Borderline Personality Disorder (BPD) affects both men and women. But what are the gender differences in borderline personality disorder? While symptoms can vary, men and women often experience BPD differently, influencing diagnosis, treatment, and long-term outcomes.
At Inner Voyage Recovery Center, we provide specialized BPD treatment through evidence-based therapies like DBT, CBT, and trauma-informed care in our PHP and IOP programs.
Understanding how BPD manifests across genders can improve care and reduce stigma. This article explores these differences and why they matter in mental health treatment.
A Brief Overview of BPD
Borderline Personality Disorder (BPD) is a mental health condition characterized by instability in emotions, relationships, self-image, and behavior.
People with BPD often experience intense mood swings, difficulty maintaining stable relationships, impulsive decision-making, and an overwhelming fear of abandonment.
These symptoms can lead to significant distress and interfere with daily life.
The DSM-5 (what therapists and psychologists use for making diagnoses) lists the key symptoms of BPD:
- emotional instability
- impulsivity
- intense anger
- self-harming behaviors
- chronic feelings of emptiness
However, not everyone with BPD exhibits all symptoms, and the severity can vary from person to person.
BPD Misunderstood
BPD is often misunderstood due to its complexity. It’s sometimes mistaken for bipolar disorder because of the mood swings, or for post-traumatic stress disorder (PTSD) because of its links to trauma.
However, what sets BPD apart is its persistent fear of abandonment, extreme difficulty managing emotions, and unstable self-identity.
Despite its challenges, BPD is treatable. We’ll briefly discuss treatment options below.
How Common is BPD in Men vs. Women?
Borderline Personality Disorder has historically been considered a disorder that primarily affects women.
Some studies estimate that around 75% of people diagnosed with BPD are female, leading to the misconception that men rarely experience the disorder.
However, more recent research suggests that BPD is likely equally prevalent in men and women, but men are diagnosed at lower rates due to differences in how symptoms present.
One reason for this diagnostic gap is that men with BPD often exhibit more externalizing behaviors, such as aggression, substance abuse, and risk-taking.
These behaviors can lead clinicians to misdiagnose them with conditions like antisocial personality disorder (ASPD) or intermittent explosive disorder (IED) instead of BPD.
In contrast, women with BPD tend to internalize their distress, showing more self-harm, depression, and emotional dysregulation. These in turn align more closely with the traditional diagnostic framework of BPD.
Additionally, societal expectations and gender norms may play a role in the discrepancy. Women are generally more likely to seek mental health treatment, leading to higher diagnosis rates. Men, on the other hand, may avoid therapy due to stigma or may have their symptoms dismissed as typical “male behavior,” such as being aggressive or emotionally detached.
Understanding the true prevalence of BPD across genders is essential. By recognizing that men and women express symptoms differently, mental health professionals can work toward more accurate diagnoses and better-tailored treatments for all individuals with BPD.
Key Symptom Differences Between Men and Women
While the core symptoms of Borderline Personality Disorder (BPD) remain the same across genders, research shows that men and women often express these symptoms differently. These variations can affect diagnosis, treatment approaches, and even how individuals experience relationships and daily life.
BPD in Women
Women with BPD are more likely to exhibit internalizing symptoms, meaning they direct distress inward. This includes intense emotional instability, chronic feelings of emptiness, self-harm, and an overwhelming fear of abandonment. Many women with BPD struggle with mood disorders like depression and anxiety, making it common for them to receive dual diagnoses. Additionally, women with BPD are more prone to eating disorders, such as bulimia or binge-eating disorder, which often stem from issues related to self-worth and identity instability.
BPD in Men
Men with BPD, on the other hand, are more likely to express externalizing symptoms, such as aggression, impulsivity, and substance use. Instead of self-harm, they may engage in reckless behaviors, such as excessive drinking, drug use, or risky driving. Men with BPD are also more prone to antisocial behaviors, which can result in a misdiagnosis of antisocial personality disorder (ASPD) or narcissistic personality disorder (NPD) instead of BPD. They are also more likely to end up in the criminal justice system rather than receiving appropriate mental health care.
These symptom differences highlight why many men with BPD go undiagnosed or are misdiagnosed. Understanding these variations can help clinicians and loved ones recognize the disorder more accurately and ensure that individuals receive the support they need.
The Link Between BPD and Other Mental Health Conditions by Gender
BPD rarely exists in isolation. Many people with the disorder experience co-occurring mental health conditions, and these conditions often present differently in men and women.
Women with BPD are more likely to be diagnosed with:
- Depression – Chronic mood instability and intense sadness are common in women with BPD.
- Anxiety Disorders – Generalized anxiety disorder (GAD) and panic disorder often accompany BPD.
- Post-Traumatic Stress Disorder (PTSD) – A large percentage of women with BPD have a history of childhood trauma.
- Eating Disorders – Body image issues and emotional dysregulation contribute to disordered eating patterns.
Men with BPD are more likely to struggle with:
- Substance Use Disorders – Alcohol and drug addiction are common coping mechanisms.
- Intermittent Explosive Disorder (IED) – Impulse control issues may lead to frequent outbursts of rage.
- Antisocial Personality Traits – Some men exhibit manipulative or aggressive behaviors that resemble ASPD.
- Gambling and Risk-Taking Behaviors – Men with BPD are more prone to high-risk activities.
Because of these differences, women with BPD are often directed toward psychotherapy and emotional regulation strategies, while men may be misdiagnosed or treated for substance abuse and aggression rather than the underlying disorder. Recognizing the unique challenges each gender faces in co-occurring disorders is crucial for effective treatment.
Why Are Men Often Underdiagnosed with BPD?
The belief that BPD is a “women’s disorder” has led to a significant underdiagnosis of men. This is partly due to how BPD has traditionally been researched and categorized, but gender bias in mental health care also plays a major role.
Many diagnostic criteria for BPD emphasize behaviors that are more common in women, such as self-harm and emotional instability. Meanwhile, men’s symptoms—such as rage, substance abuse, and risk-taking behaviors—may lead to an alternative diagnosis like antisocial personality disorder (ASPD), bipolar disorder, or depression instead of BPD.
Another barrier to diagnosis is social stigma and masculinity norms. Men are often discouraged from expressing vulnerability or seeking mental health care, making them less likely to be evaluated for BPD in the first place. Those who do seek help may have their symptoms dismissed as typical “male behavior” rather than recognized as signs of a serious personality disorder.
Because of this, many men with BPD do not receive the appropriate therapy and support. Instead, they may struggle with substance abuse, frequent conflicts, and legal troubles—all of which could be prevented with accurate diagnosis and targeted treatment.
Misconceptions About Gender and BPD
Many misconceptions exist about BPD and how it affects different genders. These misunderstandings can prevent individuals from getting the support they need and contribute to the stigma surrounding the disorder.
One of the most persistent myths is that only women have BPD. While more women are diagnosed, research suggests that the actual prevalence is about equal between men and women. The difference in diagnosis rates is due to how symptoms present and how clinicians interpret them, rather than a true gender disparity.
Another common myth is that men with BPD are simply narcissistic or manipulative. While some men with BPD may display narcissistic traits, they often struggle with deep emotional pain, intense fear of abandonment, and difficulty regulating emotions—hallmarks of BPD that are distinct from narcissistic personality disorder.
For women, the misconception that BPD is just “extreme mood swings” or “drama” minimizes the real distress they experience. Many women with BPD have histories of trauma, abuse, or emotional neglect, and their emotional dysregulation is a result of deep psychological wounds, not attention-seeking behavior.
Dispelling these myths is essential for improving mental health care. The more we understand the true nature of BPD, the better we can support those who are struggling, regardless of gender.
Treatment Differences: Do Men and Women Respond Differently to Therapy?
Borderline Personality Disorder is highly treatable, but the way individuals respond to therapy may differ based on gender. The most effective treatments for BPD include Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), and trauma-informed care. These approaches help individuals learn to regulate emotions, manage distress, and develop healthier interpersonal relationships.
Women with BPD may be more likely to engage in talk therapy and emotional regulation techniques, as their symptoms often involve internal distress, anxiety, and depression. Therapy often focuses on self-acceptance, emotional expression, and boundary setting.
Men with BPD, on the other hand, may be less likely to seek therapy and more likely to drop out of treatment early due to stigma or discomfort with emotional vulnerability. They may respond better to structured therapy approaches that incorporate behavioral strategies, mindfulness training, and goal-setting rather than focusing solely on emotional processing.
Regardless of gender, early intervention, consistency, and therapist-patient trust are key factors in a successful recovery.
Why Understanding Gender Differences in BPD Matters
Recognizing gender differences in BPD is key to improving diagnosis, treatment, and support. While women often struggle with self-harm and emotional dysregulation, men may exhibit aggression, impulsivity, or substance use, leading to misdiagnosis or untreated symptoms.
At Inner Voyage Recovery Center, we offer personalized BPD treatment. Our BPD experts help you develop emotional regulation skills and long-term coping strategies. If BPD symptoms are affecting your life, professional support can help you gain stability and improve well-being. Reach out for help here.