities, it is clear we can do much to help people with BPD improve the quality of their lives. We have made major progress in de-stigmatizing the diagnosis of BPD in females.
Finally, we are taking the next step and doing the same for males.
Previous research showed that men were about 25% of BPD cases. Today, we know it is a remarkable 50/50 divide.
How does BPD in men differ from BPD in women?
Scientific literature implies that women with BPD are more likely to demonstrate disorders of eating, mood, anxiety, and PTSD, whereas men demonstrate paranoia, passive/aggressive tendencies, narcissism, and antisocial personality disorders. Men with BPD seem to be more prone to abusing spouses instead of directing anger at themselves. They demonstrate personalities characterized by explosive temperaments, substance abuse, and a need to seek exciting experiences.
While this may be supported by the data, I believe it gives a very pejorative impression of men. In truth, there is no difference between men and women in terms of their presenting levels of psychological stress. Both are human beings who experience tremendous anxiety. Both men and women are subject to their own genetics and possibly abusive social exposures, and all have a need to be validated.
Certainly in the Roanne Program, we see men with BPD who do not present with antisocial personality disorders. They are not paranoid. They look quite different than this stereotypical labeling.
How we look at someone in distress determines, in part, how we treat them.
There is always some truth to the generalizations about behavior, but each person is unique. It is important to refrain from placing a person into statistically calculated boxes. No one deserves to be stereotyped.
Are the causes or antecedents different in BPD in men vs. women?
Specific causes or antecedents may differ. But both men and women with BPD share an underlying difficulty in managing stress and anxiety. There may be neurological or genetic causes and there may be differences in the ways in which they cope with feeling invalidated. This leads to the BPD sufferer being distracted and finding it difficult to complete their goals. Not being able to complete one’s goals causes problems with self-esteem. This cycle of feelings and behaviors can make it difficult to establish consistent and nurturing relationships with others.
Both men and women suffer equally.
We sometimes see men with some characteristics of BPD sufferers, yet they have other personality disorder markers, too. For example, anti-social personality disorder and BPD sometimes seem to overlap. NPD in some cases, too. Can you comment on this?
Certainly there are many men with BPD who also have antisocial and narcissistic personalities.
For this group, help needs to be delivered in a comprehensive way, addressing the aggressiveness and antisocial behaviors while providing containment as well as compassion and understanding. It can be extremely difficult to provide meaningful and adequate care to men (or women) who have antisocial behaviors.
However, the young men we have been working with generally do not appear antisocial. This leads me to believe that there are many men who could benefit from, and who are deserving of, care but may be reluctant to present themselves for help because they feel they don’t fit the current BPD diagnosis.
The young men we see for BPD treatment clearly do demonstrate the underlying thinking processes, meaning rigid, black-or-white thinking styles and perfectionism. They find it hard to compromise, which makes their ability to establish intimate relationships more difficult. Seeing the world in this very black or white way also makes it difficult for them to successfully master the ups and downs that come with achieving complex goals because the downs are experienced as catastrophic and overwhelming.
Of course, this way of seeing the world is common. We all do it at times. But when it becomes the predominant way of handling stress and anxiety, it becomes problematic, particularly in individuals who are prone to having intense emotional swings.
The association of narcissism and antisocial behaviors with BPD, I believe, may partly be an artifact of the group of people upon whom the studies have been based. A diagnostic system that is based on statistically valid behavioral observations but which does not address one’s inner life produces a system that may have verifiability but, many times, bears little resemblance to the individual sitting in the consultation room.
That is such an important point, Dr. Fischer. We have to understand that the picture we have may not be complete or even accurate and that each person in treatment is an individual.
The picture grows even more confusing when one observes how many other diagnoses such as depression, anxiety, bipolar, and ADD and ADHD are also part of the picture in both men and women diagnosed with BPD.
Our diagnostic system, I believe, simply presents guidelines that may be helpful.
More about men and borderline personality disorder with Dr. Fischer, posting soon.
Robert F. Fischer, M.D., is executive director and co-founder of the Optimum Performance Institute (OPI), a JCAHO-accredited therapeutic, residential, educational young adult program in Woodland Hills, CA. OPI’s Roanne Program specializes in treating young adults with Borderline Personality Disorder or BPD Traits. Dr. Fischer is assistant clinical professor of psychiatry, David Geffen UCLA School of Medicine, Department of Psychoneuroimmunology, Mindful Awareness Research Institute. He has helped young adults find meaning in their lives for nearly 35 years.
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Last reviewed: 7 Mar 2014