My Lover’s Eyes

       Due to the high positive correlation between bisexuality and Borderline Personality Disorder, we are attempting to get a better understanding of the impairments listed in the DSM 5. 

DSM  5: Impairment 7 – Interpersonal hypersensitivity (i.e., prone to feel slighted or insulted)

  Research seems to suggest that borderline personality disorder may be characterized by emotional hypersensitivity with increased stress levels, anger proneness, and hostile, impulsive behaviours. As a result we may tend to view facial expressions as being angry or threatening and respond with prolonged emotional (amygdala) feelings. Read more at: https://lawrencejwcooper.ca/my-lovers-eyes/

Borderline Personality Disorder and Anger

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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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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”.
  6. 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

Borderline Personality Disorder and Relationships

SHIRT & TIE [small] (final)(This is the fifth in the series on the relationship between bisexuality and Borderline Personality Disorder [BPD].)

In previous blogs, we have established a link between BPD and bisexuality. We have looked at two symptoms for BPD on the DSM4: symptom 1 –  fear of abandonment, and symptom 3 – identity disturbance or poor self-concept.  Today we want to look at the second symptom which is “a pattern of unstable interpersonal relationships characterized by alternating between extremes of idealization and devaluation”. The DSM5 describes it as, “Intense, unstable, and conflicted close relationships … alternating between over involvement and withdrawal”.  From my review of the literature, it appears that difficulty in interpersonal relationships may be connected to problems with the mechanisms involved with bonding. This goes back to childhood issues such as abuse or neglect.

The relations between parental bonding and attachment constructs and borderline personality disorder features were examined by Nichol et al in 2002[1].  In a sample of 393 18-year-old’s, low parental bonding and attachment scores were associated with borderline features including insecure, anxious, or ambivalent attachment, and a perception of a relative lack of caring from one’s mother.

So what is happening biologically for people with BPD.  Bartz et al investigated the effects of intranasal oxytocin (OXT) on trust and cooperation in borderline personality disorder (BPD)[2]. Their data suggests that OXT does not facilitate trust and pro-social behavior in BPD’s but may actually impede it. They suggest that this may be due to possible neurochemical differences in the OXT system.

So where does this difference originate and how does it occur? First of all, we have to view OXT not only as a hormone generated by the pituitary gland but also as a neuromodulator. In plain English, that means that OXT affects the functions of the brain. This is usually done through the excitement or suppression of neurotransmitters.  In other words, OXT works differently in people with BPD by suppressing rather than exciting the transfer of messages within the brain and from the brain to the rest of the body.

We know that OXT is involved in bonding and that bonding to one’s mate creates aversion to any other potential sexual partner. When we look at aversion, we can get some clues from the rats and wolves[3].  In the case of wolves, one experience with tainted mutton made them swear off sheep for the rest of their lives. We all have experienced a nauseating sensation after an intense emotional experience and what could be more emotional than feeling rejected by one’s own mother? Could it be that when the outflow of OXT between mother and child during early childhood is accompanied by rejection that it literally leaves a bad taste in the mouth of the child by affecting the digestive system?

So how does this apply to our sexuality? We  know that sexual attraction usually involves a release of OXT. We also know that OXT can result in aversion and even nausea when presented with an opportunity for sex with members of the opposite sex for gays and lesbians and that some heterosexuals experience similar reactions about have same sex experiences. Could this indeed be the workings of OXT?

Gays, lesbians, and heterosexuals usually have no trouble bonding, and it is the work of the bond that creates the sense of aversion, and it is the aversion that creates the emotional reaction. What about bisexuals? Because we have difficulty bonding we also have no aversion mechanisms. Therefore, we can have sex with either men or women without experiencing overpowering negative emotion. We still have the OXT rush but not biologically imprinted restrictions. We have no difficulty devouring the delirious meal set before us.

What I am suggesting is the people with BPD have difficulty forming lasting relationships because we have difficulty bonding. The OXT release has the opposite effect, we simply associate it with rejection and have an aversion to bonding itself. We enjoy sex for the sake of sex but reject the bonding that goes with it. We burn our bridges and walk away from potentially painful experiences.  That does not mean, however, that we cannot have lasting relationships. It just means that we have to work harder to form stronger and more encompassing emotional and mental bonds in spite of the negative flow of OXT.

My five suggestions for bisexuals.

  1. We don’t give up on the bond. We can still  form mental and emotional bonds by creating and repeating feelings of love for our partners .
  2. If we feel emotional aversion, we can accept it, face it, and understand where it is coming from. We can then choose to recreate a feeling of love. Every time we do this, it reinforces our love bond.
  3. We do not let our aversion feelings interfere with our sex life. We focus on the physical and emotional pleasure and use this experience to again reinforce our love bond.
  4. We keep focusing on the positive aspects of our relationship and consciously build our mental-emotional bond.
  5. We do little things to show our partner we love them. Flowers and chocolate works for women and a good back rub does wonders for a man (by the way men like chocolate too, and women like back rubs).

 

 

[1] Angela D. Nickell, Carol J. Waudby, Timothy J. Trull, (2002). Attachment, Parental Bonding and Borderline Personality Disorder Features in Young Adults. Journal of Personality Disorders: Vol. 16, No. 2, pp. 148-159. https://doi.org/10.1521/pedi.16.2.148.22544

 

[2] Bartz, Jennifer; Simeon, Daphine; Hamilton, Holly; Kim, Suah; Crystal, Sarah; Braun, Ashley; Vicens, Victor; and Hollander, Eric. Oxytocin can hinder trust and cooperation in borderline personality disorder. Social Cognitive and Affective Neuroscience, Volume 6, Issue 5, 1 October 2011, Pages 556–563, https://doi.org/10.1093/scan/nsq085

 

[3] Gustavson, Carl R.; Sweeney, Michael; and Garcia,John. Prey-lithium aversions. I: coyotes and wolves 1. Behavior Biology, Vol 17, 1976.

Borderline Personality Disorder (BPD) and Bisexuality 2

SHIRT & TIE [small] (final)

(This is the second in the series on the relationship between bisexuality and Borderline Personality Disorder.)

A study by Zubenko et al [1], using the sexual histories of patients who met standardized criteria for borderline disorder, found that 17 of the 61 men (21%) were homosexual, and 4 (5%) were bisexual compared with 7 (11%) of the 61 women. They concluded that homosexuality was 10 times more common among the men and 6 times more common among the women with borderline personality disorder than in the general population or in a depressed control group. Another study by Reich, and Zanarini,[2] concluded that same-gender attraction may be an important interpersonal issue for approximately one-third of both men and women with BPD. There were no significant differences between homosexual or bisexual orientation.

We can see from these studies that about a third of the people with BPD have some form of same-sex attraction. I was not able to locate information on the reverse to see how many bisexuals would be diagnosed with BPD, but I think we can extrapolate that the number is indeed significant. It is my belief that the majority of bisexual men and women may exhibit at least “some” of the BPD symptoms, even if they do not reach the level of a disorder where it would seriously affect their ability to function psychologically and socially.

So let’s take a look at the symptoms listed in the DSM4 (this appears to be much clearer that the DSM5). In general, it is, “A pervasive pattern of instability of interpersonal relationships, self image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five(or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self image or sense of self.
  4. Impulsivity in at least two areas that are potentially self damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or selfmutilating behavior covered in Criterion 5.
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. 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).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms “

The first of these is a fear of abandonment. We will look at this one in detail next week.

Here are my five suggestions for bisexuals:

  1. Do an inventory on the nine symptoms. Give yourself a rating between 1 and 10 with 10 being severe and frequent.
  2. If your score is 25 or greater you may have a Borderline Personality Disorder.
  3. If so you may wish to consider getting counselling.
  4. Write down the symptoms that you have noted. We will be covering these items in future blogs.
  5. If you know someone with BPD you may want to give them this website address.

[1] Zubenko, George S.George, Anselm W.; Soloff, Paul H.; and Schulz, Patricia. Sexual practices among patients with borderline personality disorder. APA PsycNet, 2018.

 

[2] D. Bradford Reich, MD; Mary C. Zanarini, EdD. Sexual Orientation and Relationship Choice in Borderline Personality Disorder Over Ten Years of Prospective Follow-Up.  Journal of Personality Disorders December 2008. Guilford Press Periodicals. Vol 22, Issue  6. 2018

Read More: https://guilfordjournals.com/doi/abs/10.1521/pedi.2008.22.6.564