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INTRODUCTION

Ever since the film Fatal Attraction, starring Glenn Close and Michael Douglas, captured the attention of moviegoers around the world, the concept of Borderline Personality Disorder (BPD) has become part of public consciousness. It is a diagnosis that has been used to refer overwhelmingly to those women who

• Have had ongoing problems making relationships work. Typically these women fall in love quickly and intensely, but their relationships are marred by unrealistic expectations and resultant conflict.

• Tend to see the world in black-and-white terms. In other words, you are either their best friend or their worst enemy.

• Demand attention. Sometimes they do this by being flirtatious; alternatively they may get attention by hurting themselves or threatening to.

• Are emotionally intense and unstable. They can come on strong sexually, but their anger can be equally intense, and they can sink into deep states of depression and hopelessness. Consequently, they can be alternately needy and rejecting.

• Cope with uncomfortable emotions through the use of alcohol and/or other drugs. Anger, anxiety, jealousy, self-hatred, depression, and boredom are only some of the emotions that the person with BPD tries to anesthetize with medication or drinking, often placing herself at risk of an overdose.

Until now the idea that men may also suffer from BPD—perhaps even in equal numbers to women—has received scant attention. There is very little written about BPD in men in the professional literature, and even less research. Treatment centers for BPD rarely admit a male patient. However, experts in the field acknowledge that this condition does exist. As Rex Crowdy, MD of the National Institute of Mental Health points out, the hallmarks of BPD, in particular the inability to manage inner feelings and to succeed in relationships, are just as common in the male population as they are among women. Yet men rarely receive that diagnosis, much less treatment for it. In addition, because men and women differ in what they mean by intimacy, their attitude toward anger, the basis on which they build self-esteem, and so on, the solutions for BPD in men and women also differ.

Hard to Love takes a fresh look at the concept of Borderline Personality Disorder and how that diagnosis may apply to as many men as women. Rather than framing it as a simple category—something one either is, or isn’t, period—we will look at BPD as a personality and temperament style that exists on a spectrum.

As this book goes to print, the American Psychiatric Association has just published the first revision in fifteen years of its Diagnostic and Statistical Manual of Mental Disorders, or DSM. DSM-5, as this edition is called, attempts to clarify the definition of a “personality disorder.” The category of BPD is retained in DSM-5, but also organizes the behaviors associated with it into two areas. Specifically, in order to qualify for a diagnosis of Borderline Personality Disorder, an individual must show significant impairment in the following two areas of personality functioning:

• Self: The individual has an essentially negative view of him- or herself.

• Interpersonal: The individual has a distorted view of others and difficulty in close relationships.

As you read further, you will see that Male Borderline Personality Disorder, as described here, matches those criteria very well. In addition, the view taken in DSM-5 is enlightened in that it does not view a personality disorder as a simple category, that is, something one has or doesn’t have. Rather, it acknowledges that personality disorders, including BPD, can vary from mild to severe. That is the point of view taken here as well.

One end of the BPD spectrum is anchored by what could be called “normal occasional male insecurity.” This is the state that describes the overwhelming majority of “normal” men. It means that even the most psychologically healthy individual can have occasion to experience self-doubt, to experience intense emotional states, and to experience conflict or unhappiness in his relationships.

At the other end of this spectrum is full-blown Borderline Personality Disorder. In between these two anchor points is a large spectrum on which men’s personalities and temperaments can vary greatly. It is only those men whose personalities and temperaments place them at the extreme end of the spectrum who truly have a mental illness for which they require expert help if they hope to ever experience personal satisfaction, inner peace, or a satisfying long-term relationship. Those who fall in the middle range—who show some of the signs of BPD but in a less severe form—are the men who are “hard to love.” It is impossible to define precisely how many of these men are out there, but judging by the accounts of those who love them, there are many of them.

Hard to Love seeks to help two groups of people. One is composed of those men who suffer from BPD to one degree or another, but who are unaware that this is in fact the cause of their living problems. Many will have been misdiagnosed, for example, as antisocial or as having a substance abuse or anger management problem. As a result, any treatment they may have received will likely have been only partially successful, if at all. These men need a clearer understanding of

• Why they are struggling with BPD.

• What they can do to mitigate the symptoms of BPD so they can stop the suffering and lead more fulfilling lives.

The second group this book seeks to help is those who are in relationships with men who have BPD. What these readers need to know includes

• How to avoid unintentionally making BPD worse.

• Ways to facilitate and reinforce positive change in the BPD man in one’s life.

This book is divided into two parts. Part One will focus on understanding Male Borderline Personality Disorder. It will include case vignettes and will answer such questions as

• Why has BPD in men been overlooked?

• What happens to men with BPD that’s different from what happens to women with BPD?

• What are symptoms of BPD in men?

Part Two focuses on solutions for Male Borderline Personality Disorder. Again, it is aimed at two audiences: men with BPD and those who are in relationships with them.

While some readers may find it useful to engage the help of a therapist when tackling the issues described in the book, many (especially those men whose personality and temperament places them somewhere in the middle of the BPD spectrum) will be able to make use of the solutions that are offered on their own.