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Borderline personality disorder (BPD) is a chronic mental health condition that is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). BPD is characterized by “a pervasive pattern of instability and hypersensitivity in interpersonal relationships, instability in self-image, extreme mood fluctuations, and impulsivity…[and] often struggle with relationship issues, lack self-esteem, have a poor self-image, and have an inability to appropriately self-regulate.” In the past, BPD was more frequently diagnosed in women than in men with a 3:1 female to male gender ratio. However, recent data suggests the differential gender prevalence of BPD in clinical settings appears to be primarily a function of sampling bias and true prevalence by gender is unknown.

Signs and Symptoms

For diagnostic purposes, the DSM-5 list nine primary symptoms for borderline personality disorder. Five of the nine must be detected before a mental health professional can make a diagnosis of BPD, although it is common for sufferers to demonstrate more than five. The nine symptoms are:

  1. Strong, largely irrational fears of abandonment accompanied by frantic, desperate efforts to avoid it
  2. In the context of relationships, alternating periods of idealization (intense love and admiration) and devaluation (feelings of revulsion and disillusionment)
  3. Persistently unstable self-image and sense of identity
  4. Impulsivity in at least two areas that can cause damage to self or others (e.g., reckless spending, substance abuse, binge eating, compulsive gambling, unsafe driving, etc.)
  5. Episodes of acute emotional disquiet (irritability, anxiety, or anguish) that last for hours or days
  6. Chronic feelings of emptiness, meaninglessness, and low motivation
  7. Explosive, intense bursts of uncontrollable anger
  8. Outbreaks of dissociative symptoms marked by extreme paranoia, suspicion, and a disconnection from reality
  9. Suicidal threats and actions and self-harming behavior (e.g., cutting, burning, pulling out hair, scratching the skin until it bleeds, etc.)

The overall symptomatic profile for borderline personality disorder is largely the same for men and women. Nevertheless, there are some differences in the way the symptoms of BPD manifest in the two genders. In general, men with BPD are:

  • Highly sensitive to criticism, and aggressive in response to perceived insults
  • Overly controlling in relationships
  • Intensely jealous and possessive
  • Quick to become disillusioned with others, and openly expressive of their contempt
  • Subject to instantaneous mood changes
  • Excessively irritable and prone to episodes of explosive anger
  • Likely to compensate for feelings of inadequacy through risky, dangerous behavior

As this list reveals, BPD in men presents as hostility and aggressiveness more so than is seen in women with borderline personality disorder. Findings from one study illustrate that men with BPD are more likely (58 percent versus 44 percent past-year incidence) to develop substance use disorder than women with borderline personality disorder.

For Information and Support 

Every family in need of mental health treatment must select a program that will best suit the needs of their family. When one member of a family struggles, it impacts everyone in the family unit. To maximize the benefits of treatment we work closely with the entire family to ensure that everyone is receiving the support they need through these difficult times. Seeking help is never easy, but you are not alone! If you or someone you know needs mental health treatment, we strongly encourage you to reach out for help as quickly as possible. It is not uncommon for many mental health difficulties to impact a person’s life, long term. Pursuing support at the beginning of one’s journey can put the individual in the best position to learn how to manage themselves in a healthy way so they can go on to live happy and fulfilling lives.


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