‘In Search of the Borderline Male’: Counselling psychologists’ talk about male clients with a BPD diagnosis

Topic: Borderline Personality Disorder (BPD) is a highly contentious and controversial mental health diagnosis. Often characterised as the quintessential personality disorder, it is widely described as being diagnosed much more often in women than in men. Clinical and research samples often reflect this, yet community prevalence studies do not support any such gendered prevalence disparity. Various attempts have been made to explain how either BPD or its application might be gendered, but none have made provided a compelling explanation for the disparity, and few have explored the issue discursively.Method: Semi-structured interviews were carried out with UK Counselling Psychologists who had experience of working with men with a BPD diagnosis. Transcripts were subjected to a form of critical discourse analysis, to create a reading of accounts that might answer research questions on participants’ understanding of the BPD male, including differences from and similarities with the BPD female, as well as their understanding of the gender disparity around this diagnosis and presentation.Findings: Participants’ accounts were found to draw on four discrete interpretative repertoires, covering psychiatric, psychological, psychotherapeutic, and societal realms, which produced varying and conflicting conceptions of ‘the BPD male’. Contradictions produced by these repertoires led to the identification of dilemmas. and the ways participants made discursive sense of these was analysed. Men who might meet BPD diagnostic criteria were variously constructed as no different from women meeting the criteria, yet also fundamentally ‘othered’ within all but one discursive realm. Issues around diagnostic practice and feminised psychological services were identified.Conclusions: The BPD gender disparity can be understood by conceptualising it not as a product of psychological difference between men and women, but as resulting from systemically, institutionally, and culturally situated diagnostic and psychotherapeutic practices, influenced by hegemonic constructions of gender. Consequently, gender-informed diagnosis and services are suggested