Borderline Personality Disorder (BPD) – Pathological personality traits in Disinhibition – impulsivity: acting on a momentary basis without a plan or consideration of outcomes (DSM5).
As mentioned in previous blogs, over 2% of the population have some degree of Borderline Personality Disorder (BPD) and roughly a third of those with BPD are also bisexual. There are no stats for the reverse – the number of bisexuals with BPD – but my guess is it would be even higher. We often engage in harmful behaviours to ease distress in the short-term, despite the possible serious negative consequences in the long-term. Of the BPD population 8 to 10% of us eventually commit suicide – this rate is more than 50 times the rate of suicide in the general population and 10 times the rate in people diagnosed with Depression, and that does not even include those of us who depart because of drug overdoses. One of the defining traits that is connected with suicide attempts is impulsivity. In this blog we are going to take a look at how this trait of BPD affects us as bisexuals and we are going to focus on developing plans and strategies with due consideration of outcomes. First let’s take a look at the science to see what we are up against.
Cackowski and others used self-reporting to study 31 unmedicated women with BPD and 30 healthy matched women controls using measured response inhibition under resting conditions and after experimental stress induction. Patients with BPD reported higher impulsivity under both conditions. They concluded that there is a significant impact of stress on self-perceived state impulsivity and on response disinhibition in females with BPD.
So what is happening in the brain? Leyton and others studied 13 medication-free men and women with borderline personality disorder and 11 healthy controls using positron emission tomography (PET Scans) during a survey of go/no-go commission error activities. In both men and women, negative correlations with impulsivity scores were identified in the medial frontal gyrus, anterior cingulate gyrus, temporal gyrus, and striatum. They concluded thatsynthesis capacity in corticostriatal pathways may contribute to the development of impulsive behaviors in persons with borderline personality disorder. In the male subjects, low trapping was also observed in the medial frontal cortex extending into the orbitofrontal cortex, as well as in the corpus striatum. These sites correspond to regions that seem to be involved in mediating the planning, initiation, and inhibition of goal-directed behaviors, working memory, and emotional affect.
What it Means
So what does this mean in plain English? Well friends, we have a problem. Not only do we engage in risky behavior, not only do we seem to intentionally neglect to plan ahead, but under stress we seem to forget all the plans that have been planted in our brains by past experiences and the good intentions of therapists. As bisexuals this is often connected to our sexual behavior. We tend to seek encounters to relieve stress and we tend to avoid safe sex to add a risk factor that adds a level of excitement and pleasure. There is a reason for this. It is the way we are wired. Because of our genetic predisposition to be over sensitive, and the environmental factors that have shaped our behavior patterns, we now have a brain that says run like hell from pain, indulge in pleasure, and to hell with the consequences. The brain scans indicate that both men and women have difficulty reacting to sensory information to controlling emotions (corticostriatal pathway). Women seem to rely more on an emotional response whereas men run into further difficulty when we try to organize that information for decision making (frontal cortex extending into the orbitofrontal cortex). We both end up in the same place with seeking emotional relief usually by avoiding pain and seeking pleasure regardless of the consequences (temporal cortex, limbic areas). This seems to be particularly relevant under stress. As bisexuals we actually seek the pleasure and stress that goes with is rather than try to avoid it. So how do we combat our natural reactions, especially under stress?
Here are my five suggestions for bisexual borderliners:
1. First line of attack is to control your stress and anxiety levels. To do that you have to learn to read your body signals and stop the anxieties in their early stages before they blow up and you lose control. After that – game over until next time.
2. The best way to relieve anxiety is to get out of your emotional mind (corticostriatal pathway). The best way to that is to shut down all thought because at this stage thought leads back to emotion. You can do this by deep breathing. By concentrating on your breathing you interrupt the flow of negative energy into your brain. I recommend the thirty second breathing activity (in the past I said eight for anxiety relief, but science now suggests thirty for healing and building new brain patterns). Take a deep breath and then slowly let it all out (I recommend a stop watch rather than counting). When there is no air left, hold that until the 30 seconds are up. Keep doing this until you feel a sense of peace, calmness and control.
3. Once you have achieved this sense of peace, you are now free to confront your emotions. Self-talk your way through the process. I recommend doing this out loud as this will engage more of your brain and bring some organization processes to the emotional center. Tell yourself why you are seeking sex. If it is for pain relief or to alleviate stress, don’t do it. Find a better way to deal with the pain. If it is for pleasure and you have considered the consequences (besides just pleasure) than go ahead and enjoy. Bisexual women are naturally good at this. They are usually more emotionally intelligent than men and allow themselves the freedom to explore their emotions with their sex partners resulting in an emotionally and physically pleasing experience (sorry for the sexism but there is some truth in it). Bisexual men tend to shut down their emotions all together and just focus on the physical pleasure and may miss out on the broader pleasures that come with intimacy.
4. Now that your emotions are under control, you are ready to tackle the problem that caused the emotional reaction. This is where your orbitofrontal cortex comes in. You can do this in two parts. First see where the event fits into your life story. You may gain insight into what has happened in the past to cause you to react this way. You can then decide what it is you wish to build into your life in the present and future through your sexuality. By looking at the whole picture, the top down approach, you can see where individual decisions fit into the greater good for yourself. You can then bring your sexuality and the emotions connected with it into your bigger life picture thus adding meaning and purpose into your sexuality.
5. You can then go on to making a plan and putting gates and strategies in place for when these kinds of situation occur in the future. Men are good at this; it’s the emotions that they cannot handle. Both men and women bisexuals with BPD need to build new thinking and behavior patterns. If your plan does not seem to be working, and if you seem to be sabotaging your own goals and happiness, you may need to seek professional help. Whatever strategies you put in place don’t give up on them. It took me sixty years to develop my self-defeating thought and behavior patterns and it took me two years of constant vigilance to change them. Just keep believing in yourself, learn to say you are sorry (including to yourself), learn from the experience, reset your goals and strategies if needed, and remember that you can do this. You are a beautiful and powerful spirit being. Your sexuality is there to bring pleasure, intimacy, and love into your life. Keep the goal in mind and work towards that goal one step at a time.
 Cackowski, S.; Reitz, A.; Ende, G.; Kleindienst, N.; Bohus, M.; Schmahl, C.; and Krause-Utz, A.. Impact of stress on different components of impulsivity in borderline personality disorder. Cambridge University Press. March, 2014.
 Leyton, Marco; Okazawa, Hidehiko; Diksic, Mirko; Paris, Joel; Rosa, Pedro; Mzengeza, Simon N.; Blier, Pierre; Benkelfat, Chawki. Brain Regional α-[11C]Methyl-L-Tryptophan Trapping in Impulsive Subjects With Borderline Personality Disorder. The American Journal of Psychiatry. Vol 158, Issue 5, 2001
Published Online:1 May 2001 https://doi.org/10.1176/appi.ajp.158.5.775