Borderline Personality Disorder (BPD) is a multifaceted mental health condition marked by significant instability in emotions, self-image, and interpersonal relationships. Traditionally, BPD has been more frequently diagnosed in women; however, recent studies show that men are equally susceptible but are often underdiagnosed or misdiagnosed. This discrepancy underscores the necessity of understanding how borderline personality disorder in men differs from borderline personality disorder in women.
Understanding the Presentation of Borderline Personality Disorder in Men
Men with BPD are less likely to seek help and more likely to be misdiagnosed with antisocial personality disorder, substance abuse, or even bipolar disorder. In fact, while clinical samples often report that roughly 75% of BPD diagnoses are in women, community-based research tells a different story. Epidemiological studies like the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) have found that borderline personality disorder in men may occur at nearly equal rates as in women—suggesting the diagnostic imbalance is more about perception and systemic gaps than actual prevalence.
One reason for this disparity is that borderline personality disorder in men often presents differently than it does for women. While emotional dysregulation is a hallmark in both genders, men may externalize their distress through aggression, substance use, or risky behavior. In contrast, women are more likely to internalize emotions, displaying symptoms such as depression, self-harm, and chronic feelings of emptiness. This difference in symptom expression can influence both the type of help men seek and how clinicians interpret their behaviors.
How BPD Is Commonly Diagnosed in Women
While women are more frequently diagnosed with BPD, their symptom profiles tend to align more closely with the criteria laid out in the DSM-5. They often experience:
- Deep fears of abandonment
- Chronic feelings of emptiness
- Identity disturbances
- Intense, unstable relationships
- Emotional reactivity and self-injurious behavior
These internalizing symptoms—such as anxiety, mood swings, and suicidal ideation—are often more visibly aligned with traditional models of personality disorders and therefore more likely to be recognized by clinicians. Women with BPD are also more likely to seek therapy voluntarily and to receive interventions like Dialectical Behavior Therapy (DBT), which is particularly effective for addressing emotional dysregulation and suicidal ideation.
In some ways, the overdiagnosis of BPD in women can also be a disservice. Studies show that women of color may be disproportionately labeled with BPD in lieu of trauma diagnoses, leading to treatment that may not fully address the root of their distress (Beck & Castillo, 2021). While women are more likely to receive a diagnosis, that doesn’t always mean they’re getting the right kind of help.
Symptoms of Borderline Personality Disorder in Men vs. Women
While many core symptoms overlap across genders, there are consistent trends in how those symptoms manifest. Understanding these gendered expressions is essential for clinicians trying to make accurate assessments.
In men, BPD symptoms often lean toward:
- Explosive anger or irritability
- Risk-taking or thrill-seeking behavior
- Substance abuse and addiction
- Emotional detachment or numbing
- Difficulty identifying and expressing emotions
- Trouble with authority or frequent legal issues
In women, symptoms may more commonly include:
- Self-harm or suicidal behavior
- Intense mood swings
- Fear of abandonment
- Chronic feelings of worthlessness
- Hyper-attachment in relationships
- Severe depression or anxiety
Because borderline personality disorder in men tends to look more like antisocial behavior or anger management issues, many go undiagnosed or are treated within the criminal justice or substance abuse systems. Without proper psychological assessment, the underlying condition remains hidden beneath the surface-level behaviors. This can lead to cycles of ineffective treatment, frustration, and worsening symptoms.
Diagnosis and Treatment Outcomes for Borderline Personality Disorder in Men
Even when borderline personality disorder in men is correctly identified, treatment pathways often diverge from those of their female counterparts. Men are less likely to be referred to psychotherapy and more likely to receive minimal interventions or medication alone. Studies suggest that men receive significantly fewer evidence-based treatments such as Dialectical Behavior Therapy (DBT), which has proven effective in treating BPD. Furthermore, a more holistic approach might also incorporate therapies like EMDR for depression to address co-occurring mood issues that can impact treatment engagement and overall well-being. When enrolled in structured therapy programs, however, men respond well—though current therapies may be more finely tuned to address the internalizing symptoms often seen in women.
Research published in the Journal of Clinical Psychology found that after 12 months of DBT, both men and women improved, but women showed greater reductions in affective instability and self-harm. These findings don’t suggest that men are less capable of recovery but instead highlight the need for gender-responsive approaches. Borderline personality disorder in men may benefit from more structured, goal-oriented models that align with how male clients often engage in therapy.
BPD in Trans and Non-Binary People
While much of the research and clinical understanding of Borderline Personality Disorder (BPD) has historically focused on cisgender men and women, it’s vital to recognize that trans and non-binary individuals also experience BPD. However, their experiences can be uniquely shaped by the complexities of gender identity, societal stigma, and the process of gender transition. This section aims to shed light on some of these important considerations.
Intersection of Gender Identity and BPD
For trans and non-binary individuals, the core features of BPD, such as unstable self-image and intense emotional fluctuations, can become intertwined with their gender identity journey. For example, the process of exploring and affirming one’s gender can be emotionally intense and may overlap with emotional dysregulation, a common characteristic of BPD. Internal conflict related to gender identity, or external invalidation of that identity, can contribute to feelings of emptiness, instability, and difficulties in relationships.
Unique Stressors and Their Impact for Trans and Non-Binary People
Trans and non-binary individuals often face significant stressors that can exacerbate BPD symptoms or make them more challenging to manage. These stressors can include:
- Discrimination and Microaggressions: Experiencing prejudice and subtle forms of bias can lead to chronic stress and emotional distress.
- Lack of Acceptance and Support: Rejection from family, friends, or community can intensify feelings of isolation and worthlessness.
- Gender Dysphoria: The distress caused by a mismatch between gender identity and assigned sex can contribute to anxiety, depression, and self-harm.
- Navigating Transition: The medical, social, and legal aspects of transitioning can be emotionally and logistically demanding.
- Internalized Transphobia or Enbyphobia: Internalizing negative societal messages about transgender and non-binary identities can damage self-esteem and contribute to mental health challenges.
Trans and Non-Binary Specific Presentation of BPD Symptoms
The way BPD symptoms manifest in trans and non-binary individuals may not always align neatly with the typical presentations seen in cisgender men and women. For instance:
- Self-Image Instability: This might be closely linked to their gender identity and the process of self-discovery and affirmation.
- Intense Relationships: Difficulties in relationships could be compounded by societal biases, lack of understanding from others regarding their gender identity, or anxieties related to disclosure.
- Emotional Dysregulation: Emotional reactivity might be heightened by the stress of navigating a world that often doesn’t fully recognize or validate their existence.
- Self-Harm: Self-harm could be a coping mechanism for gender dysphoria, internalized stigma, or the emotional pain of discrimination.
Diagnosis and Treatment Considerations for Trans and Non-Binary People
It is crucial for mental health professionals to approach diagnosis and treatment for BPD in trans and non-binary individuals with cultural humility and a deep understanding of gender identity. Misattributing BPD symptoms solely to gender identity issues or vice versa can lead to misdiagnosis and ineffective treatment. Gender-affirming care is paramount, meaning that the therapist acknowledges, respects, and supports the individual’s gender identity throughout the therapeutic process.
Societal Stigma and Emotional Suppression
Gender norms play a significant role in how borderline personality disorder in men is experienced and treated. Cultural expectations often discourage emotional expression in men, which can exacerbate symptoms like anger, irritability, and dissociation. Emotional suppression not only fuels the disorder but also delays diagnosis and intervention. As a result, many men with BPD end up cycling through the criminal justice system or substance use treatment centers before ever being formally assessed for a personality disorder.
This stigma isn’t just cultural—it’s clinical. A study from the American Journal of Psychiatry found that clinicians were more likely to diagnose women with BPD even when presented with identical symptom descriptions from male and female patients. This highlights the systemic challenges men face in getting the care they need. Normalizing emotional vulnerability and creating safe, judgment-free therapy environments are crucial to engaging more men in effective, sustained treatment.
Paving the Way for Gender-Sensitive Mental Health Care
If we are to close the gap in diagnosis and treatment, the mental health field must continue evolving toward gender-sensitive care. That includes recognizing how borderline personality disorder in men presents uniquely, rethinking how we assess for it, and making specialized support more accessible. At the Center for Effective Treatment, we draw on over 45 years of combined experience to support people across the gender spectrum in overcoming BPD, trauma, substance use, and emotional dysregulation. Schedule a consultation today.