Borderline Personality Disorder (BPD) in Men: Signs, Symptoms, & Treatments

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental health condition marked by intense emotions, difficulty maintaining relationships, and frequent mood swings—often described as “hot and cold” behavior. People with BPD may experience deep feelings of emptiness and struggle with uncertainty about their identity. BPD has four recognized subtypes, and symptoms can vary significantly from person to person. Understanding these variations is key to recognizing how BPD affects individuals differently.

Signs & Symptoms of BPD Men

Borderline personality disorder in men includes a combination of BPD symptoms such as intense anger, antisocial behavior, substance use, suicidal ideation or attempts, and novelty seeking. Despite typically exhibiting more aggressive behaviors than women with BPD, men more commonly go either misdiagnosed or undiagnosed altogether.

Although a person of any gender may experience similar symptoms, there are signs of BPD that are more prevalent in men, including intense displays of anger, antisocial behavior, and substance use, among others. This is possibly due to a man’s propensity to engage in externalizing behaviors, compared to a woman’s tendency to internalize BPD symptoms.²

Signs and symptoms of borderline personality disorder in men may include:²

1. Displays of Intense Anger

More so than their female counterparts, men with BPD struggle with extreme anger (BPD rage), explosive episodes, aggression, and violence. Research suggests this may be due to deficiencies in an area of the brain known as the lateral prefrontal cortex, which is responsible for sending signals that calm the parts of the brain that respond to perceived threats.³

2. Antisocial Behavior

One study found that antisocial personality traits–such as lying, lacking empathy, and disregarding right and wrong– occurred in 57% of men versus 26% of women.^1,4 Antisocial behaviors may be signs of BPD when they are done to avoid abandonment (e.g., conning someone to get them to stay in a relationship with them) or as a means of demonstrating intense anger towards someone else (e.g., bullying or engaging in physical altercations).

3. Substance Use

Men with BPD are significantly more likely to abuse substances than women.^1,5 Those who engage in such behaviors tend to experience negative affect, alexithymia (the struggle to express emotions), and dissociation.² They may use substances as a way of coping with these and other symptoms, as impulsive behavior, or as a means of self-harm, all of which are common in those with BPD.

4. Impulsivity

Impulsivity is a core symptom of BPD and involves engaging in risky or careless behaviors without consideration of long-term consequences. Whereas women with BPD may engage in this behavior through eating or dieting habits, men with BPD are more likely to act out against others or use substances.^5,6 Additionally, while these behaviors are common for BPD patients, some experts believe that impulsive BPD is its own subtype.

5. Self-Harm Behavior

Self-harm is a common symptom of BPD, affecting 65-80% of people with a diagnosis.⁷ In men, self-harm can take many forms, including cutting, burning, punching (oneself or objects), and head-banging. These actions may serve a variety of purposes, such as garnering a sense of agency or distracting from emotional pain. They could also be due to one believing they are deserving of punishment.

6. Suicidality

Like self-harm, suicidality (both thinking about and acting on the desire to complete suicide) is characteristic of BPD and may serve a variety of functions (e.g., escape from reality, chronic emptiness, hopelessness, and feelings of worthlessness). Men with comorbid unipolar depression or bipolar disorder are twice as likely to commit suicide compared to women with BPD.²

7. Unstable Relationships

Men with BPD may form insecure attachments, making their dependency, insecurity, and fear of abandonment known to loved ones. Insecure attachments may manifest as revenge-seeking behaviors or aggression toward friends when feeling left out. Men with BPD may also engage in BPD splitting, which involves viewing others as all “good” or all “bad.” Additionally, males may have an unstable relationship with themselves, sometimes resulting in frequent career changes and/or rapidly changing interests.

8. Narcissism & the BPD Connection

Men with BPD are more likely to experience symptoms of vulnerable narcissism and grandiose narcissism.⁸ The relationship between BPD and NPD is complex, with some individuals meeting criteria for both disorders. While these symptoms may be indicative of a comorbid narcissistic personality disorder (NPD) diagnosis, they may also be an attempt to cope with an unstable sense of self or sensitivity to others’ criticism or rejection characteristic of BPD.

Why BPD in Men Often Goes Undetected

BPD often goes underdiagnosed or undetected in men for a number of reasons, and research shows that women with BPD are three times more likely to receive an accurate diagnosis than men.⁹ This may be due to factors including gender differences in clinical presentation, clinician bias, and variations in the treatment settings.

Unfortunately, men are less likely to pursue treatment than women due to the negative stigmas associated with mental health. Oftentimes, men feel that they must live up to certain social masculine expectations, resulting in a subconscious resistance to seeking help.

Reasons for overlooking BPD in men may include:

• Clinical presentation: Gender differences in the presentation of symptoms may lead to men’s symptoms being disregarded or attributed to an entirely different issue (i.e., substance use disorder).
• Clinician bias: While findings on clinician bias are mixed, one possible explanation for men’s underdiagnosis of BPD is that clinicians perceive intense anger in women as diagnostic, whereas for men they view it as characteristic of masculinity.⁹
• Treatment utilization: Men with BPD are less likely to utilize psychotherapy and pharmacotherapy services than their female counterparts.¹ Thus, willingness or opportunity to use treatment services may contribute to different rates of BPD diagnoses given among men and women.

Treatment Options for Male BPD

Men with BPD have several options for borderline personality disorder treatments. Generally, dialectical behavior therapy (DBT) for BPD–a structured treatment involving individual therapy, skills groups, and phone coaching– is the front-line method chosen by practitioners. DBT emphasizes learning and implementing skills such as mindfulness for BPD, distress tolerance, emotion regulation, and interpersonal effectiveness.

Due to the social and genetic components of BPD, involving loved ones in a person’s treatment plan through family therapy can optimize its outcomes.¹⁰ Some patients may also benefit from medications for BPD to help with symptom management.

If you are struggling with the negative symptoms of BPD, you should consider choosing a therapist who specializes in BPD by exploring an local therapist directory. You can also consider one of the many online therapy options available to receive treatment from the comfort of your own home, or virtual intensive outpatient programs at Charlie Health for more personalized care.