(This is part of an ongoing series linking bisexuality with Borderline Personality Disorder)

 As we have delved into factors involving the sixth symptom for Borderline Personality Disorder (BPD) on the DSM IV, and the corresponding section of the DSM 5, we seem to be getting deeper and deeper into the traits exhibited by people with BPD.  We started with episodic dysphoria which basically can be translated into problems with coping with the content of our life stories.   We then moved onto anxiety and tapped into research that indicated that BPD patients have to deal with one or more anxiety disorders.  Last week we looked at Generalized Anxiety Disorder and today we want to take a closer look at Panic Attack Disorder, or its sister, Anxiety Attack.

According to research we have quoted in past blogs, approximately 90% of people with BPD have some form of clinical anxiety dysfunction. Further research indicates that about 50% experience anxiety or panic attacks. These attacks occur frequently because of difficulty coping with sudden stresses brought on by criticism, rejection, or the threat of separation from people who are important. These reactions, if consistent and occurring over a prolonged period of time, can lead to physical symptoms such as migraines and other syndromes. Intense and prolonged anxiety attacks can be a major cause of suicidal attempts. 

An anxiety attack, according to the DSM 5, involves a period of intense fear with four or more of the following symptoms:

• palpitations, pounding heart, or increased heart rate
• sweating
• trembling or shaking
• sensations of shortness of breath or smothering
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• feeling dizzy, unsteady, lightheaded, or faint
• feelings of unreality or being detached from oneself
• fear of losing control or going crazy
• fear of dying
• numbness or tingling sensations
• chills or heat sensations

Based on my own experience, my attacks involved a constriction of my breathing, including tightness in the chest, and the proverbial lump in the throat, or as mentioned above, a feeling of choking. It was like this tightness went from the chest, to my throat, culminating in a feeling of physical numbness flowing over my brain. When I tried to react to the criticism, it usually changed the level and intensity of my speech, leading to what appeared to be a high-pitched angry outburst. I also experienced that I was no longer in control of what I wanted to say or do, and that these incidences were occurring almost beyond my own mind and body.

For many years after my divorce and crash, my intense feelings of rejection and abandonment caused me to retreat into a form of social hibernation, where I isolated myself from any possible  threatening social situation. However, when I got married for the second time, I could no longer avoid social conflicts, and I found I was demonstrating an extreme out-of-control reaction to minor sources of criticism. When this occurred, I had to remove myself from the house and take a long walk until the adrenaline rush subsided. However, I was left with an even bigger problem now because guilt and shame had replaced anger. She in turn would withdraw and go silent which further accentuated my feelings of rejection. These anxiety attacks would usually last no more than half an hour, but the guilt and shame would last for days. This went on until the pain of emotional separation was greater that the guilt and shame. I would then painfully reengage with her and try to work out the cause of the initial reaction. 

We have been married now for four years and, with her patience and persistence, and hours and hours of discussion, we have come to grips with my anxiety attacks and developed strategies to avoid and diffuse them before they go into the guilt and shame stage. I have finally learned to deal with these feeling of rejection and abandonment. I have come to realize that she is in for the full ten yards. She has no intention of rejecting or abandoning me. Occasionally these anxiety attacks still occur but I can resolve them by reminding myself that I am not being rejected and I do not have to fear abandonment. These issues are now resolved in minutes rather than days and they are becoming less and less frequent.

So how do we deal with these anxiety attacks? One of the ways is through medication. I now take a very low dose of a mild anti-anxiety, serotonin enhancing, drug. This relieves the intensity of the generalized anxiety feelings and provides a stop gap to a full blown anxiety attack. Needless to say, one should proceed with caution and only with a doctor or psychiatrist who is equipped to monitor the drug affects and make the necessary adjustment to the types of medication and the dosage. We are our own best guide. If it works, we will sense it. We have to watch for and monitor the side effects.

One of the side effects unfortunately, or perhaps fortunately, can be a reduced libido, which in the case of us bisexual males, this can be somewhat of a relief. I have found that I can still become aroused and engage but the urgency to perform is gone. Ejaculation, although desired and still available, is no longer the goal. I now have more control over my biological processes and seek intimacy rather that sexual release. In addition, I no longer use gay sexual encounters or fantasies as a way to reduce my anxiety thresholds.

But medication, at best, is only part of the answer.  Advocates of treatment for panic attack recommend cognitive therapy. The key is to be able to recognize the causes of the anxiety and take cognitive measures to reduce the thresholds. In other words we learn to soothe ourselves.

Here are my five suggestions for bisexuals with BPD:

1. We learn to recognize and accept that we have borderline personality profiles and that we belong to the 50% group who have to learn to live with anxiety attacks.
2. We explore the possibility of engaging in anti-anxiety drug therapy, but we do not go into this blind. We find a doctor or psychiatrist that we trust and who will work with us to monitor and seek the best drug with the lowest possible dosage. When a drug is prescribed, we research it and discuss our findings with our physician. We should notice a marked decrease in anxiety attacks while still functioning normally in every other way.
3. We engage in cognitive therapy. Cognitive therapy simply means we change our thinking patterns. We can do this on our own or, if we do not feel comfortable with that, we find a therapist who will engage in Dialectical-Behavioral Therapy (more on this is future blog). If we do this on our own, here is a simple formula for dealing with disagreements with loved ones:
   • We recognize the internal source of our anxiety (usually a feeling of rejection or abandonment).
   • We deal with this inner source by self-soothing. For example: there, there now, it’s okay; we can handle this; we are loved; there will be no rejection.
   • We recognize the external source of our anxiety (usually criticism) and deal with it.  We let the person know we are having anxiety issues. We tell them how we are feeling. For example: “I am having a hard time dealing with what you just said, can you please reword that in a gentler manner”.
   • We seek external and internal resolution. We talk it through with the person we are dealing with and then talk our self through the process until the soothing takes place.
   • If it’s a loved one – we ask for a hug.  
4. If the above process is inappropriate for the circumstances, we learn to sooth ourselves. When we feel we are being criticized, we need to deal with the feelings associated with the criticism before it leads to an anxiety attack.
   • We practice the magic square (four breaths in, hold for four seconds, four breaths out, hold for four seconds, repeat).
   • We then get through the situation the best and quickest way we can, usually by accepting the criticism and then behaving appropriately.
   • We then soothe ourselves by recognizing that we just had an anxiety attack and telling ourselves it’s natural and okay and that we handled it beautifully.
   • We go through the incident again in our minds to see how we were triggered and how we can handle the situation better in the future.
   • We give ourselves a hug.
5. We engage in long term anxiety control. For more details, see the last blog for suggestions to control generalized anxiety.