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.
Paul and Meg met in a bar when they were both in their mid-twenties. Meg rarely visited bars, in fact, she rarely dated, but she had been persuaded by some friends to go celebrate one of their birthdays. Paul had also been there with friends, and the two groups somehow gravitated to one another, eventually pairing off in a casual sort of way. Paul did not come on strong to Meg (which would have immediately turned her off), but before he left he did ask if it would be okay if he called her some time. She was skeptical, but gave him her number, and was pleasantly surprised when he called three days later, asking if she’d care to meet for coffee. Again, this low-key approach is what appealed to Meg.
Meg had been raised in a suburban middle-class family and had a younger brother and two younger sisters. Her father had been a teacher and made enough money to enable Meg’s mother to work part-time at the local library while devoting the lion’s share of her time to parenting and keeping house. Theirs was, Meg said, “the all-American family, at least when you looked at us from the outside.”
Meg was bright and did well in school. She also enjoyed active play, and was more interested in building things and climbing trees than in traditional “girls’” pursuits like playing house or skipping rope. She was, unfortunately, also the victim of her father’s occasional fondling hands and his tendency to be a voyeur. “I remember being angry that my parents would not allow us kids to have locks on our bedroom doors,” Meg said. “That meant that I had to be constantly on guard for my father walking into my room, which I shared with my next youngest sister Joann. He was most likely to barge on in right after I took a shower, so I became very sure from an early age to always have some clothing on. The couple of times I complained he’d get all huffy and act like I was being ridiculous.”
Meg believed that her mother never suspected that her father was a voyeur, much less that he’d tried groping his daughter on several occasions. Meg coped with the groping in two ways: by keeping her distance and also by “dressing down.” “I had the largest collection of baggy jeans and sweatshirts you’ve ever seen!” she told me with a laugh, adding “It fit my tomboy personality.”
“But it could also serve as camouflage, don’t you think?” I suggested. Meg nodded.
Meg knew that Joann shared her experiences and concerns, though to a lesser
