Bisexuality and Borderline Personality Disorder and Self-Harm Urgency

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Over 2% of the population have some degree of (BPD). Of this population 8 to 10% commit suicide – this rate is more than 50 times the rate of suicide in the general population and ten times the rate of suicides due to depression alone. Approximately one-third of people with borderline personality disorder (BPD) also identify themselves as bisexual. The number of bisexuals who have BPD traits I believe would be much higher.  This blog is an attempt to understand the nature of one of the traits, disinhibition, so that we can survive and even thrive as bisexuals with BPD.

Pathological personality traits in Disinhibition -Impulsivity: A sense of urgency and self-harming behaviour under emotional distress (DSM5)

                Colle and other[1] looked at the relationship between self-harm and a sense of agency (feeling in control of the environment) in a small group of 20 BPD patients, nine of whom presented self-harming behaviors, and compared them with an age-matched control group. A sense of agency was evaluated through The Sensory Attenuation Paradigm, a comparison with externally generated sensations. The results of this study suggest that self-injurious actions constitute a coping strategy for increasing the sense of perceived control of the environment. The idea is that by inducing physical pain, patients may regulate feelings of distress related to loss of control, estrangement from reality, and experiences of numbness. Self-harm actions appear to enable a new set of emotional and physical sensations which allow the individual to feel alive or in control again by making a plan and carrying out an intentional action. However, the study suggests that the temporal relief afforded by NSSI behaviors is not effective for the long-term reduction of dissociative symptoms.

                 Fossati and others[2] looked at the relevance of emotion with negative and positive urgency (impulsivity) as it related to self-harm activities.  In their study involving 1,157 adolescents who were attending public high school in Italy, they used the Borderline Personality Inventory (a 53–item self–report questionnaire), the Difficulties in Emotion Regulation Scale (DERS), and the UPPS-P Impulsive Behavior Scale (a 59-item self-report measure designed to assess five impulsivity-related traits). Their findings provide support for the tendency for adolescents to act impulsively when experiencing heightened emotional arousal, both negative and positive.  Negative urgency frequently led to self-harm activities. Their findings also suggest that Positive Urgency may be the dimension of an impulsive predispositionto experience a positive sense of well-being by engaging in reckless behaviors such as heavy drinking or sexual promiscuity “just to celebrate” or “just to have fun”. These results suggest that both negative and positive urgency may be emotion-driven based on underlying fears related to BPD.

                These studies indicate that there are several factors involved in self-harm activities stemming from the disinhibition trait for people with BPD. The first is a sense of dissociation from reality. According to Cole and others self-harm activities may be an attempt to get back into a sense control over our own bodies and therefore a sense of control over our lives in general. The study by Fossati and others suggests that disinhibition may also be due to a sense of negative (to avoid) or positive (to pursue) urgency and this sense of urgency appears to be created by out of control emotional forces. The goal is either to fight or flee in the case of a negative impulsive drive or to experience pleasure in the case of a positive one. It may be that the urge to experience pleasure could be to find an outlet to experience something positive in an otherwise negative world. However, we also realize that this source of high risk pleasure is just another way to harm ourselves.

                When it comes to us bisexuals with BPD, we may be using our sexuality as a means to break out of our otherwise cold and impersonal perceived reality. This positive urgency or impulsivity may be the result of pent up negative emotion, pain, or just a need to break out of the often restrictive heterosexual lifestyle we have created. We set out to supercharge our feelings so that we can feel real again. Our same-sex self then becomes our reality and our heterosexual life becomes some kind of trap that we have created to help us survive. However, once we come down from that high, we realize that our heterosexual self is our real self and the life we truly want to hang on to.  Once in this state the same sex excursion can become a kind of self-harm activity where we continue our dishonest behavior in the hopes of destroying the lives we can no longer maintain. If we are not honest with our partners and live in an honest relationship this duality can lead to a breakdown where suicidal thoughts may appear to be the only solution.

My Five Suggestions for Borderliners

1. Recognize that you are in a struggle to avoid some pain by substituting forms of pleasure that are tainted by inappropriate motivation. You do not necessarily have to change the behavior but you will have to change the motivation. If you are engaging in sex to escape pain or a perceived negative dissociative reality it can become a compulsive addictive pattern.

2. Make a conscious decision to seek pleasure just for the sake of pleasure rather than letting it take over subconsciously. Once in a conscious state your sexual pursuits become a matter of choice rather than a compulsion. You are now free to enjoy your sexual experiences without shame or guilt.

3. Honesty is always the best policy and that has to start with being honest with yourself. If bisexual experiences are important to you and you are not in a relationship then by all means engage and enjoy. No shame. No guilt.

4.  If you are in a relationship you will have to make a conscious decision on whether or not to tell your partner. But be honest with yourself. If you are just hanging on to the relationship because you feel co-dependent or are relying on them and your relationship to escape fears of abandonment then this is not the reason to stay together. You may choose to make a conscious decision to keep your two lives separate and secret but this seldom works.

5. If you are genuinely in love with this person you are now free to make a conscious decision to stay with this person in a monogamous relationship or to explain your need for bisexual experiences with the realization that it may result in the end of the relationship. Either way make the decision consciously, don’t just let it happen.

[1] Colle, Livia; Hilvio, Dize; Rossi, Roberta;  Garbarini, Francesca; and Fossataro, Carlotta.  Self-Harming and Sense of Agency in Patients With Borderline Personality Disorder. ORIGINAL RESEARCH ARTICLE Front. Psychiatry 2020.

[2] Fossati, Andrea; Gratz, Kim L; Maffei, Cesare; and Borroni, Serena. Impulsivity dimensions, emotion dysregulation, and borderline personality disorder features among Italian nonclinical adolescents. Borderline Personality Disorder and Emotion Dysregulation. 2014.


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