The Almost Effect

Helping the nearly alcoholic

Men with Borderline Personality Disorder

Having BPD can be like "living on the outside looking in"

I met Michael about a year after he and his wife Diane had gone for two counseling sessions following an incident at home. One evening, after they returned from a gathering with friends, Michael accused Diane of flirting with the husband of a woman who was Diane’s best friend. Diane acknowledged that she’d had a few drinks that night, but she was taken aback and denied that she’d been intentionally flirtatious. This was not the first time that Michael had made such accusations. In fact, he had a longstanding habit of accusing Diane of wearing “sexy” clothes when they went out, of flirting with other men, or of exchanging glances with other men when they went out for dinner.

Despite Diane’s denial a fight ensued, which she could not de-escalate. Then, as he made to leave the room Michael pushed Diane. She stumbled backwards, knocking over a table and lamp, and fell to the floor. Michael’s yelling, combined with the racket made by the table and chair and Diane’s fall, woke their two children, who emerged from their bedrooms in tears. Michael then proceeded to stomp around the house, upending a chair and further frightening the kids. He then left, got into his truck, and drove off. At that point, fearing for what might happen next, Diane called her best friend, hastily dressed the children, and spent the night there.

Michael figured out where Diane and the children had gone as soon as he returned to his house to find it empty. He called there, asked to speak to Diane, and apologized profusely. He also agreed, albeit reluctantly, to see a counselor with her again.

 Two of the issues that came up in those first counseling sessions were Michael’s drinking and what Diane described as his moodiness. Whereas Diane had cut down severely on her drinking beginning with her first pregnancy, Michael drank two or three cocktails every night, which he justified as providing relief from his stressful job as a financial adviser. But as Diane explained, “If Michael gets into one of his moods, his cocktails only make it worse.”

Men with BPD 

Michael suffers from Borderline Personality Disorder, or BPD. Like the vast majority of men with this disorder, however, he has not been diagnosed as such. Instead, the counselor he and Diane met with initially gave him two diagnoses: alcohol abuse and impulse control disorder. Michael was told that he needed to stop drinking and enroll in an anger management program. And though this may be objectively true—Michael may indeed have had did have a drinking problem, and his behavior at times was aggressive—this turned out not to be of much help in changing Michael’s behavior.

One reason why men like Michael are often misdiagnosed is because BPD typically manifests itself in different ways in men than it does in women. Here are a few examples of how BPD manifests itself in men:

  • Aggressively thin-skinned: On the few occasions when Diane tried to talk to Michael about any behavior on his part that bothered her—such as his drinking--he would fly into a rage and drive her away. Also, on these occasions he would sometimes accuse Diane of thinking she was “too good for him.” In other words, as insecure as he might be, Michael always took the offensive when he felt criticized.
  • Controlling through criticism: BPD men are more inclined to compensate for the lack of control they experienced as children by being overly controlling in their adult relationships. This often takes the form of being overly critical. For example, despite the fact that Diane had a full-time job just as he did, Michael was quick to criticize her if the house was messy or if dinner was not ready on time.
  • Irrational jealousy: Michael’s reaction after his and Diane’s night out with friends, along with his inclination to accuse her of being inappropriately “sexy” are good examples of this. It was, of course, Michael’s insecurity and his unconscious need to monopolize Diane’s attention that drove this behavior.
  • Possessive but detached: As much as Michael’s jealousy might be seen as possessiveness on his part, his role as a husband and parent was pretty much detached. He did not share much of his emotional life with Diane; and he showed relatively little interest in his children’s day to day lives.
  • Rejecting relationships: Over time Michael had turned sour on virtually every friendship he had.  From Michael’s perspective, people were always falling short, always letting him down. He’d describe them as stupid, incompetent, or untrustworthy.
  • Holding grudges: “Michael can hold a grudge like you wouldn’t believe!” Diane said. He could talk about how his boss, a co-worker, or Diane had let him down even years after the fact. And even then Diane often failed to see the “offense” that
  • Using sex to relieve insecurity: Sex, for Michael, was not only an erotic experience, but something that temporarily quelled his free-floating anxiety and insecurity. As a result he often pressured Diane for sex at exactly the rimes when she was least interested in it—for example, when the stress in their relationship was high, of after he’d driven her away with his aggressive defensiveness.
  • Substance abuse: This is common in women with BPD as well, though women appear to be more vulnerable to abusing psychotropic medications, while men like Michael are inclined to drink or smoke pot. Michael drank as a means of anesthetizing the free-floating anxiety that had hung over him for his entire life.

 

When Michael accepted my suggestion that we meet individually for a while I was both surprised and pleased. In our first session he opened up and told me that he was, frankly, worried that his behavior and attitudes, if unchecked, could drive Diane away. Already he’d sensed some distance between them. He did not want to lose his marriage and family—so in his words he was “ready to talk.”

What this talking led to was my understanding of how Michael’s past had shaped his adult personality. His father had abandoned him and his mother when Michael was five. Michael never saw the man again. His mother, who was an alcoholic, subsequently married and eventually divorced another alcoholic, who was hostile and abusive to Michael. She’d had another son by her second husband, and this boy was the recipient of whatever largesse that man had been capable of.  Moreover, though younger, Michael’s stepbrother had quickly learned that he could abuse Michael, if not physically then emotionally, by making sure he got almost all the attention and material benefits his parents had to give.

Michael’s mother, meanwhile, seemed to have decidedly divided loyalties. Sometimes, Michael said, she would defend him when she thought he was being treated unfairly; at other times she would stand back and do nothing. Similarly, she could be affectionate with Michael at times, but only when they were alone together. Most of the time, Michael felt ignored.

Michael had never spoken much to anyone about his childhood, including Diane. She knew only that Michael had had it “tough” as a child, but she had no real insight into what Michael had actually experienced. And she had never met his family, as Michael had broken contact with them well before they started dating.

A breakthrough came as a result of a very simple statement that Michael made in response to my asking his if he could give me an image of what it felt like for him, growing up in that family. At first he laughed, but then his expression turned sad. “It was like I was on the outside of that so-called ‘family’, looking in.”

I’ve heard this same description of their childhood so many times from men with BPD that I’ve come to see is as a template for working with them. To put it simply, through therapy they need to change their stance in life from “being on the outside looking in”, to “being on the inside, looking out.” In fact, I often refer back to this phrase when setting therapeutic goals and working on them

Recovering from Male BPD

            Recovery for men like Michael is not so simple as sending them to an anger management class. It is in many ways as intense as treatment for women with BPD. But it must begin with both the therapist and the man with BPD realizing just what it is that are dealing with, and where its roots lay. The good news is that, with persistence and determination, men like Michael can recover from the emotional burdens that BPD places on them and those who love them.

 

@2014 by Joseph Nowinski

Joseph Nowinski, Ph.D. is a clinical psychologist and author of Hard to Love: Understanding and Overcoming Male Borderline Personality

Joseph Nowinski, Ph.D., is the supervising psychologist at the University of Connecticut Health Center.

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