Borderline personality disorder (BPD) in men is more common than many realize, though it often presents differently than BPD in women. Men with BPD may struggle with intense emotional fluctuations, aggression, relationship difficulties, and impulsive behavior, but these signs can be easily overlooked or misunderstood. Recognizing the signs and symptoms early and understanding how BPD affects men is the first step toward seeking help and managing the disorder.
Therapy for Borderline Personality Disorder
BetterHelp has over 30,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week and is FSA/HSA eligible by most providers. Take a free online assessment and get matched with the right therapist for you.
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.
Help for BPD
Talk Therapy – Get help living with Borderline Personality Disorder from a licensed therapist. BetterHelp offers online therapy starting at $65 per week and is FSA/HSA eligible by most providers. Free Assessment
BPD Treatment for Teens & Young Adults – Charlie Health’s virtual intensive mental health program for young people (ages 11-33) includes curated groups, individual therapy, and family therapy for teens and adults with serious mental health issues. Insurance accepted. Learn More
DBT Skills Course – DBT is a popular treatment for BPD. Learn DBT skills with live weekly classes and online video courses. Free Trial
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.
In My Experience
Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
-
Sansone, R. A., & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in clinical neuroscience, 8(5), 16.
-
Bayes, A., & Parker, G. (2017). Borderline personality disorder in men: A literature review and illustrative case vignettes. Psychiatry research, 257, 197-202. https://doi.org/10.1016/j.psychres.2017.07.047
-
Bertsch, K., et al. (2019). Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder. Neuropharmacology, 156, 107463. https://doi.org/10.1016/j.neuropharm.2018.12.010
-
Paris, J., Chenard-Poirier, M. P., & Biskin, R. (2013). Antisocial and borderline personality disorders revisited. Comprehensive psychiatry, 54(4), 321-325. https://doi.org/10.1016/j.comppsych.2012.10.006
-
Zlotnick, C., Rothschild, L., & Zimmerman, M. (2002). The role of gender in the clinical presentation of patients with borderline personality disorder. Journal of personality disorders, 16(3), 277-282. https://doi.org/10.1521/pedi.16.3.277.22540
-
Johnson, D. M., et al. (2003). Gender differences in borderline personality disorder: Findings from the Collaborative Longitudinal Personality Disorders Study. Comprehensive psychiatry, 44(4), 284-292. https://doi.org/10.1016/S0010-440X(03)00090-7
-
Brickman, L. J., et al. (2014). The relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college sample. Borderline personality disorder and emotion dysregulation, 1(1), 1-8. https://doi.org/10.1186/2051-6673-1-14
-
Euler, S., Stöbi, D., et al. (2018). Grandiose and vulnerable narcissism in borderline personality disorder. Psychopathology, 51(2), 110-121. https://doi.org/10.1159/000486601
-
Skodol, A. E., & Bender, D. S. (2003). Why are women diagnosed borderline more than men?. Psychiatric Quarterly, 74(4), 349-360. https://doi.org/10.1023/a:1026087410516
-
Fitzpatrick, S., Wagner, A. C., & Monson, C. M. (2019). Optimizing borderline personality disorder treatment by incorporating significant others: A review and synthesis. Personality Disorders: Theory, Research, and Treatment, 10(4), 297. https://doi.org/10.1037/per0000328
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: (No Change)
Medical Reviewer: (No Change)
Primary Changes: Added Borderline Personality Disorder worksheets. Fact checked and edited for improved readability and clarity.
Author: Brooke Schwartz, LCSW
Reviewer:Benjamin Troy, MD
Your Voice Matters
Can't find what you're looking for?
Request an article! Tell ChoosingTherapy.com’s editorial team what questions you have about mental health, emotional wellness, relationships, and parenting. Our licensed therapists are just waiting to cover new topics you care about!
Leave your feedback for our editors.
Share your feedback on this article with our editors. If there’s something we missed or something we could improve on, we’d love to hear it.
Our writers and editors love compliments, too. :)
Additional Resources
Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.
Talk Therapy
BetterHelp – BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week and is FSA/HSA eligible by most providers. Take a free online assessment and get matched with the right therapist for you. Free Assessment
Brightside Health – develops personalized plans that are unique to you and offers 1 on 1 support from start to finish. Brightside Health accepts United Healthcare, Anthem, Cigna, and Aetna. Appointments in as little as 24 hours. Start Free Assessment
BPD Treatment For Teens & Young Adults
Charlie Health’s virtual intensive mental health program for young people (ages 11-33) includes curated groups, individual therapy, and family therapy for teens and adults with serious mental health issues. Insurance accepted. Learn More
DBT Skills Course
Jones Mindful Living Dialectical Behavior Therapy (DBT) is a popular treatment for BPD. Learn DBT skills with live weekly classes and online video courses for only $19 per month. Free One Week Trial
Free BPD Newsletter
A free newsletter from Choosing Therapy for those impacted by BPD. Get helpful tips and the latest information. Sign Up
Choosing Therapy Directory
You can search for therapists by specialty, experience, insurance, or price, and location. Find a therapist today.
Best Online Therapy Services
There are a number of factors to consider when trying to determine which online therapy platform is going to be the best fit for you. It’s important to be mindful of what each platform costs, the services they provide you with, their providers’ training and level of expertise, and several other important criteria.
Best Online Psychiatry Services
Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.