Thursday, September 12, 2013

[Guest Post] Confessions of a Male Borderline – Part 2

Are you ready for Part 2 from our friend LostInTransit? No need to delay. So where were we…

Confessions of a Male Borderline – Part 2

For one thing, I am not outwardly aggressive. I have a lot of aggression, but I tend to Act In, not Out. I can scream bloody murder in my head and picture the world going up in flames while helping an old lady cross the street with a smile on my face. Yes, I do get into fights every once in a while, but not more than any other person I guess. I do tend to get drawn to violent situations though. I even put myself in them for the adrenaline kick it gives me. Those situations and situations involving sex (I quickly started to combine the two) are the only situations I feel truly alive. The only few precious moments that the empty gaping void within me can be filled and I am truly in the here and now instead of locked up somewhere in my own head. I like demonstrations that get out of hand, fights that break out in the street, police chases, fires, well you name it. Please understand I don’t create them though, I merely manage to get involved in them if they happen. For example, a few weeks ago there was this big manhunt in my neighborhood for this burglar just as I came back from a party in the middle of the night. You can imagine what happened next. I was the one being stopped and frisked because I might be that burglar. Annoying? Yes. Exhilarating? Absolutely. It’s all I can do not to start running just to get the police to chase me. I guess that’s what makes me a high-level borderline, the ability to stem certain urges in their tracks before they get the best of me. But for the most part I keep up a fa├žade and implode only when I’m at home and alone, taking it out on myself as best I can. I won’t pick a fistfight just because I feel bad, I tend to not want to bother others with my problems and prefer dealing with them alone and in the dark.


Like I already said I quickly started to combine sex and violence although not in the way you’re probably thinking of right now. I do not own a black van with tinted windows, I don’t lurk in parks to bother jogging women and I definitely never, ever raise a hand against my partner. No, it’s more subtle than that and I direct the violence at myself. Violence comes on many different levels, and need not involve hitting of any kind. I have always been highly sexual, finding from an early age how much sex interests me and always hungry for more. Sex is the thing to fill the emptiness within me. I use it to feel alive, and to connect to someone. In the heat of the moment, with two bodies using each other up to the core, that’s when I feel at peace with myself and the world. I feel one and whole instead of my usual shattered self. I depersonalize and derealize very quickly, and I need the touch of another person to know I’m there, to drag me back to the present and this earth. And the feeling that comes with an orgasm frees up the dopamine my mind seems to lack continuously. But of course, having sex every once in a while wasn’t enough, not by a long shot. After a sexual encounter I can last two days before getting edgy, a week before I get nervous and after that I feel like a heroin junkie in need of a quick fix. I have done it all. Watching endless amounts of porn, visiting prostitutes, phone sex, chat sites, cam sex, blind dates via the internet…

Ah yes, those… It is not a female prerogative to be promiscuous.  Me, a heterosexual (well mostly) male, can be more promiscuous than any girl. I will stake my reputation on that. It’s very hard to get in touch with women over the internet (at least the non-paying kind) for the kind of blind date I was looking for so I resorted to gay sites instead. It was a goldmine. Most of the men coming on those sites are hidden gays with a wife and a job who don’t want their natural inclinations to come out in the open. I’m tall and very slender, with dark hair and I have this gothic vibe going on, complete with the tattoos and the black clothing. So they cued up for me. It was intoxicating to get someone, a man I have never met, who hasn’t even seen a photo of me yet, to beg for me to come over, especially after I revealed what I might let him do to me. It combined the kind of rush I need to kick start my brain. I was never certain what I would get into. Was it a hoax? Would I get beaten up and robbed (That actually nearly did happen to me once)? What if something happened and I would wake up seropositive or something? What if I got raped? With these kind of blind dates you simply don’t know what will happen.  I found that dark unknown to be utterly exhilarating and I was living this hidden life next to my own everyday life. Online I would be someone else completely, with a fake name, a fake background, and I could switch between my personas with ease.


But of course no one can keep up that kind of thing for long. I was slowly self-destructing, letting myself be abused and used, and drowning in the murky swamps that have grown rife on the internet. I was a plaything, a toy for the pleasure of others, nothing more. And in the end it only fed the despair and the hopelessness I seem to have such an unlimited supply of. I knew it was only a matter of time before something truly bad would happen to me, something I could not recover from, so I opened up about it in therapy. It has lessened my behaviors, but I still haven’t found a constructive replacement for the ecstasy that comes with that kind self-destruction.


I never did substance abuse. For one, I’ve lived abroad for most of my life and we just didn’t have hard drugs back then. We did have weed, and I used that, but that was very much for recreational purposes, half the fun coming from it being illegal. I remember smuggling weed and joints in school and chases by armed military with tracker dogs in the middle of the night. When I moved, I quit because the fun got out of the stuff pretty fast. Also, people already used to think I was on drugs most of the time even when I was completely sober so I definitely didn’t need that to be able to party. I do drink and smoke though. I always find it difficult to draw the line between abuse and a “healthy” consumption of both alcohol and cigarettes. Admittedly, smoking three packs a day while drinking a bottle of vodka could be termed as substance abuse but I never did that. I am on the other hand, hooked on both and while my daily habits have never impaired my overall functioning it is something I have to keep a lid on.


I’ve always wanted to smoke. Don’t ask me why, it’s just one of these things you can crave and when I was fifteen I decided the time had come. I took to cigarettes right away and it’s a decision I never came to regret. For me, a cigarette represents a moment of relaxation and introspection, a moment that is truly mine. But I also am attracted to the slow destruction cigarettes came to represent. I like the idea of slowly wasting away my life, and help myself to what’s hopefully going to be an early grave. That comes under the header of self-destructive tendencies right there, and I know now that I will have to give up my favorite pastime in order to help tackle those tendencies and disturbing thoughts.


The same goes with alcohol. I know quite a lot about alcohol, I’ve worked in a liquor store and it’s something of a hobby of mine. I’m known for it and people often come to me with questions about what to buy or how something tastes. But I also use it to drown my sorrows. It’s one of the reasons that my evenings are usually better than my days. I keep a firm grip on myself and only drink in the evening and almost never to excess, but I am very much aware that all in all I partly drink for entirely the wrong reasons. It’s not something I need to give up straight away, but it is a point to consider.



Obviously, I could go on and on, but I will leave it that for now. What I have tried to do is paint a picture of borderline being not so black and white as most people think, but a spectrum disorder that has its overall focal points but is also unique to each individual, and a picture of a disorder that is strongly colored by cultural perceptions of gender differences, as viewed through my own personal experiences. Gender differences in BPD is a subject that is being researched more and more, but that definitely needs even more attention as I believe that it would come as a big benefit to therapists and patients. What’s more, it might help give a voice to those men out there who are borderline but don’t come out about it or can’t relate all that well. I thus gladly put out the call to let yourself be heard. Lastly I would like to thank Haven for this opportunity. Her blog is a daily source of much needed information, advice and understanding and I can only hope to contribute to that. 



Wednesday, September 11, 2013

Guest Post: Confessions of a Male Borderline - Part 1

Hello Everyone. As promised I have something special for you. Today I will be presenting you with Part One of a special Guest Post by our friend LostInTransit. He was kind enough to open himself up and share his experiences with us. I’m very grateful for his contribution as I know how difficult it is for people to put their experiences down on paper, let alone share them with the collective, but I also think it’s incredibly valuable to have a man’s perspective where we have so few. Please give him your support as I do. So without further Ado I give you…


Confessions of a Male Borderline


I will never forget my own reaction when a psychiatrist first put to me the idea that I might have a Borderline Personality Disorder.  For one I had never thought I might have a disorder at all. For me it was a bit like cancer or AIDS. As soon as you have a little pain in your stomach or something, you don’t immediately think about something as bad as that right? So for years, I simply thought I was an idiot who would make it to thirty-five if I was lucky and would die alone and bleeding somewhere in a gutter. It had never even crossed my mind to do a bit of research on the internet, even though I doubt it would have helped me, it took a serious breakdown two years ago for me to finally accept the idea that there might be something seriously wrong and that I might need help fixing it. Of course I knew about Borderline, but nothing more than what every lay-man would know about it, which is next to nothing. I have known a few borderline girls in my time, and they were all seriously out of whack, invariably great in bed, and we always totally got each other. In hindsight it should have set me thinking… So all I knew was that it was something girls had who always screamed and cried a lot, and that was exactly what I said to the psychiatrist who had spent a grueling hour trying to pries open my brain: how could I have something like that? I hardly scream, I never cry, I only use razorblades for shaving and I definitely love my grilled steaks too much for me to have any kind of eating disorder.


But then again, I was all over the place at the time. My suicidal tendencies had finally gotten the better of me, continuing my studies was out of the question, I was on the brink of a psychotic breakdown and I was already diagnosed with having a dysthymic disorder and a major depression. So I decided over the course of several months, while being in therapy for my depression, that I could either dismiss my therapists as soon as the depression was over (something I had always done up until then), or cut the macho crap and seriously look at the idea of having either borderline or another disorder.


I started out with ADD. According to my psychiatrists I either had ADD, Borderline, a form of autism or a bit of all three. I don’t know how other people out there do it, but for me I usually trust my gut when confronted with something like this. Knowing full well I hate the idea of any diagnosis I knew that I could trust my instincts to guide me in my research without fears of just picking a disorder for the hell of it. Because I prefer not to have any diagnosis at all, to tell you the truth, and I never understood people who go for self-styled, internet induced diagnoses. Either you have something or you don’t (yes I’m very hard-lining and conservative like that). Me being me, I started to read whatever professional literature there was on the subjects that concerned me. While it proved very interesting, the problem is that because professional articles and books notoriously lack personal stories, I could identify with practically anything the DSM has to offer. So I needed personal stories. I swallowed my phobia for that part of the internet that deals with this kind of thing and immediately hit on a goldmine of information. It was insane. I never knew people kept whole blogs, vlogs, and so forth about their lives, their problems, and the way they coped with them. On Youtube I found a mass of people sharing their story in videos they made; there were less good written blogs but stumbling across Haven’s writings satisfied that more than enough. And it wasn’t only fascinating, but there was no self-pity, like, at all! The stories were interesting, constructive, forward-looking, in-depth and powerful. What’s more I could identify with them on a level I never thought possible. It was like a door being opened in my mind, and I finally knew, after years spent wondering what the hell could be wrong with me, that I found that my personal brand of weirdness had a name: Borderline Personality Disorder. By then, the ADD was already out of the equation as the tests I had done were all negative. I probably have some autistic tendencies but I’m not really concerned with those. Testing was quite inconclusive, and I decided to let that rest for the time being.

Borderline. I let it roll of my tongue a few times, as if testing it for inconsistencies, but I knew I had found what I had subconsciously been looking for, for a very long time. It’s such a mixed feeling. On the one hand the relief of knowing it’s something that people know about and might even be fixed, and on the other hand the anguish of having to put up with a label. It’s when I hit my very first wall. Because you see, I happen to be a boy, and not a girl. When I told my psychiatrist about my hunch he responded warily, maybe even with a bit of disbelief. That shook me as he and his colleagues were the ones that put the idea of a possible personality disorder in my head in the first place. My mother dismissed it out of hand, saying she was worrying how “they” would be able to talk this idea out of my head when it was clear I didn’t have it. What’s more, a couple of my friends, both girls, had gone to the psychiatrist with the same symptoms I exhibited and got Borderline slapped on their foreheads and carted off to therapy in the time it takes you to say “personality disorder”. So why was I dismissed like that? Was it truly because I’m male?


It didn’t take me long to realize that there was precious little known about borderline males. I won’t go into a review of the literature, as I know Haven already did that, but the few articles I found were not much to go by. Apparently males have a tendency toward outward aggressiveness, thus being labeled anti-social instead of borderline, a tendency towards substance abuse where females will more quickly develop for example an eating disorder, and on the whole are more liable to be processed through the judicial system while females tend more towards the psychiatric system. That made it difficult to find my bearings (it’s still difficult) as practically everything was written about and through the female perspective. Don’t get me wrong, I definitely relate to the underlying point of view, or the underlying problem, but it’s in the details where I get lost a bit. Also I don’t dismiss any problem, be it a tendency to pick a fights in bars or a tendency for bulimia. They are all severe problems, and even though some of these usually tend to be found in one or the other gender, there are of course overlapping cases. I for example have a male friend with severe eating issues. What I’m trying to say is that when something is written through a certain perspective, it might be difficult for the other sex to relate, even when the underlying issues are the same. But the biggest battle I fight is that apparently I react to some problems in the same way females do, and so I have to overcome my ego and a certain amount of machismo to address these problems and accept that I have them.




… are you hooked? I am. Stayed Tuned for tomorrow’s Part Two… 




Tuesday, September 10, 2013

Living With Borderline Personality Disorder (BPD) [From a Man's Perspective]

I found a blog article written by a man that did exactly what I did (except more briefly) way back when I first started this blog. He dissects each DSM criteria for Borderline Personality Disorder and describes how he experiences them. I love stuff like this. Too often society likes to tell us that men and women are so different. Oh really? Let’s see about this…

AUGUST 1, 2013 BY NATHAN C. DANIELS 

Borderline Personality Disorder (BPD), not to be confused with Bipolar Disorder, is the most consistently challenging condition I struggle to live with. For the benefit of myself, and others like me, I’m going to explore this life-threatening disorder. I’ll present information and offer a first-person account of what living with BPD is like and how it affects me personally.

I’m hypersensitive on an emotional level and extremely over-analytical, intellectually. My thoughts and feelings are balls in a lottery tumbler, and I never know when the next drawing will be or which ball will be drawn.

I’m a firm believer that reality is a matter of perception. That’s a terrifying truth, when you’re living with BPD and your perception of yourself and the world around you changes as frequently and drastically as the track on a rickety old roller coaster. Unfortunately, this isn’t a thirty-second thrill ride with built-in safety features. BPD is a dangerous psychological disorder I’ve had to deal with my entire adult life.

What is Borderline Personality Disorder?

BPD is a personality disorder that causes those afflicted to suffer extreme instability in self-image, behavior, and emotion. A disorder existing on the border of neurotic and psychotic behavior, BPD was recognized and named accordingly in 1980. This is a serious mental condition, and people living with BPD are highly prone to self-abuse and suicidal tendencies.

I consider this a life-threatening illness because approximately 10% of those diagnosed with BPD successfully commit suicide, and are prone to making decisions designed to threaten quality of life and mortality. I think it’s also noteworthy that this disorder rarely exists by itself, usually co-occurring with, and complicating, other mental conditions like depression and Bipolar Disorder.

There are nine criteria in the DSM-IV used to diagnose BPD. An individual typically needs to identify with at least five of these characteristics for an official diagnosis. Personally, I represent all nine, and I’ve endangered my life on several occasions as a direct result. I’m going to list the nine criteria here and offer an example of how each affected me one time or another.


DSM-IV Diagnostic Criteria & Me


[1] Frantic efforts to avoid real or imagined abandonment.

I’m constantly analyzing my behavior in an effort to assess whether or not I’m acting “normal,” because I live in perpetual fear that my girlfriend will abandon me if I show signs of mental illness. I have an unshakable sense of dread that if I can’t force myself to act “normal,” my six-year old son will think I’m “crazy” and be afraid of me, as I thought my father was crazy and I lived in fear of him.


[2] A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

My relationships with my immediate family members defined intense and unstable, paving the way for similar relationships I’d seek out as an adult. I choose emotionally abusive partners, who cheat on me and complicate my life, and my perception of my partner can change on a dime for no reason at all. One day, they’re the best thing that ever happened to me. The next day, I’m convinced they’re the source of all my pain and never really loved me at all.


[3] Identity disturbance: markedly and persistently unstable self-image or sense of self.

Sometimes, when I look in a mirror, I find my reflection disgusting and ugly … I have to look away. Sometimes, I think I’m attractive. Today, I might think I’m the best partner a woman could ask for. Tomorrow, I might think I’m a burden to my girlfriend and son … they’d be better off without me. One morning I was beaming with pride over my writing. The same afternoon I destroyed my last copy of the book I wrote, disgusted with my lack of talent.


[4] Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

During low times, I’m prone to reckless spending. I’ve maxed out all my credit cards, taken out unnecessary loans for frivolous spending, and had to claim bankruptcy. I’m ashamed to admit how much time I spent drunk or high behind the wheel of my car for years after my parents died.

I even prostituted myself to a suspicious man when I was a homeless teenager. I let him lead me into the woods, hoping his true intention was murder … it wasn’t. Most recently, I walked out on my family, and rented a condo, where I planned to die in self-induced isolation.


[5] Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

I struggled with suicidal thoughts and behavior for twenty years. My self-abuse began with digging my fingernails into my skin when I was a child. It progressed to cutting and cigarette burns as a teenager and, as an adult, I’ve broken my bones and doused myself with boiling water. I still struggle with the urge to hurt myself, and I’m constantly plagued with intrusive visions of self-mutilation.


[6] Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

Severe anxiety cripples my ability to function in society. I have Social Anxiety Disorder and I suffer debilitating panic attacks on a daily basis, which led to developing Agoraphobia. I have a positive attitude by nature, believe it or not, but my mood can become so dismal I feel a need to isolate myself completely. This often involves hiding in bed for hours, or days, and I can be impossible to get along with … every conversation becomes an argument at these times.


[7] Chronic feelings of emptiness.

Often, my life is dreamlike and I feel more like a ghost than a human being. I’m a phantom, operating in an unreal world, and it feels like nothing I do matters or has value. All my relationships are illusions, and I’m convinced I exist without substance or meaning.


[8] Inappropriate, intense anger or difficulty controlling anger.

Rage overcomes me, and I feel it well up inside me to the point that my skin starts tingling, flushes, and gets hot to the touch. I might have to lie down … just breathe. I’m fortunate that this symptom has never gotten out of control. I believe my experience in martial arts and meditation, my use of bodybuilding as a healthy venting mechanism, and my highly developed sense of self-awareness enable me to repress my frequent urge to smash things or lash out.


[9] Transient, stress-related paranoid ideation or severe dissociative symptoms.

I started dissociating when I was a child, a result of the abuse I endured. This psychological survival skill has been with me since, and to this day, I begin dissociating at the slightest hint of stress or panic. Sometimes I have a series of days when I weave in and out of dissociative states. This alien sensation ranges from, difficulty concentrating to catatonia, and it’s had a negative effect on my school ears, ability to work, and social acceptance.


********************************************

Of course as individuals we all have unique lives, but I don’t think when it comes to men vs. women we’re actually having a battle at all. It really is a matter of taking one individual at a time because who of us can’t relate too much of this? Maybe some of the details differ, but the general picture?....


Tomorrow I have a special treat for you. A two part special Guest Post! It’s incredibly important that we have true to life accounts from those of us who have experienced the things we struggle with. I think his story is something very relatable and I hope it will inspire other guys out there to speak up and give us some feedback as well. 





Monday, September 9, 2013

New Refuge and Asylum Shop


Hey Everyone, 

I've spent some time revamping my on-line store. I've gotten away from CafePress and moved to a new store that has more styles and higher quality fabrics. I've also added a more original art inspired the things we go through everyday. 

As an added bonus, for September only if you buy 2 or more items use the coupon code: FALL2013 .... and get FREE SHIPPING! That's always nice.



As always the shops story states: 

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Just like the phoenix rises from the ashes to be reborn, so can those of us fighting Borderline Personality Disorder rise above the challenges we face and be reborn into a healthier, happier life. Have hope! 


Thanks for visiting my online shop! Find what you're looking for yourself or great gifts for your friends. You'll find unique merchandise with my art on t-shirts, sweatshirts, mugs, pins, and more. 

All proceeds will go towards BPD research, raising awareness, and breaking the stigma! Your support means the world to me and to everyone struggling with BPD. 

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It doesn't have all of the same home goods offered like the pillow, key chains, shot glasses, and what not, so you'll still have to check the CafePress store for those, but they will still be there if you want them. 


You may also have noticed I added a Donation button to the left above as well. The economies have been tough here lately (mostly my car died after having to fix it for the 4th time and I had to buy a new one so I'm broke) so if you don't want to buy a shirt but you'd like to contribute (Donation to BPD research, keeping the Forum going, etc.) feel free to drop a dollar or two. Every bit helps and I'd be incredibly appreciative. 



Yours Always,

Haven

THE ROLE OF GENDER IN THE CLINICAL PRESENTATION OF PATIENTS WITH BORDERLINE PERSONALITY DISORDER

Here’s an interesting article that I found on the role of Gender in Clinical Presentation of Patients with BPD. It’s interesting because it notes some points that I agree with but I haven’t seen expressed anywhere else, or that have been utterly and completely ignored everywhere else. Let’s take a look.


Caron Zlotnick, PhD, Louis Rothschild, PhD, and Mark Zimmerman, MD



This study examined gender differences in the pattern of comorbid disorders and degree of impairment among outpatients with borderline personality disorder (BPD). A total of 130 outpatients with BPD were assessed for various lifetime impulse-related disorders and post-traumatic stress disorder and for indices of impairment. Compared with women with BPD, men with BPD reported significantly more lifetime substance abuse disorders, antisocial personality and met criteria of intermittent explosive disorder that did not overlap with a diagnosis of BPD. Women with BPD reported significantly more lifetime eating disorders than men with BPD. No gender differences were found in degree of overall impairment. These results suggest that male and female patients with BPD, although equally distressed, present with different lifetime patterns of impulse-related disorders.


In the last decade, the literature on the relationship between gender and borderline personality disorder (BPD) has generated much controversy and little clarity. Recently, BPD has been characterized as the “bad girl” of psychiatric labels (Becker, 2000), a charge that was based on the presumption of an increase in the application of the borderline diagnosis to women and the existence of a sex bias in the clinical diagnosis of BPD. Unfortunately, research on the gender rates of BPD and analogue studies of a sex bias in BPD have been equivocal. Two community-based studies did not find that BPD was related to gender (Torgenson, Kringlen, & Cramer, 2001; Zimmerman & Coryell, 1990), whereas another found that women were significantly more likely to have BPD than men (Maier, Lichtermann, Klinger, Heun, & Hallmayer, 1992). Although empirical studies with clinical samples generally report that BPD is predominately exhibited by women (e.g., Zanarini et al., 1998a), research conducted on outpatients with major depression has found that either (a) men were significantly more likely to meet criteria for BPD than women (Carter, Joyce, Mulder, Sullivan, & Luty, 1999); or (b) there was no significant gender differences in BPD (Golomb, Fava, Abraham, & Rosenbaum, 1995). Research that supports a sex bias in BPD has found that clinicians are more likely to rate female clients with a higher applicability of the BPD diagnosis than they rate male clients (Becker & Lamb, 1995), whereas other analogue research has found no significant relationship between the diagnostic attribution of BPD and gender of patient (Adler, Drake, & Teague, 1990).

So we have some conflicting studies here. Some studies show that more women present with BPD, but others show there are NO gender discrepancies. Could this be because men simply don’t seek professional help as often?  Or are misdiagnosed more for so many reasons, including gender bias?

Despite the accumulating research on the role of gender in the presence of BPD, little attention has been given to the different ways in which men and women are affected by the disorder. Within a sample of personality-disordered patients, Zanarini and colleagues (1998a) found gender differences in the “type of disorder of impulse in which they specialized” (p. 1738), with male borderline patients significantly more likely to meet criteria for lifetime substance use and females significantly more likely to meet criteria for lifetime eating disorders. Furthermore, women with BPD had a greater likelihood of posttraumatic stress disorder than men with BPD (61% vs. 35%). Also, different patterns of Axis II comorbidity for this sample of men and women were found, especially for the dramatic cluster (Zanarini, Frankenburg, Dubo, Sickel, Trikha, & Reynolds, 1998b).

It’s definitely important to note the differences in men and women. I also think because of societal pressure, men tend to work harder to hide their impulsive behaviors from prying eyes so they’re more difficult to diagnose.


The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project examines whether male and female outpatients with BPD present with a different pattern of comorbidity, especially impulse-related disorders. This report extends prior research in that we examine gender differences in comorbidity within a patient sample unselected for personality disorders and also examine gender differences in level of impairment among borderline patients.


RESULTS

Of 1,410 participants who were administered the SIDP-IV, 15 were excluded due to missing data. Of the 1,395 participants included in the current study, 105 (70.5%) women and 44 (29.5%) men were diagnosed with BPD. Of these 149 patients, most were Caucasian (N = 131, 87.9%) and the mean age of patients was 31.4 years (SD = 8.9). The majority of the 149 participants had completed high school or some college education (N = 132, 88.6%) and 34.2% were married or cohabitating (N = 51). There were significantly more women with BPD (N = 105/869, 12.1%) than men with BPD (N = 44/526, 8.4%), (c 2 = 4.7, df = 1, p < 0.05). Women with BPD were significantly more likely to be younger (M = 29.9 years; SD = 8.5) than men with BPD (M = 34.8; SD = 9.2) (t = -3.1, df = 147, p < .005). No other demographic differences between men and women with BPD were found.


In terms of gender differences in the comorbidity profiles of patients with BPD, men were significantly more likely than women to meet criteria for a lifetime substance abuse disorder, intermittent explosive disorder (had it not been eliminated due to co-occurrence with BPD), and antisocial personality disorder, whereas women were significantly more likely than men to meet criteria for a lifetime eating disorder. To examine whether these gender differences were specific to the impulse-related disorders, we examined gender differences in patients with BPD in disorders that are related to gender and disorders in which impulsivity is not a feature of the disorder (i.e., panic disorder and major depression). There were no significant differences between men and women with BPD in these comorbid disorders. In a series of logistic regressions controlling for age, with gender as the dependent variable, and with the comorbid disorder, which was found to be significant in the above analyses as the independent variable, each of the comorbid disorders remained significant.

That’s a mouthful towards the end. So in the long run men tend towards lifetime substance abuse disorders, intermittent explosive disorders, and ASPD. Women were more likely to have co-occurring lifetime eating disorders in terms of impulsivity.  To help them determine whether the gender differences were directly related to the impulse related problems in BPD they did a control test with other BPD patients who did not demonstrate impulse control issues. In conclusion their data demonstrated that gender was significant when controlling for the comorbid impulse disorders.

To explore whether the pattern of comorbidity in male and female patients with BPD was specific to only those patients with BPD, we examined the comorbidity profiles of the full sample of patients with the exclusion of those patients who met criteria for BPD (N = 1,246). Within this larger sample (N = 1,246), men were significantly more likely than women to meet criteria for a lifetime substance abuse disorder, intermittent explosive disorder, and antisocial personality disorder, whereas women were significantly more likely than men to meet criteria for a lifetime eating disorder, posttraumatic stress disorder, major depressive disorder, and panic disorder.

Interestingly this pattern held up for the larger non-BPD population as well. They ran the same gender bias study excluding the BPD patients and found that the men were more likely to meet criteria for lifetime substance abuse disorder, intermittent explosive disorder, and ASPD. They then found that women were significantly more likely than men to meet criteria for a lifetime eating disorder, posttraumatic stress disorder, major depressive disorder, and panic disorder.



DISCUSSION

The main finding of this report is that there were gender differences in the pattern of lifetime impulse-related disorders in a sample of outpatients with BPD. More specifically, substance abuse disorders, intermittent explosive disorder, and antisocial personality disorder were found to be significantly more common in the histories of male borderline patients than female borderline patients. In contrast, eating disorders were found to be significantly more common in the histories of female borderline patients than male borderline patients. These findings are consistent with those of earlier studies of borderline inpatients that found lifetime substance use disorder and antisocial personality disorder to be more common among men and lifetime eating disorders to be more common among women (Zanarini et al., 1998a,1998b). Unlike prior research (Zanarini et al.,1998a), this report did not find significant gender differences in comorbid posttraumatic stress disorder among patients with BPD. Differences in methodology and samples may have accounted for the divergent findings, especially since the sample used in prior research was comprised of inpatients who were selected for a personality disorder. Another possibility for the difference in this result is that the inpatient sample in the other study, in contrast to our out- patient sample, was more clinically severe and may have experienced more sexual trauma, a trauma that is strongly associated with posttraumatic stress disorder and the female gender (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995).


The current report found no gender differences in degree of impairment among patients with BPD. This finding of gender differences in the type of disorder suggest that both groups of borderline patients are equally impaired but, perhaps, express their distress differently. In this study, the gender differences in Axis I and Axis II disorders found in our subsample of outpatients with BPD were also found in the larger sample of outpatients without BPD; these findings are congruent with findings in epidemiologic studies of gender differences in psychiatric disorders (Hsu, 1996; Kessler et al., 1994). Therefore, it is possible, that the pattern of differences found in men and women with BPD is not associated with the diagnosis of BPD but is an expression of male and female pathology in general. However, this report, unlike our larger sample of outpatients without BPD and unlike epidemiologic studies (Kessler et al., 1994, 1995), did not find gender differences in rates of major depression, posttraumatic stress disorder and panic disorder. This report’s finding that there were gender differences in only the type of impulse-related disorders (i.e., eating disorders for women and substance abuse, antisocial personality disorder, and intermittent disorder in men ) is consistent with gender role theories on affect regulation, which suggest that in response to negative affect, women use more self-focused activities than men (Morrow & Nolen-Hoeksema, 1990). Because the data in this report were correlational, it cannot be presumed that the diagnosis of BPD differentially increases the risk of certain impulse-related disorders in women and men. Clearly, prospective, longitudinal research is needed to address the role of premorbid BPD in the development of comorbidity in both genders.


Future studies are also needed to assess whether gender differences in patterns of comorbidity among borderline patients persist over time and whether these disorders differentially impact the course, outcome, and treatment of BPD. The findings from this study need to be replicated, especially with a community sample and with a sample of general psychiatric in-patients.



Men tend to be outward directed and women tend to be inward directed? Hm, still seems like an overgeneralization to me. Who’s willing to bet in 5 years we’ll be hearing about male waifs that are more inward directed and high functioning but quiet so no one knows. Regardless, I do think it’s important for clinicians to recognize that there is likely to be a significant difference in the presentation of symptoms between men and women in order to make diagnosis more viable. That way people are more likely to get the help the need and deserve. 


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