As a resident Psychiatrist, through the years of my training, I have observed that, along with several other concepts, borderline personality disorder in men carries a weight of misconception. Many assume that BPD is a “woman’s disorder”, but nothing could be further from the truth. Over the last few years, I have worked with men whose emotional pain is profound, and I have seen how, with the right therapeutic techniques, they can not only survive but flourish.
Today, I wish to invite you to my consulting room as we explore 7 effective treatment options for borderline personality disorder in men. Think of it as a guided tour through hope, rather than anxiety and despair.
“Healing doesn’t mean the damage never existed. It means the damage no longer controls our lives.”
— Anonymous
I admire this quote and often share it with patients when things get overwhelming.
Why do men with BPD face unique challenges?
Before discussing the effective treatment modalities, let me tell you one thing: Men with BPD usually present differently than women and are often misdiagnosed. Men tend to externalize symptoms such as anger, substance misuse, self-harm, etc, and tend to hardly ever identify with emotional language. And neutrally speaking, it’s the society’s fault, not theirs. Expressing emotions is often considered a sign of weakness for men, so they tend to suppress their feelings. Therefore, it gets externalized into other ways. Indeed, men are more likely to be diagnosed with Substance Use Disorder, Bipolar Disorder, Depression, or Generalized Anxiety Disorder. Without a correct diagnosis, men are least likely to receive appropriate management as compared to women.
Thus, when I encounter a man with BPD, I frequently need to combat reluctance, stigma, and underdiagnosis, or even misdiagnosis. At times, I have to coax a patient into Psychotherapy with humor: “Sure, we will talk, but I don’t charge by the minute. I promise!”. The right approach must respect his identity and vulnerabilities.
Keeping this in mind, here are 7 evidence-based treatment options I frequently integrate while managing borderline personality disorder in men.
1. Dialectical Behavior Therapy (DBT)
According to the National Institute of Mental Health, it is a gold standard treatment for Borderline Personality Disorder. It is the most studied treatment for Borderline pathology. DBT helps patients in managing intense emotions and reducing risk-taking behaviors. In my experience, this therapeutic strategy is particularly powerful when adapted to the male style, focusing on the behavioral skills, concrete problem solving, and practical structure.
DBT consists of four core features:
- Mindfulness
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness
While introducing the treatment modalities to a patient, I describe DBT as a “Swiss Army Knife” for their emotional toolbox. When a man with BPD tells me, “Doctor, I can’t control my anger and I just lash out abruptly”, I start teaching him a distress tolerance skill like “TIP” (Temperature, Intense exercise, Paced breathing) on the first day of Psychotherapy.
Numerous studies show DBT reduces hospitalizations, suicidal behavior, and deliberate self-harm. With that being said, DBT is not a quick fix. It typically requires running for 6-12 months, sometimes longer, and requires dedication from both therapist and patient.
2. Mentalization-Based Treatment (MBT)
MBT aims to strengthen the patient’s mentalizing capacity, i.e, the ability to understand oneself and others in terms of mental states (beliefs, desires, feelings). In men who are inclined towards externalizing blame or rigid thinking, MBT helps open up a reflective space without judgment.
While working with a man with BPD, I might say: “Let’s pause before jumping to conclusions like ‘He pissed me off’, and explore what you felt, and what you felt he thought?”
This is a brief example of mentalization in action.
Clinical research (including in male cohorts) indicates that MBT can reduce anger, impulsivity, and deliberate self-harm over time. In my clinical practice, I usually combine MBT with DBT elements for a hybrid treatment blueprint.
3. Transference-Focused Psychotherapy
Deeply embedded in Psychodynamic Theory, TFP’s prime focus is on the patient-therapist relationship as a microcosm of the patient’s internal relational dynamics. The idea here is to help integrate split, polarized self or other images and therefore, reduce projective identification.
Some men hesitate to take “Talk Therapy” considering it soft, but when framed as relational detective work, like, “We will explore how your mind projects onto me, then unravel it together”, they get curious. According to my observation so far, TFP is suited when a patient has good tolerance for insight and reflection.
Although limited data exist as compared to DBT, TFP has been shown to reduce BPD symptoms and improve relationship functioning.
One caveat: TFP requires two sessions per week with a skilled Psychotherapist.
4. Shema-Focused Therapy (SFT)
Schema-Focused Therapy integrates behavioral, cognitive, experiential, and interpersonal techniques to modify lifelong maladaptive schemas (also known as deep beliefs incorporated from childhood). This therapy is particularly useful in men whose early life adversities (e.g, abandonment, neglect, defectiveness) drive chronic dysfunction.
During a session with an internally wounded man, I might say: “Your ‘Defectiveness/Shame’ schema whispers you feel as if you are unworthy-let’s confront that inner critic together”. Experiential techniques (e.g., Imagery, Role play) can help men feel emotionally engaged rather than detached.
Some meta-analytic work supports schema therapy for BPD, especially for male patients who can handle deep work. I often employ SFT modules after stabilization by DBT or MBT.
5. Systems Training for Emotional Predictability & Problem Solving (STEPPS)
Let me tell you this one thing very clearly. STEPPS is a skills-based, adjunctive group therapy program that augments other treatments. It is rarely ever used independently. It emphasizes emotional regulation and problem-solving in a structured, group format.
Most of the time, I suggest my patients join a STEPPS group (if available) to reinforce the skills they have learned in individual therapy. I advise them: “It’s like a gym for your emotions, so it serves as a time to build emotional muscles in a group of believers.”
In men with BPD, STEPPS has been shown to significantly reduce the temperament issues, impulsivity, and risk-taking behaviors.
6. Pharmacotherapy/Psychotropics
The most important point to keep in mind is that no drugs can cure borderline personality disorder in men. The key purpose of Psychotropics is to target specific symptom domains, including aggression, mood lability, comorbid depression, anxiety, and impulsivity.
We have evidence from randomized control trials and meta-analyses that mood stabilizers such as Lamotrigine, Topiramate, and several atypical antipsychotics help mitigate aggression, mood disturbances, and transient psychotic features if they happen to be any. Antidepressants may be of some help in case there is a comorbid depression, though their effect on core BPD symptoms is modest.
In my prescribing years of practice, I always ensure I start my patients on the lowest effective dose and titrate to the optimal dose slowly and gradually so that I can avoid any possible side effects my patients might have. I remember one patient who said, “Doctor, please, give me as many pills as needed because I can’t take this anymore. I want my brain to behave”.
I politely replied, “Consider medications as an auxiliary guidebook, not a dictator of outcomes”.
It is mandatory to monitor adverse effects, drug interactions, and the risk of polypharmacy. Also, pharmacotherapy alone is of no help. It always works best when given in combination with Psychotherapy.
7. Adjunctive Lifestyle & Psychosocial Interventions
Sometimes the most underrated interventions are those that take place beyond the therapist’s formal chair. In case of borderline personality disorder in men, I encourage:
A. Exercise and Physical Routine:
A 30-minute walk or daily morning aerobic exercise calms the nervous system, stabilizes the chaotic mind, regulates mood swings, and builds routine. I often say to my clients, “Don’t sweat your emotions, train them”.
B. Mindfulness/Meditation Rituals:
Apart from a formal DBT, casual mindfulness or meditation rituals, including deep breathing/yoga, help ground reactivity.
C. Psychoeducation:
Educating a man and his family about BPD, its neurobiology, and relational dynamics fosters insight and reduces blame. It helps families to understand the suffering of the patient rather than blaming him for all the shortcomings, thereby ensuring healthy relationships.
D. Social Support & Peer Groups:
Men generally tend to hide their feelings with the fear of being stigmatized or labeled as weak. However, they might be able to express their grief or concerns in a group that they know is going through the same situation. Structural support groups can reduce isolation.
E. Crisis Planning & Safety Protocols:
Never forget to create a crisis safety plan with your patient to prevent self-harm or any risky behaviors. Your patient must be safe, especially while taking therapy from you.
F. Occupational or Vocational Therapy:
The majority of the men suffering from BPD struggle with job roles, especially consistent jobs. For some reason, they are not able to keep up with it. Try to help your patients build purposeful work routines that can buttress self-esteem and give them an ego boost.
A holistic model ensures we treat the full human being, not just the symptoms.
Humor & Humanity Hand in Hand
Amid all this serious and stressful work, humor is my secret weapon. I will quote an instance:
My patient once said, “Doctor, I scream at the wall every time I am frustrated”. I laughed and replied, “Well, at least the wall doesn’t talk back, yet.”
Humor builds rapport with the patients and reminds them that they are not just pathology, but are breathing human beings with joyful hearts. They deserve happiness as well.
Also, I sometimes share a light quote in session with my patients:
“I have a degree in splitting from chaos; I’m just trying to major in integration now.”
Yes, that’s a bit cheeky, I know. But it helps in building a rapport with the clients and, in my view, it’s therapeutic.
Final Thoughts (From My Couch to Yours)
It’s been a couple of years since I discovered the world of Psychiatry, but still, whenever I mention borderline personality disorder in men to my fellows, I witness raised eyebrows. Yet, every man I have treated has taught me that beneath the emotional outbursts, there is an impulse towards authenticity, connection, and repair.
If you are a man with BPD or a loved one of such a person, know that this road is bumpy. Therapy is hard, messy, and exquisite. This path includes pain, doubt, and relapse. However, I have seen men emerging from the storm, less reactive, more intentional, more humane.
If you want to know more, reach out to Youth Table Talk.
FAQs
1. What if the patient resists therapy or drops out?
Dropout is a well-known risk, especially in men. It can be reduced by building a trustworthy relationship with your patient, with transparent goals and realistic pacing. Humor and flexibility can also help.
2. How long does it take before therapy starts showing its results?
Some men take notice of smaller wins (better emotional regulation, fewer temper tantrums) within 6-8 weeks of consistent therapy. More profound changes (identity integration, stable relationships) can take up to months or even years.
3. Can BPD relapse after treatment?
Yes, relapse can occur, especially during high-stress phases or major life transitions. I reassure my patients that relapse isn’t failure, it’s feedback.
4. Does spirituality or faith-based practice help in BPD?
Actually, it does. Spiritual reflection, prayer, or meditation can reinforce emotional regulation and meaning-making. Incorporating faith values often helps men find an ethical compass and a sense of belonging, both of which are antidotes to impulsivity and emptiness.
5. What if a patient feels therapy isn’t working?
That’s not unusual. And not a failure at all. Sometimes, the therapeutic alliance or treatment modality isn’t the right fit. Therefore, I encourage my patients to discuss their queries openly rather than remaining silent.
References
- National Institute of Mental Health. “How Is Borderline Personality Disorder Treated?”
- Mayo Clinic. “Borderline Personality Disorder: Diagnosis & Treatment.”
- The McLean Hospital – Treatment options for BPD & DBT.
- Chambless & Crisp, What Works in the Treatment of Borderline Personality Disorder (PMC)
- NCBI articles on pharmacologic treatments in BPD
- APA Monitor article on treating BPD
- Systematic review of men with BPD treatment utilization
Talia Siddiq, is a qualified MBBS doctor and she is doing specialization in psychology. She has a good experience of working with people suffering from mental issues. She has written extensively on most common yet unattended issues faced by the youth such as psychological issues, relationship problems, self-harm, addictions, career counseling, financial freedom etc.
