After years of struggling with depression, impulsive behaviour, trouble with relationships, a distorted self-image, frustrated attempts at therapy and ineffective medication regimes, David O’Garr found himself sitting in the waiting room of a mood disorder clinic.
After a three hour wait, and a brief consultation, he emerged with a new diagnosis—borderline personality disorder—and little else.
When O’Garr looked into it, he encountered a dearth of resources for men, intense stigma attached to the disorder, and hostility surrounding it. The diagnosis spurred the loss of his job and a major personal upheaval.
He later wrote of the experience, “I felt lost. I had no idea what BPD was or what it meant…To then be told, as I interpreted my diagnosis at the time, that I was not a whole person–just felt like I was barely there at all.”
“The leprosy of psychiatric diagnoses”
In spite of increasing awareness, a culture of shame still shrouds mental illness. Although maladies like depression and anxiety have gained some hard-won sympathy from society, words like ‘schizoid’ and ‘bipolar’ still conjure images of the threatening and incomprehensible.
Borderline personality disorder has the dubious distinction of retaining that stigma even among mental health professionals. Sometimes referred to as the ‘leprosy of psychiatric diagnoses’, borderline patients are rumoured to be hysterical, manipulative, incurable and even dangerous. Some practitioners will outright refuse to treat them.
Men with borderline personality disorder get the shortest end of a stunted stick; not only are they thrust into a highly stigmatized group, but they’re made to feel they’re the only ones there. Although it’s now been suggested that there are just as many borderline men as women, until recently, on the books, there was a 3:1 female to male ratio in BPD.
When O’Garr sought out a community, his main source of support was Twitter, and he credited just knowing there were others like him as a stepping stone to healing. When asked how many other men he connected with online, he pauses.
“I didn’t really connect with many men with borderline personality disorder,” he says. “I connected with women. There just wasn’t many of us out there.”
In the land of women
Pete Miller, MR. R. Psych, 42, is co-founder of BreakAwayMHE.com, and has been on both sides of the desk. As a mental health professional, he’s worked with and treated clients with BPD. He’s also been one of them.
Miller’s experience as both the healer and the healed have given him insight into the disorder’s skewed gender pattern.
“In my psychology practice, I do see BPD more often in female patients than I do in male patients,” says Miller. “In my experience about 8 females to every 2 males. Also when males do attend therapy, they tend to have only a few sessions rather than complete a full intake, diagnosis, and treatment.”
Miller suggests that the prevalence of women in treatment isn’t necessarily because there are more of them, or that they need more help; rather, current social constructs make it more difficult for men to ask for help, and then commit to getting it.
“Being a male with a condition like this, it can be very hard to admit to because of stigma, but also very difficult or impossible to allocate time to deal with it,” says Miller.
“Most men are almost entirely preoccupied with training to earn a living, earning a living or supporting a family. Treating BPD effectively may also involve informing family members how best to interact with the suffering person, therefore requiring even more time, transparency, and vulnerability.”
Miller was also aware of the stigma against men with borderline personality disorder as abusers, selfish, or incapable. Forums for loved ones with BPD are filled with tirades against liars, cheaters and abusers; a commonly repeated question is ‘are borderlines capable of love’? Even for a mental health professional, these cultural tropes can be deeply damaging.
“Honestly, I was also afraid of being exposed as ‘broken person’ or ‘a piece of garbage abuser’” admits Miller. “Likewise, if my partner ever discovered I had serious mental health issues that would take extensive work to correct, then maybe she would want to give up on me.”
A clinical blind spot
The problem with diagnosing men with BPD isn’t just personal; it’s clinical.
Personality disorders don’t have the advantage of a biological test for detection. Rather, patients need to meet five out of nine criteriaoutlined by psychiatry’s bible, the DSM V: an unstable sense of self, volatile relationships, an intense fear of abandonment, impulsive behavior, unstable moods, suicidality, chronic feelings of emptiness, excessive anger, and disassociation. How these manifest themselves, and how clinicians interpret them, is what matters most.
Like O’Garr, Miller struggled for years before his diagnosis.
“I had issues throughout childhood, teens, and early adulthood in regards to anxiety, emotions, and functioning in relationships,” reports Miller. “At a few points [I] went to doctors and therapists to investigate things, but the investigations were always short-lived, either because doctors offered suggestions and treatments to address the apparent physical manifestations of my problems…or I couldn’t connect with whoever was attempting to counsel me.”
Clinicians, tasked with identifying profound mental suffering in short spaces of time, are subject to the same gender norms we all grow up with. Unfortunately for men, traditional concepts of masculinity are often incongruent with mental stability.
Studies have suggested they are more likely to consider personality disorders in men if it interrupts their functioning at work, rather than their emotional well-being—which gives a grim prognosis for men who suffer profoundly, but quietly.
Other symptoms can also be obscured by our notions of masculinity. ‘Manly’ men drink hard. The more sexual partners they have, the better. They struggle with their feelings. Anger and violence are wired into their biology. Much of what is ascribe to being a ‘real’ man can be signs of a real problem.
Resources and treatment
As society tackles how gender norms adversely affect women, there is burgeoning recognition that that knife cuts both ways. Although treatment for men still appears to be lagging, both medicine and communities are rallying to recognize and help men with BPD.
Miller’s organization, BreakAwayMHE.com, was designed specifically for those who struggled to find hope in their diagnosis, or who—for logistical or psychological reasons—had trouble accessing services.
“Part of the reason for, and design of, BreakAwayMHE.com was to not only keep the information free to all, but to offer an alternative avenue for the information to be received by people who wouldn’t normally receive it through traditional means,” wrote Miller in an e-mail. “The male population (and perhaps others as well) may be less likely to seek out therapy using traditional formats, but nonetheless still very much require the information to get started with helping with themselves and initiating a healing journey.”
As a patient, O’Garr advocates for increased training on how to treat men with borderline personality disorder, citing one instance where a therapist seemed to be intimidated by his expression of emotion during therapy, which can be hard work for a patient.
“The thing is, is that when I get emotional, I get loud,” explained O’Garr. “I feel my therapist I was working with at the time seem[ed] to almost cower away from me as my voice rose. Which led to me not being able to really open up about everything I needed to work on or process, because I felt like she was afraid of me.”
“Which I understand and validate, here is a not-so-small guy getting loud and she was pretty tiny, but ultimately I feel it did me a disservice.”
“I feel like having some sort of training for social workers on how to work with or deal with men in these sort of scenarios might be a bit better.”
O’Garr, now 34, no longer meets the criteria for borderline personality disorder, and currently lives in Hamilton, Canada, using the theater and writing as a continuing form of therapy. Miller lives in Alberta with his family. His organization has been growing and expanding since 2014, attracting users worldwide. Both are living embodiments of the fact that BPD in men is real, but far from an aberration, a character flaw, or a life sentence.