Impulsivity, Borderline Personality Disorder, and Bisexuality

SHIRT & TIE [small] (final)(This is the fifth in the series on the relationship between bisexuality and Borderline Personality Disorder [BPD]. In previous blogs, we have established a link between BPD and bisexuality, and we have looked at three symptoms for BPD on the DSM4: symptom 1 –  fear of abandonment, symptom 2 – unstable relationships, and symptom 3 – identity disturbance or poor self-concept.)

Today we want to look at symptom 4, which is “impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating”). The DSM5 places impulsivity under pathological personality traits and under the subcategory of disinhibition. Some of the words used to define impulsivity are: “Acting on the spur of the moment; difficulty establishing or following plans; and self-harming behavior under emotional distress”.

When we look at the literature, stress seems to be the primary factor leading to impulsive behavior[1], especially among women with BPD[2]. A review of the literature by Gagnon[3] identified two neuropsychological diagnostic criterions: a preference for immediate gratification and discounting for delayed rewards, and a failure to properly process feedback information and to monitor action in decision making.

So what does this mean? In my case, stress was a huge factor in my life. Whenever I felt overwhelmed by circumstances, I would seek out excitement and pleasure, and preferably a combination of both. My outlet was gay sex. It was the only stimulus that could bring my anxiety to a climax and allow by body to get into the parasympathetic system again. This was the only way I could relax for a few moments and build up enough courage to go on living. During this time, I would shut down all my evaluation processes. I even preferred unsafe sex in unsafe places. It was like I needed the extra excitement provided by the dangerous behavior and perhaps I was unconsciously seeking death to end my anxieties once and for all. There was no thought of consequences. I just needed my fix.

Neurologically what was happening was that my brain was not necessarily making bad choices; it was making the only choice available at that time. It was either crash and die or take action to activate the pleasure center of my brain and restore the chemical balance needed to survive. So my impulsive behavior was very specific. It was the only area in my life that I took chances. For most people with BPD, impulse might be in other areas of risk but the process is probably the same. For us bisexuals with BPD, I would wager that most of our impulsive behavior is related to sex.

Here are my five suggestions for bisexuals:

  1. We need a life strategy for dealing with stress. What works for me is  usually a quiet time in my gardens, or a nature walk through the forest, or  some time on my bench by the sea. The key is to find our special place and plan to use it as needed.
  2. If we have difficulties with non-stress related impulsivity, we can try to build in a buffer between thought and action. We can learn to develop a warning sign system and employ it on a regular basis. We can practice asking these questions: Is this something I really want to do? Is it safe? Can I live with the consequences?
  3. We can try to take our partner into consideration. The second level of questioning should be to ask if our actions will harm or emotionally hurt someone else, especially someone we love and share our life with.
  4. We may wish to spend time with our partner or with a bisexual friend, trusting them with our desires, asking them for help in evaluating our  impulses,  and building our thought and behavior control mechanisms.
  5. Impulses are not necessarily bad. We have been given a spirit of adventure. If is safe, does not cause harm to anyone, and we can live with the consequences, we are free to enjoy.

 

[1] Cackowski, S.; Reitz, AC; Kliendienst, N.; Schmahl, C.; and Krause-Utz, A.; Impact of stress on different components of impulsivity in borderline personality disorder. Psychol Med. 2014 Nov;44(15):3329-40. doi: 10.1017/S0033291714000427. Epub 2014 Mar 6.

[2] Aquglia, A; Mineo, L.;Rodolico, A.; Signorelli MS; and Aquglia E. Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study. Int Clin Psychopharmacol. 2018 May;33(3):121-130. doi: 10.1097/YIC.0000000000000206.

[3] Gagnon, Jean. Review Article Defining Borderline Personality Disorder Impulsivity: Review of Neuropsychological Data and Challenges that Face Researchers. Department of Psychology, Journal of Psychiatry and Psychological Disorders. Volume 1, Issue 3. June 2017,

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