Borderline Personality Disorder in Men: Symptoms, Stigmas, and Treatment
Mental Health ConditionsBorderline Personality Disorder
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Borderline Personality Disorder in Men: Signs and Symptoms to Watch For

Borderline Personality Disorder in Men: Signs and Symptoms to Watch For
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Updated on January 10, 2025
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People with borderline personality disorder (BPD), one of 10 types of personality disorders,

 find it difficult to control their emotions. They feel extreme emotions for a long time after a triggering event and have challenges returning to a stable emotional state afterward.

Around 3 in 4 people with a BPD diagnosis are women. But according to the National Alliance on Mental Illness, men may be equally likely to have BPD but show different symptoms that lead to an incorrect diagnosis.

It’s vital to recognize symptoms in men, because the risk of death by suicide is about 40 times higher in people with BPD than the general population. BPD can be treated, and treatment can help improve quality of life and prevent severe complications.

Note: When this article and the research cited within it refers to “men” or “males,” that means men assigned male at birth.

Signs and Symptoms of BPD in Men

The symptoms of BPD look different in different people. A person may have mood swings and lack a clear self-image, leading to relationship issues and emotional difficulties. A person with BPD may view the world through extremes, perceiving everything as either good or bad. Rapidly changing interests and reckless or risky actions are also common.

Other symptoms may include:

  • Unstable relationships with others, including attempts to avoid real or imagined abandonment (suddenly entering or leaving relationships)
  • Impulsive behaviors like substance abuse, unprotected sex, reckless driving, binge eating, or spending sprees
  • Self-harm
  • Suicidal ideation
  • Intense and rapid mood changes
  • An ongoing feeling of emptiness
  • Anger that is out of proportion to the trigger, or difficulty controlling it
  • Dissociative symptoms, such as feeling like the world isn’t real or that you’re in some way separate from yourself

A review of 118 papers, published in 2022, acknowledged that the current literature on the differences between males and females with BPD is “fragmented and inconclusive,” but it also found that males with BPD were more likely to exhibit symptoms of aggressiveness and impulsivity — also known as “externalizing” symptoms — than females. Therefore, males were less likely to experience “internalizing” symptoms like intense fear of abandonment, self-identity issues, and dissociation. Comorbid disorders, such as those relating to mood, anxiety, and eating, also occurred more often in females, while substance use disorder tended to be the comorbidity that appeared most often in males. Additionally, females were found to be more likely to engage in self-harm or suicidal behavior.

A study published in 2024 found that males with BPD did not always show more signs of aggression than females, even though evidence supports higher levels of aggression in males who do not have BPD than females without the condition. BPD may in fact reduce the difference between male and female aggression levels.

Finally, despite the above reports of women with BPD being more likely to exhibit self-harm or suicidal behavior, a 2024 paper concluded that men with BPD also exhibited this symptom, though in a different form. It found that self-harm in women usually took the form of cutting, while men were more likely to hit themselves. It also stated that men with BPD might have a higher risk of death by suicide than women.

Diagnosis Can Be Tricky

People with BPD may not be aware of the effects of their condition, meaning they possibly don’t seek treatment for the disorder directly. Instead, they may seek help for depression or anxiety that develops after damaging life events, such as a divorce or job loss, that may have in part resulted from BPD. More women receive a BPD diagnosis than men in the United States, but it’s possible that the condition occurs in a similar number of men. The Cleveland Clinic suggests that doctors may misdiagnose BPD in males as depression or post-traumatic stress disorder.

Mental health professionals may misdiagnose conditions because of their own biases about sex and gender. Healthcare providers use several tools to line up symptoms with diagnoses, but these may not account for differences in experience between sexes. According to the American Association of Medical Centers, social stigma and lack of skills to express complex emotions may prevent men from seeking care.

On top of the complexity of diagnosing BPD in anyone, men may specifically face increased social stigma in connection with this personality disorder. For example, the 2024 study above examined how 415 U.S. adults responded to short descriptions of BPD subtypes, some of which described characteristics mainly common in males and others that occurred more in females. The researchers found that descriptions of male-linked BPD characteristics evoked more anger, fear, higher levels of stigma, and less sympathy than those of female-linked traits.

Treatment Options

BPD is difficult but not impossible to treat. Over time, treatment may lead to fewer symptoms, better function, and more stable quality of life.

 People may also need treatment for other conditions that occur because of BPD, including:
The main treatment for BPD is psychotherapy. This involves talking to a mental health professional who can help you understand the fears and contributing factors to thoughts and behaviors that are barriers to relationships with others.

  • Dialectical Behavioral Therapy (DBT) This therapy is specific to people with BPD and aims to help individuals embrace reality, adjust and reduce self-destructive behaviors, and control intense emotions.

     According to a study published in 2021, DBT was most effective for managing behavioral symptoms of BPD compared with Systems Training for Emotional Predictability and Problem Solving (STEPPS), which is discussed more in detail further in this article.

  • Cognitive Behavioral Therapy (CBT) CBT presents goals and provides a structure to help people understand how their thoughts impact their actions. This type of therapy can provide a roadmap for “unlearning” negative or destructive thought patterns and developing healthier ones.

  • Schema-Focused Therapy (SFT) This approach to therapy builds on CBT techniques but includes methods from additional psychotherapies. SFT aims to empower patients to adjust embedded, destructive patterns present throughout their lives. It focuses on daily living outside therapy, the patient-therapist relationship, and addressing traumas from childhood that often contribute to BPD. The Society of Clinical Psychology suggests research “modestly supports” it as an effective treatment.

  • Mentalization-Based Therapy (MBT) This therapy uses mindfulness and guided visualization to help an individual understand what they and others are thinking or feeling, known as mentalization. This is vital for self-knowledge, building an identity, and emotion and impulse control. MBT can be particularly helpful for people with BPD, who often have difficulties with mentalizing.

  • Transference-Focused Psychotherapy (TFP) This type of therapy focuses on a person with BPD’s distorted, exaggerated view of themselves that could be driving extreme mood changes, self-esteem issues, and problems in relationships. TFP’s goal is to support people with personality disorders to view themselves more realistically and in a more balanced way. This may promote better relationships with others and better daily function.

  • Systems Training for Emotional Predictability and Problem Solving (STEPPS) This is a group therapy program that includes family members or romantic partners in the sessions along with a therapist. STEPPS uses elements from CBT, helping the group to work with the condition in three main sections: learning about BPD, establishing emotional control techniques, and practicing behaviors to improve daily life. This can improve communication between patients with BPD and the people in their lives. STEPPS might also make BPD less severe, reduce depression and anxiety symptoms, reduce the tendency to feel negative emotions, and improve quality of life, per a review published in 2022. On the other hand, this review found the method didn’t reduce the number of hospitalizations, self-harm acts, or suicide attempts, so further research is necessary.

No medications have approval by the U.S. Food and Drug Administration (FDA) for BPD treatment because no evidence suggests they are effective for treating symptoms. Some doctors may prescribe medications for conditions that result from BPD, such as depression, anxiety, or disturbed sleep.

Most people with BPD don’t require hospitalization, but they might if they experience the following:

  • Suicidal ideation with a risk of imminent action
  • Severe negative thoughts, psychosis, or agitation
  • Self-harm that gets increasingly severe
  • Worsening related mental health or substance use disorders

Despite its severity, around 60 percent of people with BPD see symptoms improve long-term, according to StatPearls.

 Some people find that symptoms get better in their forties, and with treatment, symptoms become manageable and quality of life improves.

When to Seek Help

Addressing the stigmas around men seeking help for BPD is crucial, as they have a higher risk of suicide but remain less likely to connect with treatment.

 Without treatment, or if treatment is unsuccessful, people with BPD have an increased risk of substance and alcohol use disorders, depression, self-harm, and suicide. Up to 1 in 10 people with BPD die by suicide, per Cleveland Clinic.

 Treatment might also reduce the impact of BPD on relationships, employment, finances, and family connections.
Consider speaking to a physician if you recognize symptoms of BPD in yourself. They may ask about the impact of symptoms on daily life and rule out other mental health disorders, like depression. You can also choose to inform those closest to you about a BPD diagnosis once you feel comfortable, as they may be able to take part in treatments like STEPPS to help or look out for behavior indicating a crisis. They may also need support since BPD’s effects can ripple through a family. People who know they have BPD should contact their healthcare provider if symptoms worsen or new symptoms appear.

If you or someone you know is talking about self-harm or is in a state of extreme distress, contact the Suicide and Crisis Lifeline on 988 or message the 988lifeline.org online chat. This will connect you to trained crisis counselors.

The Takeaway

  • BPD may be as likely to develop in males as females, but the bias of medical professionals and stigma around externalizing symptoms may serve as barriers to diagnosis and treatment, despite the higher risk of men with BPD attempting suicide.
  • BPD is mostly treated through psychotherapy, and there are several options for patients to choose from.
  • This disorder is manageable, and treatment generally improves quality of life, enhances relationships, and reduces the effects of other conditions that may occur due to BPD, such as depression, anxiety, or bipolar disorder.

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Angela D. Harper, MD

Medical Reviewer
Castle Connolly Top Doctor

Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

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Adam is a freelance writer and editor based in Sussex, England. He loves creating content that helps people and animals feel better. His credits include Medical News Today, Greatist, ZOE, MyLifeforce, and Rover, and he also spent a stint as senior updates editor for Screen Rant.

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In his spare time, Adam enjoys running along Worthing seafront, hanging out with his rescue dog, Maggie, and performing loop artistry for disgruntled-looking rooms of 10 people or less.

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Resources
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