About Randi

Randi Kreger has brought the concerns of people who have a family member with borderline personality disorder (BPD) and narcissistic personality disorder (NPD) to an international forefront through her best-selling books, informative website, and popular online family support community Welcome to Oz.

 
 

New Book on Borderline Personality Disorder in Men


My column about men with borderline traits or borderline personality disorder was very popular. You can see it at http://www.psychologytoday.com/blog/stop-walking-eggshells/201104/borderline-disorder-in-men-overlooked-misdiagnosedhere.

Since then, a new book came out called Hard to Love: Understanding and Overcoming Male Borderline Personality Disorder.Joseph Nowinski, Ph.D., Central Recovery Press, Las Vegas. It's written for men with BPD or BPD traits, but friends and family will also find it helpful. The material in this blog came from the book.

From Psychologist Debra Mandel's foreword:

"For years, psychology has been heavily saturated with attention on women and their relationships, as if the male gender didn't matter. Tons of attention has gone toward understanding and diagnosing insecure and emotionally unstable women, both in the worlds of counseling and self-help.

"However, the male gender has been seriously short changed. Well, men too can suffer from low self-esteem, insecurity, and enormous self doubt that can compromise the stability of their intimate relationships. Because we've tended to stereotype men as the 'tough ones,' we've missed the boat on understanding the complexity of their inner world.

Joseph Nowinski says that a man's ability to recognize and cope with the borderline personality disorder (which affects them in equal numbers as women) is distinctive. Because men want to "save face" and won't seek help--even for simpler problems like anxiety and depression-- few studies on them exist.

Most therapists are clueless that men also have BPD even though the most conservative estimates say one in four BPD sufferers is male. In one study, researchers presented a group of 52 professionals working in California with the bio of a fake patient with clear borderline traits.

When the "client's" name was female, the clinicians made the correct BPD diagnosis. They misdiagnosed the patient's when the "client's" name was male, even though the two descriptions were identical. Research suggests that men with borderline personality disorder are:

More likely to demonstrate an explosive temperament and higher levels of novelty seeking than women with borderline personality disorder

More likely to evidence substance use disorders while women with the disorder are more likely to have eating, mood, anxiety, and posttraumatic stress disorder

More likely than women to have co-occuring antisocial personality disorder, narcissistic disorder, and/or intermittent explosive disorder

Men are more likely to have had treatment for surface substance abuse problems while women are more likely to have histories characterized by eating disorders and more prescription medications and psychotherapy

Nowinski sees these issues as the "face" of MBPD (male borderline personality disorder):

INSECURITY: Distrusting that people can be counted on, won't take advantage of them, and are honest and trustworthy

FREE-FLOATING ANXIETY: Being anxious for no obvious reason. It's a vague but persistent fear that they must watch their back or their loved ones will take advantage of them. This can lead to substance abuse, working excessive hours, exercising too much, driving too fast, or intense jealousy. As in women, it can also be evidenced by self-harm and eating disorders.

SELF-HATRED: "If only I could be more (or less) whatever, then I'd be lovable." Nowinski says, "I've worked with men who grew up feeling second best and who also punished themselves for it. My patient Brandon, for example, felt invisible because he wasn't as athletic and popular as his brother. As a result, he grew up feeling invisible. As a result, although he's a good attorney he's merciless on himself. He keeps comparing himself to others. When he didn't make partner and someone else did I thought he was going to have a nervous breakdown."

JEALOUSY: The insecurity that lurks at the core of the MBPD personality also drives these men to be possessive. Who wouldn't feel possessive if deep down they felt like damaged goods? These men can become very controlling, such as insisting he knows where his partner is at all times or disrupting their privacy. (This is also extremely common among women with BPD).

SEXUAL ISSUES: Men confuse sex with intimacy (don't we all?). They try to compensate for loneliness, anxiety, and/or insecurity through sex. Some develop a sexual addiction. Sex can be a means of reducing anxiety or self-loathing.

As is true for women, Nowinski says, the vast majority of men with BPD are not unlovable—rather, they can be hard to love. The first step is always opening onesself up to the pain and stop using other lovers, people, and things to manage it. In his chapter "Facing the Demon Within," he writes:

As much as borderline men might wish they could cast off their insecurity and move on, the reality is that a more realistic goal is to acknowledge that it exists, recognize where it is coming from, and then learn ways to mitigate  it so that it doesn't make you miserable or contaminate your relationships.

It time it can be reduced from a demon that dominates and controls their lives to a small beast that may rear its head from time to time, but never takes control.

Nowinski (who also has a blog on Psychology Today) has chapters or sections about determining where you are on the spectrum on MBPD; giving a voice to your feelings; looking at the roots of your insecurity (things like rejection, abandonment, and ambivalence); moving from self-hatred to self-acceptance, adding balance to your lifestyle, learning boundaries between themselves and others; and building psychological resilience.

As I skim through the book, I can see it will be tremendously validating to men who have the strength to consider that just because he's not perfect doesn't make him unworthy. However, men will need many more tools, therapy, and possibly medication to recover. Friends who have the ability to be consistent, stable, and loving (without being pushovers) are of great help. Believing in an all-loving God also seems to help sufferers for obvious reasons.

Of course, work with a specialist or highly qualified clinician is especially vital. If you don't find the right one at the beginning, keep looking! Fit means everthing. Most importantly, if you feel suicidal or homicidal, find help immediately. One of the most dangerous times is when the partner breaks up with the MBPD and he feels he has nothing left to lose. This may be when murder/suicides happen.

Men--please--open up to your friends and family. They want to help you and will admire your strength and be so glad you honored them by asking for help. Make that call today!

Sources (other than the book) include:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115767/

https://courses.washington.edu/dbt560/genderBPD.pdf

http://wesscholar.wesleyan.edu/cgi/viewcontent.cgi?article=1158&context=div3facpubs

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