Boys and Borderline Personality Disorder: Are Symptoms Different and Why Is the Diagnosis So Often Missed?

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Borderline personality disorder (BPD) usually develops during late adolescence. It affects the way young people perceive themselves and the world around them, interact with other people, and manage their emotions.

Young people with BPD may experience intense, changing emotions, a fear of abandonment, an unstable sense of self, and urges to engage in impulsive, sometimes dangerous, behaviours.

One of the most challenging parts of living with BPD can be recognising that there is a problem. This might be really difficult, especially when people around them don’t know much about the disorder.

What’s more, many people – including professionals – assume that BPD is mainly experienced by girls and women. This means that many boys and male adolescents with BPD may go unnoticed, unable to access the treatment they require and deserve.

Is BPD As Common In Boys as Girls?

Many more women receive a diagnosis of BPD than men. Some data suggests that about 75% of people diagnosed with BPD are female, although this ratio changes among different groups.

But, despite these differences, research shows that among the general population, BPD is about as common in men as in women. A 2008 study found that there were no significant differences in the prevalence of BPD depending on gender.

Through interviews with 34,653 adults, they found that on average 5.9% met the criteria for BPD at some point in their lives – 5.6% among men and 6.2% among women.

While there is less research on the gender differences in the prevalence of BPD among adolescents, it’s likely that they are also not significant.

The prevalence of personality disorders in general is about the same in adolescents and adults and personality disorder symptoms usually stay relatively stable over time. This means that BPD may be as common in boys as in girls, despite differences in diagnoses.

Why Can BPD Diagnosis in Boys be Missed?

If BPD is as common in males as in females, we are left with an important question: why are BPD diagnoses among boys and men so often missed?

One possible reason is that there is a gender bias among psychologists, psychiatrists, and other mental health professionals who assess and diagnose borderline personality disorder.

Gender biases happen when mental health professionals understand the same symptoms and clinical presentations differently depending on their gender. So, if a man, woman, and non-binary person all showed the same symptoms, they may still receive different diagnoses.

Research suggests that a clear gender bias (or a sex bias, based on biological sex) is present in the diagnosis of borderline (and other) personality disorders.

Gender biases are sometimes caused by gender stereotypes. This means that practitioners expect certain genders to act in certain ways, such as more emotionally or more aggressively. When someone presents with these behaviours, they may be less likely to see them as a result of a mental health disorder, but instead as a ‘normal’ behaviour. 

For example, when adolescent boys show certain symptoms of BPD like aggressiveness or impulsivity, mental health professionals may be more likely to see them as a typical phase of adolescent behaviours than if a teenage girl showed the same behaviours.

The same stereotypes may apply to intense outward expressions of anger or other emotions, as feminine gender roles often demand from women greater control and suppression of emotions.

In other cases, gender biases can be caused by the understanding – or sometimes misconception – that certain mental health disorders are more common in some genders than others.

For example, a misconception that BPD is more common in women than men may lead to practitioners diagnosing teenage girls with the disorder more often. This, in turn, can support the misunderstanding that it is, in fact, more common, and so on. 

When it comes to diagnosing BPD, it’s not clear what exactly causes the gender bias. One study found that a sex bias is most present when people show ambiguous symptoms and making a diagnosis is more difficult.

They suggest this implies the bias is based on ideas about the prevalence of BPD, rather than gender stereotypes. However, other studies have argued that gender stereotypes also play an important role.

Are There Gender Differences in BPD Symptoms Among Adolescents?

In recent years, some researchers have identified certain subtypes of BPD. In particular, experts have suggested there may be an internalising and an externalising form of the disorder. Adolescents with internalising BPD tend to experience intense, often spiralling emotions that they struggle to cope with, often turning to self-harm or other impulsive behaviours in response.

On the other hand, those with externalising BPD may express their distressing emotions towards others, through intense displays of anger or by blaming other people for their experiences. Both groups of young people find themselves in intense, emotional pain that, when unable to regulate their emotions or self-soothe, they make desperate attempts to cope with.

Some research has found that these subtypes are linked to a young person’s gender. In one study, female adolescents were more likely to have internalising BPD, while male adolescents showed more externalising patterns. These differences may have important implications for young people’s treatment and recovery.

While many of the core traits of BPD remain the same in both subtypes, internalising and externalising behaviours may require very different kinds of psychological treatment to address and support lasting recovery.

What Are the Developmental Pathways for Male Adolescents with BPD?

There’s no single cause of borderline personality disorder among teenage boys and young adults. Scientists think that BPD is likely caused by a combination of different factors – particularly childhood experiences and relationships with caregivers.

A recent study asked parents of men with BPD to describe aspects of their child’s early life, childhood, and adolescence. They noticed several common characteristics in the way these young people behaved at different points in their development. 

As infants, many young boys showed:

  • Excessive separation anxiety when they were infants
  • An inability to make themselves feel better in times of distress (self-soothe)
  • Unusual sensitivity

During childhood, common characteristics included:

  • Victimisation and unusual sensitivity
  • Impulsivity and lying
  • Feelings of emptiness
  • Body image issues

As adolescents, parents described their:

  • Continued impulsivity, feelings of emptiness, and body image issues
  • Unusual thoughts and behaviours

Many boys who developed BPD had experienced sexual abuse as infants or sexual or physical abuse during childhood. Others had experienced bullying or other forms of peer victimisation. In line with other research, the study suggested that traumatic experiences often play a key role in the development of BPD among boys.

Childhood Body-Image Concerns Among Boys with BPD

Many young males who develop BPD struggle with body image concerns, sometimes leading to eating disorders. Anorexia and bulimia nervosa may be almost 50 times as common among preteen boys who later develop BPD.

While the exact link between preteen eating disorders and BPD isn’t clear, experts think that poor relationships with parents, social isolation, and difficulties regulating emotions may contribute to the development of both eating problems and BPD.

Understanding the connection between disordered eating and BPD may help mental health professionals to identify those at risk of developing the disorders.

For example, clinicians may offer therapeutic interventions to young people with body-image concerns that focus on emotional regulation, mentalisation, interpersonal relationships, and other skills that can help to prevent and treat BPD.

Treating Borderline Personality Disorder Among Boys

Living with BPD isn’t easy. However, there is plenty of help and support available to help boys and young men manage symptoms and recover from the disorder. Many young people with BPD live independent, fulfilling, and productive lives.

Treatment for BPD usually involves a support team involving a psychologist, social worker, occupational support, and/or other professionals. Clinical care is typically based on therapeutic approaches that help young people with BPD to identify and change unhelpful behaviours while accepting their emotions and learning to love and care for themselves.

In particular, dialectical behavioural therapy, a talking therapy specially developed for BPD, encourages a dual approach of radical acceptance and positive change.

Many adolescent boys with BPD have experienced some – or many – forms of trauma. Trauma therapy that sensitively and carefully addresses past experiences to allow complete processing and healing plays an important role in many treatment programs.

Healing from trauma can have a big effect on a young person’s inner and outer world, affecting how they view themselves and interact with others.

The Wave Clinic: Private Mental Health Support for Young People

The Wave Clinic offers specialist recovery programs for young people, helping them to build fulfilling futures. Our private centre is situated in the breathtaking natural beauty of Malaysia, providing a unique setting for introspection, healing, adventure, exploration, and personal growth.

Combining exceptional clinical care with education, social responsibility, and life skills development, we work with young people to reconnect with themselves and their dreams.

We understand that young people require specialist treatment that reflects their developmental needs. Our team is made up of experts from around the world with extensive experience in teenage and adolescent mental healthcare, ensuring each young person receives the very best treatment available.

Our centre is fully equipped with the medical resources needed to keep young people at the highest risk safe, including 24-hour medical support and intensive care beds.

If you’re interested in finding out more about our programs, please reach out to us today. We offer world-leading recovery programs that open doors to the future.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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