BPD diagnosis in men

I am writing this post as a result of watching http://t.co/6JWIeNlR42 by https://twitter.com/AtypicalAeshe. This got me to thinking about the men and women in my life who may have had BPD criteria.

I am in awe of people who give so much of themselves to complete strangers in raising awareness and understanding of BPD issues. So I wish to also shed some light on this subject through my experience as a recently diagnosed 45 yo male with BPD.

Trawling twitter I often find that most of my followers are female (In another life I would have welcomed this, but now not so sure), which I find statistically odd.

As far as I can gather BPD occurs in 2% of the general population of which 75% are women.  How much of this discrepancy can we put down to macho-ism or mis-diagnosis? In my personal life when I cast a diagnostic eye over my peers I can see BPD traits in both a few men and women. 

As birds of feather flock together, BPD sufferers are often drawn to the same social circles in my experience. The reason I believe is that we are the only ones who accept and forgive each others behaviors and emotional instability due to a heightened sense of empathy and an unconscious understanding of emotional responses. Therefore, in my opinion of my own circle, it is somewhat even the ratio of men to women I notice on reflection with BPD criteria.

My mother who is quite elderly now and is beyond self change, I am sure suffers (although she would never recognise or admit to it) from BPD. She grew up in the 1930’s and 40’s in a society where self awareness was considered a egotistical luxury and mental health problems were best treated in an asylum with electric shock treatment or a lobotomy.  I pity her for not being able to control her emotions and still see her struggling on a day to day basis to control her unknowing mind. She developed a fierce work ethic, adopted orphaned and injured native animals, doted over her children and grandchildren and developed many other coping mechanisms (all to excess) to distract herself from her own internal turmoil. She would die of shame if she knew I was writing this about her. However a leopard can’t change it’s spots and I see a definite and consistent BPD genetic disposition in our family over generations, which has been handed down through the generations like an unwanted or loved heirloom.

My brother (who I have always and still idolize) has had his own issues with anger management, relationships and emotions yet these fall within the society norms of – “It’s ok to yell at your kids, if you are just trying to teach them”, “it’s ok to have a couple of beers at night, it helps you relax”,  yet I can still see whispers of the diagnostic criteria in him. This is not so bad as it makes him compassionate and empathetic. He has always protected me where he could because of this. He is also passionate about his business as a stock agent and has huge kudos and respect from his employees and industry peers. Although he has some BPD traits he does not suffer a mental health disorder as such.

This is relevant as I have 2 friends who are definitely BPD. Both male, both unaware of BPD.

As an aussie bloke there is an unspoken expectation that you are tough as nails, drink beer, like sheila’s (women), work hard, play harder, show little emotion (anger excepted) and especially not be a wuss (pronounced like puss and means – sissy, feminine, unmanly). I’m sure most societies throughout the world have their own manifestation of this. As a result we are reluctant to talk to anybody about how we FEEL.

My first friend who has recently lost his job after taking time off to sort his issues out. He knows he has depression but that’s all. I am sure this is the diagnosis for many men who face BPD in Australia, as it was for me for so, so many years.

I recently received a letter from a hospital which stated that BPD was not known as a mental health disorder and that BPD was all new to them (I got a written retraction a few days later after informing them it is in the DSM IV and I was sure their psychiatrists would be familiar with the DSM).

Depression is the diagnosis you get when they can’t put a finger on your mental health issues. It’s the common cold diagnosis a sore chest gets on the first presentation to a GP. Although it could be a lung disease.

Depression has a “just get over it” stigma attached and a pharmaceutical treatment component to it in Australia, so there is a definite reluctance for men to speak about it even to their mates (friends). Depression is easy to diagnose, BPD not so easy and often overlooked in men as a women’s only disorder. I wonder how many men are living in confusion with a diagnosis of depression and can not understand why their lives are not improving although they have been medicated and sought counselling and treatment for depression.

I have spoken to my mate about his depression diagnosis and found he was going to the same charleton quack of a psychologist I wasted time with. He was more interested in my medicare card that offering me real help. My mate told me about his non improvement even after six months of treatment, medication and counselling. This was all too familiar to me. He was  unsure of what to do next, his only resolution was to change to another job, as not working was sapping his self esteem. He, like myself has had to consume copious amounts of weed over the years to suppress and dull our emotional pain and anxieties.

I have known many, many men who suppress their emotions through alcohol, drugs, sex, gambling, etc, etc. The construction industry is littered with such broken souls. All too tough or too ashamed to admit to a problem.

My own long struggle with BPD and obtaining a informed diagnosis has faced many hurdles and took 26 years from the time I became responsible for my own well being and fully aware there was something quite not right in my head shed.

Diagnosis was hindered by practitioner incompetence and knowledge at the time and still to this day,  I started this diagnosis journey in 1986 at 20 yrs old when saw my first psychologist (the seaside sounds and pipes of peace still haunt me). I knew something was not right, that I didn’t think or act like others, within society norms, unless I wore the chameleon mask that adapted to situations as I felt I was expected to. I cant remember the diagnosis at the time (or even if one was given) but I remember if someone now tells me to sit down and relax and take three deep breaths I think I will have to punch them, this was a bad experience, I remember thinking to myself how can I relax with my incessant internal dialogue and that horrible sea sounds and pipes of peace going on all at once.

Regardless of this bad first experience the one constant in my life has been a almost frantic desire for self awareness and understanding. I have attended GA, NA, AA and sought rehabilitation for cannabis (to sustain a relationship) in a month long inpatient rehabilitation center. I have tried most antidepressants and psychiatric medications, with the result equivalent to sucking on a sugar cube. Endless, fruitless counselling sessions, dumping on some poor sod my baggage, to give me a moments or twos respite from myself by transference. I have been a constant pain in the arse to the local hospital for a good ten years. Not that my BPD got any worse (it hasn’t changed since I was eight it is and always has been moderate to severe), but the associated life problems such as relationships and co-morbid untreated conditions such as cannabis dependency, depression, suicidal thoughts, emotional regulation and behavioural problems festered and became unmanageable. I got sick of telling my story to people who didn’t have the understanding, empathy, knowledge or desire to see me well (remember a health care worker is also working to provide themselves with an income, plus, a natural rejection of attention seeking behaviour), it feels like I have regurgitated the same never ending spiral of my fractured life to anyone who had to listen (through want or sufferance), but it more often than not fell on deaf or unconcerned ears.  I never spoke to anyone about suicidal thoughts, such was my shame and guilt of these. I felt like there are so many people struggling to live and I just wanted to die.

I attended a famous drug counselor who told me when I expressed concerns about my mental health and depression that “you don’t have depression! Your just a drug addict” This was the same person who boasted to me when I told him I had been a Customs Officer in a previous life that he used to “smuggle” heroin through the airport I worked at, to try to either impress me or win me over. How fucked up and uninformed is he. It took me years to get over this guilt trip.  Rule One in drug rehabilitation is to ensure the patient does not suffer an underlying mental health disorder, otherwise your just treating a co-morbid condition ie. a coping mechanism. When this coping mechanism is gone the disorder is what is left, resulting in further pain, confusion, relapse and heightened self loathing. This also applies to any coping mechanism, as I have tried most, if the root cause of the main problem is not addressed nothing will change. An analogy of this is if your car stops with a flat battery as the generator has broken, sure you re-charge the battery and it may even run okay for a while, even may take another few recharges, but eventually because the generator is stuffed your battery will eventually die and just not work again. Treating co-morbid conditions gave me some short term respite and false hope, yet eventually the main problem returned with a vengeance leaving me confused and frustrated my efforts where in vain.

I had attended many times to the local Area Mental Health Service which resulted in a dual diagnosis of Dysthymia (depression) and Impulse Control Disorder (after I shouted at them). These themselves are quite disturbing diagnosis and I don’t wish to diminish the affect these have on those who are unfortunate enough to suffer from them. I did what I always do upon diagnosis and researched these. They didn’t quite fit as it did not explain the behavioural, long term depression, relationship, behavioural problems or emotional control issues I faced.

In frustration as  I had exhausted all mental health services in the area (some refused to even speak to me after confrontations on gaining access to treatment and psychologists) I started looking further a field in Melbourne. I attended a GP in Melbourne who was adamant I had adult ADHD, as he suffered (often diagnosis depends on the assessors field of expertise), yet research suggested to me this was also incorrect. More frustration and self loathing resulted.

Diagnosis only came to a head when I had a panic attack when I attended ED and received no assistance, resulting in another trip to the police holding cells and subsequent further self harm and distress.

What was distressing the most about this particular incident (of which there have been many) was that I was exhibiting fear of abandonment, attention seeking behaviour and un-regulated emotional distress but DID NOT KNOW WHAT WAS WRONG WITH ME. But neither did any of the staff.

Knowing something is not quite right in the head shed, just not what, has kept me on this epic quest for knowledge. But not knowing what the issue is kept me in a state of confusion and frustration to the point I “said fuck it all” and gave up looking for answers. I tried to continue to struggle through life, one job to the next, one relationship to the next etc, etc. Yet BPD wouldn’t let go a despite conscious efforts to hide it by preempting conversations, meetings, social events and thoughts, it would rear it’s ugly head at the most unexpected times and would expose my fragility in the most humiliating way it could. Yet all along not knowing what was wrong was the most distressing aspect of living in un-diagnosed BPD. This brings me to my second mate.

He is me ten years ago. He is drifting from one job to the next, one house to the next, one relationship to the next. Always looking for relief in other people or drugs. He does not know whats wrong with him, but I do. I can’t approach him about this, as he would deny there is a problem in a macho response. But the pattern of behaviour is clear both from my own experiences and those I have read about, there is no denying it when you know what to look for.  I have deep empathy for this mate, he has a long road ahead, but the denial would prevent recognition and I guess he has to reach the point where he asks for help. Most blokes never do. It’s seen as a sign of weakness.  This prevents many blokes seeking the appropriate help. We are all to often quick to self assess and call it by another name such as I am just an alcoholic or just a drug addict etc, etc.  As a male I could accept being a drug addict or alcoholic as it has connotations of choice and maintains the illusion of being in some sort of control of your condition. A flawed psych has no such connotation of control and is a fundamental assault on the male ego, of being a provider, the strong role model to children, a man’s man and in control.

Unfortunately for my friend, he will struggle and I am sure he will reach out to me when he needs to. I can direct him to services, but like myself it is a journey most men travel alone or suffer in silence and shame, until it demands attention and treatment. Such is the male ego.

So, in conclusion, in my experience the ratio of BPD men actually out there in my opinion is a statistical aberration and could be far higher than we think. Although this is factually baseless, as a man who never knew and would have probably never have found out my diagnosis regardless of harrowing vain attempts to gain self awareness and understanding, I believe there are so many men out there who like me have just given up hope or don’t have the time or don’t wish to be seen as flawed and live their lives oblivious to their source of pain and frustration.

At the risk of being called a wuss. I am a man and I have BPD.




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3 responses to “BPD diagnosis in men

  1. That was beautiful! I’m so impressed by your courage! We need more men like you who are not afraid to say that they had BPD, so that others will follow in your footsteps.

  2. Reblogged this on MAKE BPD STIGMA-FREE! and commented:
    You have to read this:

  3. Finally something I yelled at my doctor about. I have a 21 year old friend with similar symptoms as myself and he refuses treatment due to how I was treated. But, he’s treating himself and it’s working well. I’m so glad to hear a guy speak out on this important issue. Not enough awareness is out there on the men suffering – I highly doubt it’s just women. The research just needs to be done. Good luck on your journey.

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