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.
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.
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.
Let me explain. Our brains are designed to avoid pain and seek pleasure, and seeking pleasure is ten times (I made that up) more powerful than avoiding pain. But it does not stop there. There are two kinds of pleasure: the activation of the quick route through the pleasure system of the brain, and the process of setting goals and achieving them. They both go through the same pleasure system, but one is short term and leads to pleasure, and the other is long term and leads to happiness.
So what is the difference between pleasure and happiness? Pleasure is easy to define; it is biological; more specifically, it is chemical. It has two purposes: to excite and then to soothe, thus completing the pleasure circuit of the brain. Our bisexual brains have decided that the quickest and most powerful way to activate the pleasure system is gay or lesbian sex. This is how it works. We are feeling down and need a fix; we need to get a high to escape the low. All drugs work this way including that wonderful hormone mix of testosterone, estrogen, oxytocin, epinephrine, and adrenalin. Together they not only excite the body, but they also serve as neuromodulators to excite the brain. Now the combined hormone/dopamine rush is on with the goal of a pleasure bath through sex. There is one other thing to consider. Having sex with our life partner is great and usually provides a high; however, if we are really down, we may need a greater high. This is where going out on the hunt, or to a lover on the side, comes into play. You see, the novelty of finding a new partner or the feeling of crossing a forbidden boundary actually adds to the charge – namely a more intense flow of dopamine and a greater adrenalin rush. At this point, desire becomes an obsession, an intense dopamine and hormone flow that can only be alleviated by accomplishing our goal – new and exciting sex. Unfortunately, there is usually no soothing after we literally come back to our senses. There is usually pain in the form of guilt and shame. Oops, no soothing. Back to anxiety.
Now let’s look at happiness which is much more complex and almost impossible to define because it means different things to different people. The closest we can get to universal agreement on happiness is intimacy. This is where sex with a life partner comes in. We look across the room and see our lover and our neurons begin to fire. We are not likely looking just for a fix. Usually, the goal is intimacy. Whenever we feel a little down or we have a hard time seeing the connection with our partner, within ourselves, with life, the world (whatever), we can connect all those dots with sex with our partner (a very clever design because it has the potential to create one more human being and save the human race one more time). This type of sex in usually slower, seeking connection as well as pleasure. This combination of connection and pleasure creates intimacy and intimacy is a form of happiness. To celebrate this reconnection with our partner, our world, and our self the brain now releases a flow of serotonin creating a soothing type of contentment and quiet pleasure; in other words, happiness. The circuit is now complete. No anxiety.
Which brings us back to New Year’s Resolutions. They simply do not work. Our brain will refuse to abandon its favorite sources of pleasure without a very good reason. So all the “I will stop” resolutions are worse than useless. They create anxiety, and unsoothed anxiety is a form of pain which the brain wants to avoid. These types of resolutions are doomed to fail, and repeated failure is another form of anxiety and pain. What about the “From now on I will…” resolutions? In this case, the brain has another objection. You see, the pay-off or reward has to be perceived as attainable and perceived as a significantly greater source of pleasure. In other words, we have to firmly believe that being “happy” will be a greater reward than the sought after pleasure. The second factor is that we also weigh the amount of effort (employed anxiety) it will take to achieve the goal. If the cost is too great the brain will not engage the dopamine achievement pleasure system. It takes a strong dopamine charged circuit to change a behavior, and the brain simply does not want to expend the energy it takes to prune and develop the circuits needed to change the behavior.
So what is the alternative? Here are my five suggestions for bisexuals:
- We do not make any New Year’s Resolution. We do not try to change our behavior. Instead, we aim to evolve into higher human beings. If we can learn to appreciate and enjoy who we are, we will be “happy”, and as long as we are happy, we will no longer have out of control anxiety, and we will no longer have the need for a sexual high to counterbalance our emotional lows.
- We can do this by awakening our higher self. It takes no effort, so our brain will be happy. We simply change our paradigm. We simply choose to accept ourselves and love ourselves just the way we are, with all our flaws. This includes our sexual orientation and our sexual desires and behaviors. They are what they are. There is no blame there is no shame.
- We continue to seek pleasure. It is a wonderful gift from the universe. Whenever we have sex we enjoy every minute of it. Every smell, every touch, every taste, every “I love you”, and how beautiful our partner is. We plan to indulge all our senses. No blame no shame. After sex, we stick around and come down together, thus releasing all our tensions and enjoying our body’s serotonin bath.
- We do not stop at pleasure, we seek happiness. This means getting rid of guilt and shame once and for all. If we have a partner, we work things out together. It will mean honesty and compromise. If we cannot work it out, we may have to make plans to part. Whatever path we choose, we have to free our sexual behavior from the guilt and shame pattern. Sex was meant to be enjoyed and to be a part of our pleasure and happiness circuits. It is too powerful a force to have working against us, and it is too precious a gift not to be enjoyed.
- We seek deeper and deeper levels of intimacy. Good sex with a partner leads to bonding, intimacy, contentment, purpose, and to feelings of control rather than helplessness. It establishes a firm base. It is that one guiding principle that our brain can understand. It is willing to try anything, any new adventure or risk as long as it adds to its feelings of intimacy and contentment.
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, 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 and Anxiety Attacks. Today we want to take a look at Social Adjustment Disorder (SAD).
A study by Kelly et al led to a startling conclusion. Patients diagnosed with BPD who scored low on overall social adjustment were over 16 times more likely to have attempted suicide than patients diagnosed with major depression. They concluded: “Recent life events may elevate suicide risk in groups already at high risk for suicide completion, whereas high levels of social adjustment may be protective against stress-related suicidal behavior.”
So what exactly is Social Adjustment Disorder? There are two factors involved in SAD – social adjustment abilities or disabilities, and adjusting to a major event. First let’s look at social adjustment. Social adjustment by definition is: “an attempt made by an individual to address the standards, values and desires of a society so as to be accepted.” People with SAD experience more stress than would normally be expected because of a history of difficulty adjusting to family and other social patterns. For example, risk may be increased by experiencing significant stress in childhood, by having a number of difficult life circumstances happening at the same time, or by experiencing a series of minor difficulties collectively over a prolonged period.
The second factor is the ability to adjust to specific life circumstances. Usually stressors are temporary and we learn to adjust over a three month period. However, people with SAD will experience ongoing difficulty lasting up to six to nine months or even longer if the cause is prolonged such a divorce or being fired and not being able to find a job in our area of expertise.
Most of the symptoms listed for SAD can be evidenced by any or all of the anxiety disorders; however here are some of the more unique ones:
- Feeling overwhelmed
- Feeling sad, hopeless or not enjoying things you used to enjoy
- Withdrawing from social supports
- Avoiding important things such as going to work or paying bills
- Suicidal thoughts or behavior
Most significantly, as noted by Kelly et al, we may be looking at the major cause of suicidal behavior, not only as related to anxiety, depression, and BPD, but perhaps the major cause overall.
The key then is to develop some strategies to get through those three to nine months. Developing healthy coping skills and learning to be resilient before hand may help during times of high stress.
Here are my five suggestions for bisexuals with Social Adjustment Disorder:
- We can call upon our higher self for guidance and strength. We remind our self that this distress is usually time-limited and that we can get through it. We recognize that even though these events are painful, they may also be a gateway for change, a time for awakening our higher powers, and a chance to seek a better life.
- We increase our health habits like diet and exercise thereby providing the oxygen and nutrients needed by a healthy brain.
- We rally our social supports. We develop a network of supportive people and groups to assist us in time of need. When we feel overwhelmed, we do not hesitate to use their services. There is a reason they made a commitment to help us. They love us.
- We check in with our doctor or mental health professional to review healthy ways to manage our stress and deal with the current problem.
- If we know that a stressful situation is coming up — such as a move or retirement — we prepare ourselves for it by making a plan for orderly transition. For example, if we have difficulty being alone during the Christmas season, we arrange to take part in some Christmas charities such as volunteering to work in the kitchen preparing meals on Christmas day – by the way, merry Christmas – thus taking our mind off our own problems and experiencing joy through someone else’s eyes.
 Thomas M. Kelly, PhD1; Paul H. Soloff, MD1; Kevin G. Lynch, PhD1; Gretchen L. Haas, PhD1; J. John Mann, MD2. Recent Life Events, Social Adjustment, and Suicide Attempts in Patients with Major Depression and Borderline Personality Disorder. Vol. 32, Iss. 6. Dec. 2000.
(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
- 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:
- 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.
- 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.
- 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.
- 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.
- We engage in long term anxiety control. For more details, see the last blog for suggestions to control generalized anxiety.
(This is the second in the series on exploring mood and anxiety dysfunctional traits for Borderline Personality Disorder (BPD) on the DSM 5, and symptom six on the DSM IV . In the last issue, we looked at episodal dysphoria; today, we will take a look at generalized anxiety.)
In a study involving ninety-two hospitalized patients diagnosed with BPD, Grambalet et al. concluded that BPD patients were significantly more likely than the people in the control groups to suffer from a wide range of anxiety disorders including: panic disorder, social phobia, generalized anxiety disorder, mixed anxiety/depression disorder, adjustment disorder, and post traumatic stress disorder. In addition, one in five patients had two or more of these disorders. Excessive levels of anxiety correlated with reduced quality of life in mental, social, and work domains.
Each of these anxiety disorders deserves to be examined in isolation, keeping in mind that we may have two or more disorders functioning at any given time. Today we want to take a look at generalized anxiety disorder.
Ninety percent of people with BDP have clinically high rates of anxiety . Generalized anxiety makes it difficult for us to maintain our ability to function in our home and work environments, thus increasing the risk of suicide and self-injury. I remember a friend of mine explaining why she had taken the whole bottle of clonazepam, an antipsychotic medication, thus ending up once again in the psych ward at the University Hospital. She said she did it because she could no longer stand the constant feeling of anxiety. As in the case of my friend, I have noticed that many suicide attempts are due to extended anxiety attacks rather than the more commonly held belief that they are due to depression.
I am sure that this story of anxiety resonates with most of us with BPD; we all know that we have constant anxiety issues in trying to survive and thrive in our own corners of the world. Like most of us with BPD, I have had to learn to live with a constant form of generalized anxiety. Some days are worse than others, depending on the stress levels. Sometimes during the day, usually after teaching my classes in psychology, I will stop for a moment and realize just how tense my body is. I have learned to read the signs and diffuse my anxiety episodes, usually by engaging in deep breathing exercises. At other times, the anxiety will create the sensation of having an elephant on my chest. This anxiety is physical as well as mental. Once this level of anxiety occurs, my brain and body will slip into the sympathetic system thus increasing the sugar levels for the energy needed to flee or fight, salt levels to raise my blood pressure to get the sugar to my muscles, and driving the administrator section of my brain to concentrate on the unknown threat rather than being able to rationally go about the business of living. At these times, I have to take a walk while concentrating on breathing, consciously engaging and forcing my mind to take control again, easing my brain into the parasympathetic system, and thus allowing my body and brain to burn off the excess energy.
Living with BPD means living with anxiety. We cannot eliminate it, but we can control it. We can take control of our minds and bodies, eliminate the anxiety, and then deal with the cause of the stress. If the stress is a normal part of our daily lives, we simply monitor and proceed. If the anxiety becomes uncomfortable, we take a break and reduce the anxiety levels and then get back to work. If we are going through a period of prolonged stress, we need to build in breaks and maintenance days off. If the anxiety leads to crisis, we engage in crisis management. We get help. We take whatever medication is necessary until the crisis has past. For some of us, we will need to stay on medication for the rest of our lives. In other words, we learn to read the anxiety levels in our brain and body and then take the necessary steps to reduce the anxiety so we can function normally at home, and at work.
My five suggestion for dealing with BPD:
- We learn to read and monitor our anxiety levels.
- We develop a strategy like deep breathing. I use a four point square visualization technique:
- Four breaths in deeper and deeper until full
- Hold for four seconds.
- Four breaths out until completely empty
- Hold for four seconds
- Repeat until experiencing a release of anxiety.
- When stress leads to conflict (internal or external) and an anxiety attack, we:
- Remove ourselves from the situation,
- Take a walk and work off the physical side effects of the anxiety.
- Return to the situation and work on it until there we feel it has been resolved. This will usually be experienced in a washed out feeling accompanied by peace and joy.
- If we have a period of prolonged stress, we will need to remove our self from the situation and take a maintenance break.
- If we are experiencing extreme anxiety over a significant length of time, measured in months or years, we may have to make major life changes.
 Grambal, A; Prasko, J; Kamaradove, D; Latalova, K;Holubova, M;Sedlackova,Z.; and Hruby, R.. Quality of life in borderline patients comorbid with anxiety spectrum disorders – a cross-sectional study. Dovepress. 2016.
This is the ninth in a series on BPD and Bisexuality
Today we want to take a look at the sixth symptom for Borderline Personality Disorder on the DSM IV, namely: “affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety, usually lasting a few hours and only rarely more than a few days)”. In the DSM 5 the symptoms are covered in pathological personality traits in the domains of negative affectivity, emotional liability, anxiousness, separation insecurity and depressively. Each of these seven traits (anxiety is the only trait specifically listed in both) deserves to be treated individually; so today we will begin with episodic dysphoria.
Episodic refers to episodic memory which is our life story that we play over and over again in our minds. It includes major events, places, and experiences. Dysphoria on the other hand is when everything in life seems to be falling apart, like the world is working against us. This seems to suggest that our life story itself is filled with feelings of continuous failure, shame, hopelessness and helplessness.
Speaking from my own experience, I simply ignored my life story until I could no longer hide from the pain that was always there just below the surface. For many years, I survived by will, religion, and the comfort of my marriage and family. I buried my past. All my accomplishments including numerous awards, athletic achievements, and three university degrees I simply looked at as failures because they lacked perfection and only perfection would allow me to feel proud of myself.
After I crashed, I finally looked at my roots and came to terms with the cause of my episodic diaspora. I began to see my accomplishments as amazing achievements overcoming the odds of being born in poverty to a single parent mother with nine children. But above all, I was able to look at my self and see that I had a beautiful mind and an even more beautiful soul. I began to truly live and enjoy the life I had been given.
I was also able to accept my bisexual gender not as something that added to my shame, but as a tremendous gift allowing me to make intimate connections with both men and women.
My five suggestions for bisexuals:
- We need to be more gentle with ourselves.
- We con rewrite our life story. We can take a look at the events in our life with a new perspective. We can visit things that are equated with shame and and remorse and see how we did the best we could under the circumstances. There really is a silver lining.
- If there are areas that still stand out, we can forgive ourselves. It’s okay to make mistakes as long as we learn from them.
- We can learn to see ourselves as beautiful creatures with beautiful minds and beautiful souls.
- When we reshape our story, we can put in positive outlooks throughout the years, total self acceptance in the present, and dream about the possibilities of a bright future.