Thursday, September 5, 2013

Often Overlooked: Men and Borderline Personality Disorder

Today I wanted to take a look at something that I’ve mentioned once or twice before but I haven’t talked about in depth, because well, I’m not a man so it's not easy for me to talk about men's experiences. However it’s an incredibly important topic because as far as the Borderline population is concerned 25% of us are men!

Borderline diagnosis in women isn’t necessarily the easiest thing to pin down, but it’s even more difficult in men. Why is that?


Borderline men often misdiagnosed with antisocial personality disorder
Published on April 15, 2011 by Randi Kreger in Stop Walking on Eggshells


Here are some reasons why BPD in men is overlooked and why we know so little about borderline men.


Men seek professional help less often

Research has shown again and again that men won't even seek treatment for less complex but equally serious mental health problems such as depression, let alone a stigmatized disorder like BPD that calls their whole personality into question. Many men see it as "unmanly" to acknowledge feelings, especially the vulnerability and abandonment fears associated with BPD. Since fewer men seek treatment, they are not available candidates for research.

Let’s be honest here. It’s hard enough to get some guys to go to the doctor when they’re vomiting over a toilet for 2 days with a 104 degree fever and clearly need antibiotics let alone need to talk about their feelings and things that society tells them they shouldn’t be admitting too. Getting some men to go to a doctor is worse than pulling teeth which at least has the draw of potentially narcotic post treatment drugs.  

Clinician bias

One study found that when 52 professionals from a mental health agency in California assessed patient vignettes, they were unable to accurately diagnose the presence of BPD in males--even though the symptoms were identical to those in vignettes of females. 

This results, in part, in the way anger is interpreted differently depending upon whether it comes from a man or a woman. "For the most part, when women are angry they are classified as irrational, frenzied, or too emotional," says therapist Andrea Brandt. "On the other hand, men's anger is sometimes recognized as strength and aggressiveness."

So what you’re telling me is… gender bias and sexism is still prevalent in the USA let alone in other areas of the world? Color me completely unsurprised. I’m a fan of being angry because amusingly, I get very clear headed. When I’m upset I may be emotional and not think clearly. When I’m angry, I’m a razor you will not pass unscathed by my finely tuned arguments. I’ve learned to sit very calmly, smile, and channel my anger in a calm, measured tone. I’ve developed a lot of self-control with my self-awareness though.

The way our culture views men and women expressing themselves is deeply biased. Men being angry is “normal” and seen as a sign of virility. Women on the other hand are immediately told, “Calm down,”, “Don’t over react” as if our emotions are not valid. Unsurprisingly if we weren’t angry enough before, we’re probably going to be even more angry now, because this is invalidating and infantilizing.

Cultural influences

Men are socialized not to expose their fear of abandonment or other emotional vulnerabilities, which are hallmarks of BPD. They are supposed to be macho and fearless, sexual studs seeking the maximum number of sexual conquests with a minimum of commitment. And if he does get "roped" into marriage, he's the one who's supposed to be on top, for fear of being called "whipped."

Most of all, if he's not as confident as he "should" be, or if he's feeling alone, depressed, or scared, by the Male Code he is not supposed to let these feelings show. He is, however, permitted anger. In some circumstances, beating someone up is even the righteous thing to do.

I really dislike this in my culture (you don’t see it all cultures and you see it even more heavily in others). Men have as much right to their feelings as anyone else. Telling them they don’t is incredibly invalidating, and it’s no wonder they in turn, do it to women so often. This also makes me wonder if the 25% is an accurate representation of the number of men with BPD. How can we possibly know?

Misdiagnosis

Imagine you're a man whose greatest fear in the world is being abandoned, second only to the terror of looking into the mirror and seeing an empty, worthless Self looking back. Imagine how hard it would be to share these emotions with the people you're scared will reject you, let alone to admit you need professional help.

Those feeling have to go somewhere. Some men use the same outlets as borderline women do, such as making suicide threats [or self-harm]. A great many of them (even more than women) anesthetize themselves with alcohol and harder drugs such as cocaine or methamphetamine. A subset, however, channel their feelings into their more socially acceptable cousins, rage and aggression.

Rex Cowdry, MD, the former acting deputy director of the National Institute of National Health, says, "A hallmark trait of BPD, the inability to manage inner feelings, is just as present in the male population, but is often exhibited in spousal abuse or other violent acts rather than the self-directed anger more often seen in women."

 Both men and women can express their fear of abandonment as physically aggressive rage toward the "cause" of their distress. However, men's level of violence is more lethal. A perceived betrayal or a real or imagined act of abandonment may trigger acting out activities such as kicking down a door, ***forcing sexual activity***, blocking the partner's escape, and threatening the partner with a weapon. Some are involved in controlling and stalking behaviors such as bugging phones, installing secret cameras, and hiring private detectives.

***Forcing sexual activity. Here’s a pet peeve. Eh hem. This is rape people. Don’t sugar coat this to make it sound more acceptable than it is, this is rape.

This aggression often results in a misdiagnosis of antisocial personality disorder (sociopath) or, in adolescents, a conduct disorder. As a result, they don't get the right treatment. What they do get is incarcerated. As a matter of fact, so many males with BPD have been incarcerated that a form of therapy for BPs, Dialectical Behavior Therapy, has been adapted for male offenders in correctional settings.

Overly aggressive behavior in men with Borderline Personality Disorder is often misdiagnosed as Anti-Social Personality Disorder. Because there is so much stigma with both of these disorders clinicians don’t want to take the time with these patients to really get to the heart of the issues with these people. Also keep in mind that often it takes a long time for us to really open up and develop trust with a clinician for them to make an accurate diagnosis. Instead they simply see AGGRESSION = ASPD = DONE. This helps no one. This is why it is so important to invest time with a therapist or clinician. Checklist items in the DSM DO NOT MATTER. It’s the underlying motivations that create those symptoms that matter.

How do borderline men differ from women?

Therapist Mary Gay, who treats many men with BPD, says she finds that borderline men frequently engage in addictive, sexually compulsive behaviors, including regularly hiring of prostitutes, having serial affairs, going to strip clubs, obsessively viewing pornography, engaging in voyeurism or exhibitionism, and compulsive masturbation. One borderline man used high-risk sex as his form of self-harm. He says:

“The out-of-control sex was something I hated myself for, it was obsessive, it felt like an invisible hand grabbing me by the collar and dragging me off to do whatever. I needed to cause enough pain and degradation to myself. The incredible guilt of the risks I was exposing my partner to really destroyed something inside me. But when the inner loneliness was strongest, sex was the only thing that would quiet the fear.”

In the past I was a fan of sexually risky behavior and exhibitionism given certain environments. The rest, nope. Now, not at all.


So men! How else would you say that your experience tends to differ from your female counterparts? 

Tuesday, September 3, 2013

Ask Haven: Potential to Hurt Me

Sorry Everyone. Last week was super hectic for me. Had major presentations and projects and big life things = extra long hours. Things should be back to normal now. Regular posting shall resume.

Dear Haven,

I’ve been dating a woman for a while now that I suspect has BPD. She’s been starting to push away and she said something recently that I’m confused by. What does a woman mean when she says “you have the potential to hurt me”? I really like her, I would never hurt her on purpose.

Sincerely,
Confused.


Dear Confused,

Ah! I know exactly what she means and I have a feeling every one of us with BPD know what she means as well.

You know the old adage “you always hurt the ones you love”? That’s really the thing we’re addressing here. This has nothing to do with your intent. It’s almost always accidental, and often in the case of BPD, not your fault at all depending on the situation (exceptions, of course, in the case of abusive partners). 

When you like someone, when you see the potential to really love someone, you see the potential for them to really impact your heart. To be even closer to you. With that closeness, comes power over your heart, power over your vulnerabilities, the places we’ve already been damaged and fight so hard to protect. You are invited within the walls we construct to keep out the villains that would stab us in that heart and potentially place your own knife, however accidentally. We live our lives struggling to find a balance of close but not too close but really, really wanting to be close, but HOLY CRAP WE REALLY NEED TO PROTECT OURSELVES FROMT THE PAIN… but not necessarily on such a conscious level. We’ve lived hard lives with a lot of damage. That we’re telling you this means we;  1. See something in you that we are really drawn to because we really like who you are, but 2. This is also kind of scary for us, because intimacy is scary for because we have been so hurt in the past.

The best thing you could probably do: Go at her pace. Respect her boundaries and gently ask her to elaborate if she feels comfortable. Expect that she may not though. She may need to slow things down to feel comfortable, allow her space, but don’t abandon her. Let her know you’ll be there for her.


I hope this helps you understand. Good luck.

XOXO,
Haven
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