We continue discussing Men and Borderline Personality Disorder with Robert Fischer, MD of the Roanne Program, which specializes in in the treatment of young adults with borderline personality disorder or BPD traits.
How does the treatment of borderline personality disorder differ for men and women?
Fundamentally, treatment does not differ!
DBT (Dialectical Behavior Therapy), mentalization, and other treatment formats are helpful for both men and women.
The differences in treatment are really more about the uniqueness of each individual.
The therapist helps each client identify their unique strengths and helps foster and cultivate those strengths. Effective therapy involves helping the client—male or female—find and develop their passion, experience moments of authentic joy, and share their experience with others.
This is what seems to be lacking in many of the cognitive behavioral approaches.
That’s a useful insight. CBT can help people regulate their behavior and emotions, but the ability to experience joy and sharing are not necessarily emphasized.
Once a person is able to regulate their emotions and relinquish the obsessional need to always be in control, the basic question for both sexes is:
How can I experience joy in my life and learn to express and share it?
I have sub-specialized over the past decade in working with young adults ages seventeen through twenty-eight. At our program we focus not only on mood stabilization, using and acquiring mentalization and DBT skills, we also provide support, motivation, and stimulation to help individuals gain the skills they need to develop relationships, explore different passions, and express and share them in the real world.
We believe this is the ticket to achieving a life worth living—for everyone.
Why did you decide to work with men with borderline personality disorder?
I became interested when I saw gifted, sensitive young men who fit all the diagnostic criteria for BPD, but who were able to work successfully in our program environment.
They were not paranoid or passive aggressive. They did not demonstrate antisocial behaviors. But the way they saw the world and the defenses that they used were similar to women with BPD.
They tended to project their feelings and moods onto others. They were extremely labile (having unstable and erratic emotions). They continually felt invalidated and tended to think in black-or-white ways.
They also continued to be unsuccessful at achieving longer-term goals because they were distracted by emotional dysregulation. Some utilized cutting and other self-destructive behaviors.
I became aware that there are many men who fit the BPD criteria who deserve and can benefit from treatment and help.
Are men likely to seek treatment for the symptoms of BPD—whether or not they know what it is?
In general, men are less likely to seek psychiatric or psychological help than women because of cultural biases. At the Roanne Program, we work with men from all backgrounds. For example, among the men who’ve come to our program are gifted actors and musicians.
When should a man consider getting an evaluation to rule out BPD?
A comprehensive evaluation by a skilled therapist is indicated:
When you experience a tremendous sense of isolation and alienation.
When you feel continually unhappy.
When you are aware that your moods are extremely dysregulated.
When you are not moving forward in your life.
Fortunately, borderline personality disorder now is becoming a more acceptable and better-understood diagnosis and real help is available for men and women.
Thank you so much for your insights, Dr. Fischer.
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.