Exploring the Pathways to Diagnosis for Men With Borderline Personality Disorder: A Qualitative Study.
J H Broadbear, M G Bhagwandas, S Crowley and 2 others
PMID 39225121WHAT IT FOUND
Eight men with borderline personality disorder described a 22-year average delay from adolescent symptoms to diagnosis.
They said anger and substance use were punished or missed, job loss often triggered crisis, and medication alone felt ineffective.
Key findings
01Eight men with diagnosed borderline personality disorder reported symptom onset around age 13 and diagnosis around age 36, with an average 22-year delay.
02Men described anger, self-harm, substance misuse and aggression being treated as behaviour problems, not mental health distress, and none received mental health support during adolescence.
03For all but one, first mental health contact led to depression diagnosis and medication only, which participants experienced as ineffective or worsening; job loss was the most common crisis trigger.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only eight men were interviewed, and they self-selected through referrals or advertising, so the accounts may not represent men with undiagnosed BPD or men in drug, alcohol or correctional settings. The interview guide was not pilot-tested, and no repeat interviews were conducted. Two transcripts were cross-coded by three raters; the rest were analysed by investigators, so the findings depend on a small research team. The study used a binary concept of gender and included only participants who self-identified as men. Twelve men were shortlisted, three could not be contacted and one withdrew before consent, so the sample came from a small recruited pool.
The easy way to misread this
Do not read this as evidence that any treatment works or that all men with borderline personality disorder wait 22 years for diagnosis. The study interviewed eight self-selected men, did not compare groups, and did not test an intervention.