How BPD Differs in Adolescents and Adults
BPD is a personality disorder that has historically been diagnosed in adults. A significant body of evidence suggests it is possible for children and adolescents to begin to develop BPD before age 18.
Because teen personalities are still forming, young people may undergo many changes before they’re considered an adult. Mood swings, instability, and other symptoms may be a sign of hormonal fluctuations, stress, or anxiety.
Those who are experiencing symptoms of borderline personality disorder need help—don’t wait to seek care in the hopes that a behavior is “just a phase” or “they’ll grow out of it.”
The importance of early diagnosis cannot be stressed enough. The sooner BPD symptoms are diagnosed, the faster treatment can begin and the better the chance to live a successful, meaningful life.
The Myth of BPD and Gender
It’s estimated that over 14 million Americans have BPD. Once more commonly diagnosed in women, the largest study done on psychiatric disorders shows that it occurs equally often in women and men.
One explanation behind it appearing to affect more women is that women are more likely to seek mental health care than men. Since research on BPD is often conducted in psychiatric settings, it was previously less likely for men with borderline personality disorder to be included in these research efforts.
Another explanation is that BPD is often misdiagnosed in men. Many men with the condition are often diagnosed with depression or PTSD.
Or perhaps the issue is that for years, the general public and many in the psychiatric community have viewed mental illness in boys and mental illness in girls in very different ways.
The Bias of Behavior
To illustrate this gender bias, psychologist Alan E. Fruzzetti, PhD, offers a simple test.
“If I told you that a student in a classroom was pounding on a desk and being disruptive, would the image of a boy or a girl enter your mind?” he asks. “Or, if I told you that a student in a classroom was upset and incessantly tapping on a desk, would you think it was a boy or a girl?”
Most of us would imagine the “pounding” student was a boy and the “tapping” student was a girl. And, when observing essentially the same behaviors, many people would describe them and react to them very differently, according to the gender of the person displaying the behavior.
There are various factors as to why we view boys and girls through different lenses.
Different behaviors are deemed acceptable or troubling depending on one’s gender, leading to different social responses for boys and girls.
In general, a girl who is angry, depressed, or displaying other signs of distress has a better chance of being treated with compassion and understanding—and being referred to counseling and treatment—than a boy.
In contrast, boys who show similar behaviors are often punished or ignored completely.
“The problem is that both boys and girls display ‘non-normative’ behaviors, and our misunderstanding of these behaviors has produced serious consequences for their mental health,” Fruzzetti explains.
Gender Gap in BPD Diagnosis
This gap between boys and girls is particularly present in the diagnosis and treatment of BPD.
BPD affects approximately the same number of men and women, but the condition is likely slightly over-diagnosed in women and significantly under-diagnosed in men.
Many studies have explored the differences between men and women who meet the criteria for BPD, finding that more men with substance use disorders are diagnosed with BPD than women, while more females with eating disorders or PTSD are diagnosed with BPD.
“When boys don’t fit social and emotional norms, their behavior can be misinterpreted,” Fruzzetti says. “Bias around gender may have a lot to do with these different diagnoses.”
For example, when men display anger, it is more often seen as a sign of antisocial behavior than it is in women, even though women with BPD show more aggression than non-BPD women, and men with BPD show less aggression than non-BPD men.
Also, established stereotypes about the nature of masculinity can lead to BPD being misdiagnosed or missed altogether.
Fruzzetti states that boys generally possess fewer social and emotional skills compared to girls, which is often misunderstood and incorrectly attributed to a lack of motivation or flaws in character.
Challenges of BPD in Boys and Men
Because of misdiagnosis and underdiagnosis, many boys with BPD do not receive any treatment, receive the wrong treatment, or worse, end up in prison.
About 20% of males in the criminal justice system actually have BPD.
According to Fruzzetti, overall, our health care system is not set up to help men with BPD. In particular, the prison system does not provide proper treatment.
In prison, biases and stigma about mental illness are intensified. Boys and men who struggle with BPD are more likely to be punished rather than treated.
“The solution isn’t to be less compassionate towards women; it’s to be more compassionate towards men,” Fruzzetti says.