We have come to the last, and perhaps most difficult to describe and comprehend, symptom on this section of impairments in personal functioning on the DSM 5, namely: “Dissociative states under stress”. When we see this definition, we immediately think of dissociative identity disorder (me Lawrence, and my other me Lawrence); however Borderline Personality Disorder, although having some similarities, is essentially quite different.
Back to my case study of my “self”. I had continuous feelings of emptiness as far back as I can remember into childhood. I remember as an eight-year-old one day stopping at the Catholic Church (where I was an altar boy) and just sitting in the pew staring at the flame that indicated that Christ was present just so I would not feel alone. However, I was different than most people with feelings of emptiness; I was also able to feel extreme anxiety and anger. It would switch from one to the other, feelings of emptiness followed by feelings of anxiety. Therefore I had one foot on the path of anxiety and suicidal thoughts but the other on the path of hopelessness. Read more at:
Impairment – Chronic Feelings of Emptiness – Third in a series related to Borderline Personality Disorder (BPD) based on the impairments and personality traits listed in the DSM5.
When we seek to define emptiness, we come up with adjectives such as hopelessness, loneliness, and isolation. But it is more than that; we feel emotionally dead, no excitement, no joy. Being alone is very difficult so we fill time up with work addiction and an unending stream of activity. At some point, we become mentally and emotionally exhausted.
Read more at
A Sad Story – A Case Study of One*
Please Note: I will use this section to add a personal application to all the technical stuff. It is my hope that if you have BPD you will realize that you are not alone and that if I can make it than you gotta believe that you can too.)
A was born into a single parent family with eight children. I was the ninth child and the seventh son. I later found out that everyone else’s father was not my father. When George (everyone else’s dad) left mom to raise the kids by herself, she was pregnant at the time, and her stress brought on a premature baby who never really got her feet under her. She died at about eighteen months due to infection from complications with teething. Looking for support, she had an affair and got pregnant with me. When I was born, she had a physical and mental crash. The other eight kids went into the orphanage and I went to live with my 76 year old grandmother. After several months, mom recooperated (pun intended), got her kids back and started to put her life back together again. Mom never bonded with me because I was her mortal sin, according to The Catholic Church, and God would soon take me anyway. Just about at that time my grandmother died and I lost my bond we shared. My thirteen year old sister quit school to raise me while mom tried to make a wage to feed her family. She never came to my games or school events although I excelled at both. I cannot remember my mother kissing or hugging me until my fortieth birthday.
Because of this rough beginning, I never developed a solid sense of self. I tried to please everyone in the hope that they would approve and show some form of acceptance and love towards me. I became a perfectionist believing that if I showed the world just how good I was they would have to accept me and love me. I must have a powerful constitution (HS) because I managed to survive for fifty-five years. That’s when I was forced to go into an extensive eighteen week, five hours a day, five days a week intensive, group therapy program. That’s when they nailed me with the BPD label, which was okay, because that allowed me to go on long term disability and still collect my salary. Paid vacation. Not.
I have been a student of BPD ever since which led to my quest to understand it, leading to the thirty-seven traits I have identified from the DSM 5* (aside: totally unscientific but makes sense to me. There I go, apologizing again – impairment 2 – for something that needs no apology. In fact, it’s a damn good idea. When I count them up looking back to those days just before the crash, I had a nine or ten on seventeen of the impairments and traits and an overall score of 242. Bet you can’t beat that.) Above all, I had a poorly developed and unstable self-image. Give me a ten on this one. That’s enough for now. Believe me, hang in there, it does get better as we will see in the following chapters.
Please Note: I think it’s time to leave the research and theories behind for a while and look at BPD from an emotional point of view. Feelings from the heart instead of ideas from the mind. So here goes. The play within the play whereby I’ll catch the conscious of the king (me)(Hamlet).
During one weekend, I attended a writer’s workshop that focused on owning our work and feeling good about it. One of the activities really hit home. We were to carry on a written dialogue with the child within. The voice of the higher self (adult) was expressed by writing with the dominant hand and the voice of the child with the other. The following is what I came up with:
Child: It’s dark in here.
Adult: Where are you?
Child: I don’t know. Mom left me here alone a long time ago.
Adult: I was always there with you.
Child: No you weren’t. I didn’t see you.
Adult: I was watching safely from a distance.
Child: Why didn’t you come and play with me? I was scared.
Adult: I’m not sure. I cared for you, but something seemed to be holding me back. Where was your mother?
Child: I never had a mother. There was a woman. She made my meals. We watched TV together but she was not my mother.
Adult: How do you know?
Child: She never held me. She never kissed me. She never said she loved me.
Adult: What about your father?
Child: I never had a father.
Adult No one?
Child: Just you. But you never held me, or kissed me, or said you loved me either.
Adult: But I was there. I didn’t do those things because I wanted you to be strong, to grow up to be a man. Surely you must remember my visits, those poems I wrote to you over the years?
Child: Yes, thank you. I still have all of them. I read them when I feel lonely.
Adult: I am sorry I neglected you. Please forgive me. But there is still time. Perhaps you can be the child of my mature years, like my grandson?
Child: Yes, I would like that. Do you have time to play now?
Adult: Yes I do, all the time in the world. We can have our own special time every day after lunch until before dinner. Would you like that?
Child: Oh yes! That would be fun. But not golf. I hate golf. How about tag or hide and seek? I can hide someplace in the dark and you can come and find me.
Adult: And yes, and we can both run for home…
Child: And yell HOMEFREE!!
Adult: Yes let’s do it.
Child: And you can hug me and say you love me.
Adult: Yes, I promise. I do love you, you know?
Child: I know.
The Silver Lining
What can we take from this? Most of us borderliners with BPD have had to survive with a wounded child, often because of childhood neglect or abuse. Because of what we have experienced, we now have the opportunity through the power of our Higher Self, to use these experiences to grow into conscious beings, to use our trials to give insight into what it means to awaken to the infinite possibilities of the universe. Once we deal with our problems with self-esteem and develop a positive self-concept, we will be miles ahead of the rest of the population who haven’t yet faced their demons and discovered their Higher Self. We can now revisit those days again and do some healing, and then pass this knowledge on to others.
My five suggestions for borderliners
- If you have no self-identity issues and no BPD problems – enjoy the read.
- If you are one of us who struggles with poor self-identity and poor self-image, you are not alone. We* can learn to accept ourselves just the way we are. We can seek a new foundation. We bond with ourselves. We bond the fragile ego-self with the spiritually powerful higher self (HS). We become our own parent and give ourselves a hug whenever we need one.
- We flood our self with self-love from the HS. We practice looking in the mirror and seeing the higher self within. We do this until we can look ourselves right in the eye and say “I love you”, and mean it, and feel it. It will feel like a rush as the HS accesses the pleasure center of the brain. When we do this, we bring the two identities, the mind self and the higher self, together. We enter into the awareness of the infinite power of our Self-identity as body, mind, and soul.
- We tell ourselves we love our self (body, mind and spirit) over and over again day after day after day, until all the old feelings are permanently erased. When confronted with a moment of self-doubt, we stop it. We tell ourselves that we are better than that; in fact, we are beautiful and powerful beings in complete control of our emotions and feelings. We make a conscious decision to let go of the negative feelings associated with low self-esteem, and embrace the positive feelings bathed with love from our higher self. We do not blame our negative mind self, we thank it for being diligent and assure it that things will be different from now on.
- Set aside fifteen minutes a day for meditation with a purpose; namely to become aware of and appreciate the presence of our higher self.
* (Last aside in this chapter: I like to use “we” because using “you” can really be hard on borderliners with an already a poor self-image that says that any kind of unwanted advice is criticism, and intervention is useless. “We” means we are not alone; we are in this together. You may wish to sign up to my newsletter and attend some of my webinars at lawrencejwcooper.ca. These are free services that I offer, because, like the Ancient Mariner, I feel compelled to tell my story to anyone who will listen.)
We have been looking at ways to live better and healthier lives as bisexuals. We discovered that a large percentage of us have had to learn to live with Borderline Personality Disorder. By looking at the impairments and traits listed on the DSM5, we can define areas that we can work on so that we can overcome issues related to our sexual orientation. I have devised the following self-administered survey to help us pinpoint some issues that we may wish to work on.
Self-administered Borderliner Survey
Give yourself a score for each item with 1 being “never, no problem” and 10 being “always, this really sucks”. When you are finished add up the scores.
37 – 50 No problem
50 – 100 Might be a few things I need to work on
100 – 150 There are some issues here that require my attention
150 – 200 I may need to seek counseling to work on some of my issues
200+ I need to take action. I am definitely at risk for depression and self harm or suicidal behavior.
- Markedly impoverished, poorly developed, or unstable self-image, ______
- Excessive self-criticism; ______
- Chronic feelings of emptiness; ______
- Dissociative states under stress ______
- Instability in goals, aspirations, values, or career plans ______
- Compromised ability to recognize the feelings and needs of others ______
- interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); ______
- Perceptions of others selectively biased toward negative attributes or vulnerabilities ______
- Intense, unstable, and conflicted close relationships; ______
- Marked by mistrust, neediness; ______
- Anxious preoccupation with real or imagined abandonment; ______
- Close relationships often viewed in extremes of idealization and devaluation; ______
- Alternating between over involvement and withdrawal. ______
- Unstable emotional experiences and frequent mood changes; ______
- Emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. ______
- Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; ______
- Worry about the negative effects of past unpleasant experience and future negative possibilities; _____
- Feeling fearful, apprehensive, or threatened by uncertainty; ______
- Fears of falling apart or losing control; _____
- Pathological personality traits in negative affectivity; ______
- Fears of rejection by – and/or separation from – significant others; ______
- Fears of excessive dependency and complete loss of autonomy; ______
- Frequent feelings of being down, miserable, and/or hopeless; ______
- Difficulty recovering from such moods; ______
- Pessimism about the future; ______
- Pervasive shame; ______
- Feeling of inferior self-worth; ______
- Thoughts of suicide and suicidal behaviour; ______
- Acting on the spur of the moment in response to immediate stimuli; ______
- Acting on a momentary basis without a plan or consideration of outcomes; ______
- Difficulty establishing or following plans; ______
- A sense of urgency and self-harming behavior under emotional distress; ______
- Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; ______
- Lack of concern for one’s limitations; ______
- Denial of the reality of personal danger. ______
- Persistent or frequent angry feelings; ______
- Anger or irritability in response to minor slights and insults. ______
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We have come to the last, (and perhaps most difficult to describe and comprehend) symptom on the DSM IV, namely: “transient, stress-related paranoid ideation or severe dissociative symptoms”. The DSM 5 includes it under significant impairments in personal function with a similar descriptor of: “Dissociative states under stress”. When we see this definition we immediately think of two severe disorders, paranoid schizophrenia and dissociative identity disorder; however Borderline Personality Disorder (BPD), although having some similarities, is essentially quite different.
First the semantics. Transient merely means that the symptom is not continuous but comes and goes depending on the levels of stress and subsequent anxiety. The term ideation refers to negative mind states or thinking patterns involving negative past experiences that, again, may come to the surface under stress. Paranoia here is much gentler than the kind of paranoia that we see in Paranoid Schizophrenia. By my own experience, I would describe it as a feeling that I do not belong, and the world out there is a dangerous place that required that I was always perfect, vigilant, and careful in my interactions with people. This leaves us with the term dissociative that we will examine more closely in the rest of this blog.
One study, although quite different in design, seems to bring what is happening into focus. Ludascher et al (2007) applied electric stimulation on the right index finger with twelve female patients with BPD and twelve healthy controls. They found significantly elevated pain thresholds in patients with BPD, with a significant positive correlation between pain thresholds and dissociation, as well as between pain thresholds and aversive arousal. In a follow-up study, Ludascher et al (2010) using script-driven imagery, produced dissociative states in participants with BPD. These states on fMRI’s were characterized by decreased pain sensitivity and significantly increased activity in the left inferior frontal gyrus (part of the OFC) which is at least partially responsible for empathy, processing pleasant and unpleasant emotions, self-criticisms, and attention to negative emotions. From these two studies we see suppression of emotional pain and interference in the functioning of some of the sections of the orbitofrontal cortex (OFC).
Typically when an emotional situation takes place (usually involving intimate relationships or high self-worth activities like work and some sports), the OFC and amygdala are activated, thus empowering us to take action and resolve the situation. Once it is resolved, these impulses are then channeled through the pleasure center of the brain producing a sense of joy and accomplishment. Serotonin and endorphin neural circuits are then activated giving us a sense of peace and euphoria. However, if the emotional situation is too intense (such as a break-up), we will eventually but a block in place along those neural circuits connected to the images and thoughts and feelings. This is a natural body function that is usually put in place to block the neurotransmitters that are coming from intense pain. The neurons simply withdraw their receptor docks, thereby preventing the messages from proceeding from the painful neural pathways to the OFC of the brain. Out of sight, out of mind. Works for most people.
But if this process has been corrupted by severe emotional problems during childhood such as emotional neglect, coupled with a supersensitive genetic predisposition, the OFC will not be able to process any additional emotional insult. The whole emotion processing system gets shut down. This theory is supported by Jones et al (1999). They assessed twenty-three patients with BPD, and 23 matched controls, with the Autobiographical Memory Test (AMT) and self-report measures. As expected, participants with BPD scored significantly higher than the control group on measures of depression, anxiety, and trait anger. However, they also scored higher in dissociative experiences that appear to be connected to general memories on the AMT. They concluded that patients with BPD had difficulty in recalling specific autobiographical memories, perhaps related to their tendency to dissociate, which may help them to avoid reliving memories that may have been emotionally painful.
These studies suggests that under stress, we lost souls with BPD tend to shut down emotional pain sensations because of our past painful experiences. Again, in my own case, whenever I was personally or professionally challenged by someone, and I felt my self-worth was at stake, I could actually feel a sense of numbness flowing through my brain and through the rest of my body. Quite simply, this suggests that some of us with BPD may have developed some kind of defense mechanism to interrupt the flow of pain within our brain. Because this pain is emotional in nature, it might indicate that we bypass our amygdala thus having an interrupted or numbing response when faced with an emotional situation.
Now this sounds like a perfectly good way to deal with overwhelming emotional situations, but there is a major drawback, which brings me to the last study in this section. Ebner-Priemer et al (2009) used an aversive differential delay conditioning procedure with 33 unmediated patients with BPD and 35 healthy controls. They discovered patients that BPD with high state dissociative experiences and showed impairment in responding to emotional learning. They concluded that emotional, amygdala-based learning processes, may be inhibited in acquisition and extinction processes in therapy and should be closely monitored in exposure-based psychotherapy. It would appear that we do not respond well to traditional therapy methods. The amygdala, and parts of the OFC mentioned in these studies, are designed to provide the plan and the power to solve problems, including highly emotional ones. It is part of a circuit that leads to resolutions, a trip through the pleasure center of the brain, and to a nice comforting flow of serotonin. When we shut down these mechanisms, we shut down our ability to solve problems and to feel the joy and contentment of growing through our experiences. And, unfortunately, we do not respond well to therapy.
So what is the answer? Again, I can only refer to my personal experience. I underwent an extensive therapy including group, cognitive, and an assortment of other strategies, with only limited success. My true healing took place when I begin to see myself as a higher self in conflict with a mind self (talk about dissociative disorder). Only then, with the support of my higher self, was I able to explore my past emotions, cry with some, yell and scream at others, and feel the hurt and loss with the rest. It allowed me to accept them, be thankful for their part in making me strong, and put them behind me. Then when old feeling returned, and I felt the numbing sensation coming on, I would connect to my higher self, and allow it to flood my mind and soul, cry, and move on.
Here are my five suggestions for those of us with a dissociative element in our BPD:
- We face our emotions. We notice that numbing sensations when we begin to shut down. We seek a quiet moment and allow the feelings to surface.
- We call upon our higher self to give us courage and strength to face them, deal with them, cry if we have to, or be angry with the people involved. We then allow the higher self to complete the circuit as the serotonin pathways are activated and endorphins are released.
- We continue to process these past emotions through contemplative therapy. In my case, I entered a state of meditation where I become aware of my higher self. I then allowed my mind to bring up past pains and deal with them. I did this on consecutive days until all the old wounds were healed. It took me several weeks before I felt the issues had been resolved.
- Whenever they resurface, I thank my mind for bringing it to my attention. If the time and space are appropriate, I give it permission to experience the old emotions. I soothe it with my higher self. “There, there it’s okay to feel this way. It’s okay to cry. it’s okay to be angry.”
- If the timing is not appropriate or if an emotional reaction might lead to further conflict and pain, I allow my mind to suppress the emotion with the promise to resolve the issue and the emotions behind it during the next day’s meditation. Once I feel comfortable with, and in control of my emotions, I will bring it up at the next opportunity with my intimate friends and family. If it just an acquaintance from work or community, I may just let it pass and chalk it up to experience.
Ludascher, Petra; Valerius, Gabriele, Stiglmayr, Christian; Mauchnik, Jana; Lanius, Ruth A; Bohus, Martin; and Schmahl, Christian. Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study. J Psychiatry Neurosci. 2010.
Ludascher, Petra; Valerius, Gabriele, Stiglmayr, Christian; Mauchnik, Jana; Lanius, Ruth A; Bohus, Martin; and Schmahl, Christian. Elevated pain in thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. 2007.
Jones, B; Heard, H; Startup,M; and Swales, M. Autobiographical memory and dissociation in borderline personality disorder. Psychol Med. 1999. Psychiatry Research. 2007.
Ulrich W. Ebner-Priemer, PhD, Jana Mauchnik, PhD, Nikolaus Kleindienst, PhD, Christian Schmahl, MD, Martin Peper, PhD, MD, M. Zachary Rosenthal, PhD, Herta Flor, PhD, and Martin Bohus, MD. Emotional learning during dissociative states in borderline personality disorder. Journal of Pschiatry and Neuroscience. 2009.
We now move on to Symptom eight on the DSM IV, namely, “Inappropriate, intense anger or difficulty controlling anger.” On the DSM 5, it is listed under pathological personality traits in antagonism and includes “persistent or frequent angry feelings”, and “anger or irritability in response to minor slights and insults.” Some articles describe this out of proportion anger as “BPD rage”. There is a relatively small sample of research on the topic, but I have located two well designed projects that should shed some light on the topic.
Cackowski et al, in a small sample of twenty-nine female BPD patients, 28 ADHD patients and 30 healthy controls, found that BPD patients reported higher trait aggression and hostility, a stronger tendency to express anger when provoked, and a tendency to direct anger inwardly. They concluded that there may be a significant impact of stress on anger in BPD patients; however, it appears to be directed towards the self rather than to others.
Krauch et al used functional MRI to observe brain scans when twenty BPD and twenty HC adolescent participants were exposed to scripted imagery. They found that adolescents with BPD showed increased activity in the left posterior insula, the left dorsal striatum, and the left inferior frontal cortex. The insula is connected to our old friends the amygdala and the thalamus and is part of the limbic system involved in processing emotions. It is also believed to be involved in the processing of physical and emotional pain in an attempt to create homeostasis or balance during interpersonal relationships. The striatum is part of the forebrain that is believed to be involved in the reward system, inhibitory control, and impulsivity. The inferior frontal cortex is, of course, our administration center that employs mind states to solve problems.
So what does this mean in layman’s terms? Quite simply, it shows that we unfortunate souls with BPD have overactive brains in the areas involving negative emotions and subsequent behavior. When our emotions are activated by minor conflicts, we have a difficult time processing the information and calming our overactive brain. We tend to react with frustration and anger, but since we are so dependent on our relationships with other for our sense of self-worth, we direct this overcharged anger against ourselves. This often shows up in self-harm activities and suicidal behavior.
So what does all of this mean? First of all, let’s deal with the data from these studies. Even though Cackowski et al’s study was carried out with women, I think we can safely employ these results to men. We have a tendency to experience the same emotions but deal with them in different ways. We tend to suppress causing an increased buildup of negative energy. When we reach our boiling point, we explode more violently than women. Therefore, even though women have more suicidal attempts than men, we tend to be more successful at killing ourselves, because we use more violent means like jumping off tall building or using a gun to blow our brains out (interesting-one way to stop the over active and pain-filled brain). Women on the other hand use peaceful means such as overdosing which, by the way, leaves a possible back door to escape.
When we look at the brain scans, they are just that. It is not definitive. It just shows what parts of the brain are active. The old orbital frontal cortex is just searching vainly for solutions from past experiences. If we believe this part of the brain is “us”, then we have a problem. However, if we believe that we are something beyond the electrochemical impulses, neural pathways, and mind states, than there is hope. If we defer to the Higher-Self, we can begin to see solutions beyond the mind states and schemas of the OFC, stop all the turmoil and impose a homeostasis or balance on the insula, and nudge the dorsal striatum to let go and complete the happy pleasure route by choosing to smile at our absurd reaction to a minor conflict. We use our higher self to pat ourselves on the back and say “there, there” and we begin to see solutions where there did not appear to be any. We can then experience an amazing surge of positive power and energy to forge a new path, not only to create balance, but to carry on with the expansion and growth of our being.
Here are my five suggestion for people with BPD and anger and impulse control problems:
- We recognize that we have anger issues. And we thank the universe (and yes I mean thank) that we still have the ability to have an emotional response to the feeling of rejection and interpersonal disagreements. If we ever lose that, it means we have quit trying to interact and may now be vulnerable to the second and more dangerous cause of suicidal behavior – hopelessness and helplessness. We always look for something to be thankful for. It gets us in touch with our higher self.
- We let the people who are important in our lives know that we have a “rage” problem. We alert them that we may have to tell them from time to time that we are experiencing a rage episode and may have to excuse ourselves from a situation with a promise to come back and resolve the issue once we have ourselves back under control.
- When confronted with a conflict, we take a deep breath and smile (if appropriate – does not work with partners during an argument) rather than responding to our brain’s emotional reaction.
- Whenever we feel the conflict beginning to turn into the rage, we remove ourselves (if we can) from the situation before it blows up to unmanageable proportions and additional shame inducing behavior that will complicate our ability to resolve the conflict. If we can’t leave the scene, we may have to eat crow (amazing birds) and shut up and take it. It helps to say “yes madam” to the boss and “yes dear” to our partners.
- We refuse to turn the anger against ourselves. We keep it objective. We find a quiet spot and employ deep breathing and self-talk. We analyse the situation and our over-heated response. We make a plan to resolve the conflict. If we have followed steps 1 to 4, we pat ourselves on the back and say, “Well done”.
- If we lose it and blow up again, we are kind to ourselves and recognize that this is part of a bigger problem. We analyze the situation to see what we can do better in the future. We apologize and restore the relationship. This should be easy to do if we have done step 2.
Cackowski, Sylvia; Krause-Utz, Annegret; Van Eijk; Klohr, Julia; Daffner, Stephanie; Sobanski, Ester; and Ende, Gabriele. Anger and aggression in borderline personality disorder and attention deficit hyperactivity disorder – does stress matter? Borderline Personality Disorder Emolt Dysregul, 2017. 17.
Krauch, Marlene; Ueltzhoffer, Kai; Brunner, Romuald; Kaess, Michael; Hensel, Saskia; Herpertz, Sabinen C; and Bertsch, Katja. Heightened Salience of Anger and Aggression in Female Adolescents With Borderline Personality Disorder—A Script-Based fMRI Study. Front. Behav. Neurosci., 26 March 2018 | https://doi.org/10.3389/fnbeh.2018.00057
As we continue on with our investigation into Borderline Personality Disorder and its relationship to bisexuality, we arrive at symptom seven on the DSM IV: chronic feelings of emptiness. On the DSM5 it is listed under: Significant impairments in personality functioning manifest by:
“Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.”
When we seek to define emptiness, we come up with adjectives such as hopelessness, loneliness, and isolation.
In a study by Klonsky, he concluded that emptiness is characterized more by low positive affect rather than high negative affect. In layman’s terms, it is not so much having negative thoughts and feelings related to negative events, but rather just being empty of, or having a lack of, positive aspects to our lives. Klonshy came up with some interesting observations. As expected, he noted a substantial overlap between emptiness and hopelessness, a subsequent robust relationship with depression, and an important relation to suicidality. By including a sub study on self-harm through self-cutting, he noted a pattern that suggested that chronic emptiness contributes to the development of suicidal thoughts and feelings, but may not predict progression to an actual suicide attempt.
This brings out an interesting point about the progression of BPD symptoms to suicide and other self-harming activities. It would appear that there may be two aspects to poor self-image that may lead down two different paths. As we have seen in past blogs, there is a strong correlation between BPD, anxiety, depression, and suicide. Traits such as self-criticism and dissociative states may lead to chronic anxiety and down the path to suicide; whereas the emptiness trait may lead to a form of self-harm where one is attempting to create some feelings to jar them back to a functional reality. And then, because no two people are exactly alike, there are numerous combinations of traits.
Back to my case study of my “self”, I had continuous feelings of emptiness as well as self-criticism. Therefore I had one foot on the path of anxiety and suicidal thoughts but the other on the path of hopelessness. To resolve my problem, I shut down my own wants and needs and stubbornly plowed forward trying to cure and heal anyone I could get my hands on, never getting any real satisfaction for doing any good for anybody. During profound periods of emptiness, I tried to fill it up with dangerous, risk taking gay sex. It worked for me for twenty-five years until my mind became overwhelmed and crashed. Even though I had suicidal thoughts, I never really took any steps to actually doing away with myself. I just grinned and bared and waited for the shoe to fall.
Looking back here is what I should have done. My five suggestions for bisexuals with BPD and with symptoms of emptiness:
- We find some way to fill up the emptiness and the way to do that is to simply remove the veil that is keeping us from seeing that we have a higher self.
- We simply shut down the noise of our wounded ego, the woe is me voice, and open our mind to the always present presence and power of out higher self.
- We wait for the emptiness to be replaced by a sense of this presence. We will always feel a sense of joy when our higher self sends an impulse through the pleasure centers of our brain.
- Whenever we feel down we repeat this process until we sense our higher self.
- We fill up and expand our sense of fullness on a daily basis. We spend fifteen minutes a day in mediation by focusing on the power and beauty of our higher self.
 Klonsky, David E. WHAT IS EMPTINESS? CLARIFYING THE 7TH CRITERION FOR BORDERLINE PERSONALITY DISORDER. Journal of Personality Disorders, 2008.
This is the fifth and last in the series on exploring anxiety dysfunctional traits for Borderline Personality Disorder (BPD) on the DSM 5, and symptom six on the DSM IV. Today we will look at mixed anxiety/depression disorder (MADD).
Although I was unable to find research into a direct link between BPD and MADD, I did find some interesting information and have taken the liberty to employ the blogger’s freedom to draw a few unsubstantiated conclusions. Fava et al in their investigation into the frequency of anxiety disorders in 255 outpatients with depression, concluded that anxiety disorder diagnoses were present in 50.6% of these patients. Moreover, they discovered that an anxiety disorder preceded depression in about sixty five percent of the time. The obvious conclusion is that these two major disorders often occur together and that clinical anxiety usually precedes and may potentially be a significant factor in the onset of depression.
Based on past blogs, I think we can safely extrapolate that people with BPD frequently suffer from MADD symptoms. Because of our fragile egos and our tendency to feel excessive amounts of shame, we are constantly having to deal with anxiety related to the overreaction of the sympathetic system and the hypersensitivity of the reticular system. Because of this constant battlefield in our minds, ninety percent of the time we develop an anxiety disorder. Consequently, this constant battle with anxiety frequently causes a breakdown in the nervous system resulting in clinical depression.
Living with BPD is definitely a difficult path, but it is not hopeless. Neither is living with MADD hopeless; although, it may seem that way when we are in the middle of it. Therefore, I think it is important to recognize our BPD symptoms and predispositions and put safety mechanisms in place before we go MADD.
Here are my five suggestions for bisexuals with, or have the potential for, MADD:
- We hang in there. The depression is just a reaction to a buildup of our anxiety. It is a call to slow the world down and get off the treadmill for a while. We accept out present state of depression, acknowledge that it is a natural outcome of our BPD, and seek professional help. MADD can be complex; therefore, when we go to our family doctor, we go to the top and ask for an appointment with a psychiatrist. A combination of anti-depressants and anti-psychotic medication will restore our chemical imbalance and get us back on track.
- Counselling now can become effective. We seek out a counselor (or stay with our psychiatrist if she is available) and begin the process of coming to terms with our BPD. We explore the original causes of our anxiety and begin to deal with them one at a time.
- We do not let our sexuality be the cause of anxiety. It is one of the best ways of getting rid or stress, anxiety, and anxiety residue. We want it to work for us not against us, so we make sure we have a healthy attitude before and after sex. No blame, no shame.
- If we know we have BPD, we make sure we have a plan in place to prevent common stresses from becoming causes of an anxiety attack and/or another anxiety disorder. This includes a support person or group to help process common issues, a diet to keep our body healthy, and an exercise program to burn off the residue of our anxieties. We can then return to the parasympathetic system and gain relaxation and regeneration.
- We carefully monitor our reticular system. We note when it is becoming engaged. We will usually feel a sense of fear, anger, or shame followed by physical symptoms. We learn to soothe ourselves by breathing exercises and self-talk – there, there – it’s okay – we can handle this.
 Fava, Maurizio; Rankin, Meridith A.; Wright, Emma C. ; Alpert, Jonathan E. Nierenberg, ; Andrew A.; Pava, Joel, and Rosenbaum, Jerrold F.. Anxiety Disorders in Major Depression. Comprehensive Psychiatry· March 2000.
As we have worked our way through the nine symptoms of Borderline Personality Disorder (BPD) on the DSM IV and the personality traits of the DSM 5, we have encountered a major section, and perhaps the core issue, on symptom six, namely anxiety. Deeper investigation into the relationship between anxiety disorders and BPD led us to the discovery that 90% of people with BPD suffer from one or more anxiety disorders. In past blogs, we have looked at the impact of Generalized Anxiety, Anxiety Attacks, and Social Adjustment Disorder (SAD). Today we want to take a look at the link between Post Traumatic Stress Disorder (PTSD) and BPD.
PTSD is receiving a lot of attention in the media especially in connection to military experiences. The second and perhaps more common cause of trauma involves long-term physical, and/or sexual abuse. Recent work in this area has led some psychologists to create a subcategory called Complex PTSD (CPTSD). These intense experiences of fear create a powerful link to the Sympathetic System and to feelings of helplessness so that the traumas are difficult to resolve. In addition, the reticular system is activated putting the individual on constant high alert thereby picking out and reacting to seemingly harmless triggers from the environment.
But what about other causes of CPTSD? Jane Leonard lists the following:
- experiencing childhood neglect
- experiencing other types of abuse early in life
- experiencing domestic abuse
Do these emotional experiences constitute a major insult to the body as well as the mind?
According to Leonard, People with CPTSD may exhibit these behaviors, all of which are also shared with people with BPD:
- abusing alcohol or drugs
- avoiding unpleasant situations by becoming “people-pleasers”
- lashing out at minor criticisms
We can see that emotional, cognitive, and behavioral similarities come into play with BPD and CPTSD, but what is the relationship if any between the causes of the two disorders? I once read in an article that bisexuals have suffered from PTSD because of the emotional and mental wounds from a thousand cuts due to their life style. But does that really constitute CPTSD? In my opinion, PTSD and CPSTD have to include major insult to the body as well as the mind; whereas, BPD is a disorder exclusively of the mind.
Cloitre et al in a study involving over three hundred subjects with complete measures of PTSD, BPD, general psychopathology, and functional impairment, concluded that four BPD symptoms separated BPD patients from PTSD, namely:
- Frantic efforts to avoid abandonment,
- Unstable sense of self,
- Unstable and intense interpersonal relationships,
- And impulsiveness.
Both groups experienced chronic feelings of emptiness. I would suggest that these symptoms have more to do with neglect and unstable home environment than actual physical or sexual injury. We would also have to consider that there may be a genetic predisposition involved in BPD, including hyper sensitivity and a need for soothing and acceptance that was denied them in childhood.
I think it is safe to say that BPD and CPTSD are different disorders; however, we have to consider that some people may be suffering from a combination of both, thus compounding the problem. As noted in an earlier blog, this is literally a deadly combination resulting in suicidal thoughts and an alarming number of suicide attempts.
Here are my five suggestions for Bisexuals with BPD and CPTSD:
- If you are one of the few who are coping with this combination of disorders, then you are a remarkable human being. Rejoice in the amazing powers of your mind and soul.
- If you are struggling with flashbacks from physical and sexual abuse, feelings of emptiness, and any of the above four symptoms or above four behaviors, you are in danger of an emotional crisis and you need to put supports in place.
- Seek professional counselling and medical treatment. There is no shame. There is no blame. According to research, begin with CPTSD therapy as these symptoms seem to be easier to deal with than BPD.
- Create a support group of people who love you. Do not be afraid to call upon them whenever you are experiencing emptiness and self-doubt. It’s surprising how powerful and effective a ten minute conversation can be in reestablishing our sense of self-control.
- If our feelings reach a crisis level , we seek physical contact with one of our support people or with a professional counselor. There is something powerful about physical and emotional connection with another human being who loves us and understands our struggles.
 Leonard, Jane. What to know about complex PTSD. Medical News Today. August 2018. https://www.medicalnewstoday.com/articles/322886.php
 Cloitre, Marylene; Garvert, Donn W; Weiss, Brandon; Carlson, Eve B; and Bryant, Richard A. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. Eur J Psychotraumatol. 2014.