Male homosexuality and borderline personality disorder: a review

Gay and bisexual men are more likely than heterosexual men to be diagnosed with borderline personality disorder (BPD). Evidence also suggests an elevated presence of mental health issues and psychological difficulties among gay and bisexual men. This review of literature evaluated previous attempts to understand the relationship between male homosexuality and borderline personality disorder. It examined various published studies related to gay and bisexual men and BPD since 1964, available on the PubMed database. Of the 67 studies, reviews, and letters to editors that appeared in the search results (excluding 210 duplicate results), 31 were shortlisted, while 36 others were excluded due to incongruence with the study criteria. The selected reports were classified under: (1) Nascent attempts to understand BPD among gay and bisexual men, (2) Epidemiology of BPD among gay and bisexual men, (3) Human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), (4) Adverse childhood experiences, and (5) Emerging trends. During the review process, the following subthemes were identified: (1) Exoticization of male homosexuality in BPD research, (2) Parallel pathologization of BPD and homosexuality, (3) A focus on HIV and STDs, (4) Recognition of prejudices and biases, (5) Child sexual abuse, trauma, and bullying, (6) Therapeutic relationship and sexual minority stressors, and (7) Bias by omission in BPD research. The themes underscore the importance of renewing focus on the overrepresentation of gay and bisexual men and the underrepresentation of heterosexual men in BPD research. It also highlights the importance of exploring BPD-specific concerns and psychosocial processes that gay, bisexual, and heterosexual men may experience.