Borderline Personality Disorder and PTSD

shirt-tie-w-out-white-background-final-3As 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[1] 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
  • self-harm

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[2] 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

[1] Leonard, Jane.  What to know about complex PTSD.  Medical News Today.  August 2018.      https://www.medicalnewstoday.com/articles/322886.php

[2] 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.

New Year’s Resolutions for Bisexuals

shirt-tie-w-out-white-background-final-13 The best advice I can give regarding New Year’s Resolutions is, “Don’t do it!” If you are striving and hoping to change your sexual behavior, “Stop trying!” Why? Because our brains do not work that way.
       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:
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

Borderline Personality Disorder and Anxiety Attacks

Bisexuality

(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
  • sweating
  • 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:

  1. 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.
  2. 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.
  3. 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.  
  4. 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.
  5. We engage in long term anxiety control. For more details, see the last blog for suggestions to control generalized anxiety.

Borderline Personality Disorder and 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[1]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[2] . 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:

  1. We learn to read and monitor our anxiety levels.
  2. We develop a strategy like deep breathing. I use a four point square visualization technique:
    1. Four breaths in deeper and deeper until full
    1. Hold for four seconds.
    1. Four breaths out until completely empty
    1. Hold for four seconds
    1. Repeat until experiencing a release of anxiety.
  3. When stress leads to conflict (internal or external) and an anxiety attack, we:
    1. Remove ourselves from the situation,
    1. Take a walk and work off the physical side effects of the anxiety.
    1. 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.
  4. If we have a period of prolonged stress, we will need to remove our self from the situation and take a maintenance break.
  5. 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.

[1] 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.

[2] Harned, Melanie s.; Valenstein, Helen R..  Treatment of borderline personality disorder and co-occurring anxiety disorders. F1000Prime Rep. v.5; 2013.

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Borderline Personality Disorder, Disinhibition, and Suicidal Behavior

img_1394-1(This is the third in the series linking Borderline Personality Disorder (BPD) with Suicidal Behavior. In the first blog, we established the link between BPD and suicidal behavior in general, and in the second blog we looked at the correlation with childhood sexual abuse.)

A study conducted by Brodsky et al [1] involving 214 inpatients diagnosed with BPD, concluded that Impulsivity was the only characteristic of borderline personality disorder that was associated with a higher number of previous suicide attempts. Could it be that impulsivity by itself, leading to risk taking, is the leading cause of suicidal behavior among those diagnosed with BPD? I think not, at least not in isolation.

So why are we splitting hairs when it comes to the causes of suicidal behavior and BPD? We know there is a link with BPD and suicide, and we know there is a link with suicide, impulsivity, and risk taking. Whether or not suicidal thoughts and behaviors are a symptom of BPD or not is not the issue. The issue is that people with BPD  are dying because of their risk taking. This is especially evident in the case of the flirtation with death through street drugs. Why are we doing that? Why are we taking risks with drugs we know are, or may be, laced with fentanyl? Why have we gay and bisexual men engaged in unsafe gay sex when it may have led to AIDS? Why such a disregard for our own lives?

Speaking from personal experience, impulsivity was not my major cause of suicidal thoughts. It was my sense of failure and hopelessness. I never made an attempt on my life but I certainly took risks that I hoped might end it for me. Perhaps, it is the combination of other affects in conjunction with impulsivity, in other words,  a kind of global personality disorder, including impulsivity, that puts us at risk not just for suicidal thoughts but for actual suicidal attempts. Perhaps it is merely not wanting to live our lives anymore because there is too much pain coupled with a desperate sense of helplessness and hopelessness.

So what can we do about it? Therapy should begin not with what has happened in the past, and not the sense of hopelessness in the present.  We have to start with finding something to be thankful for, and what a better place to start than with life itself. We have to stop viewing life through the eyes of our damaged egos and begin to see the possibilities of a life we would love to live that is being offered by our higher self. We have to close our eyes and ears to the message of hopelessness and helplessness and open ourselves up to the message of hope and love from our higher self. We should be focusing on what life can be, not what it was not. We have to learn to dream again and see the possibilities of a life of peace and contentment, a life that we would truly love to live. There is a light at the end of the tunnel; we just have to open the eyes of our higher self to see it.

Here are my five suggestions for bisexuals with BPD:

  1. We can look deep inside ourselves and find that sweet spot at the center of our being, the home of our higher self. We can do this through meditation where we seek out that especial place that is within all of us.
  2. During the day, we just stop the madness for a few minutes and enter into a state of short meditation where we seek the presence of our higher self. It will give us a moment of peace.
  3. If we stay in the moment, our higher self will begin to heal our wounds and dissolve our sorrows. It may be just a quiet knowing, or it may be an emotional charge as old feelings come to the surface and are let go. We do not try to analyse where the feeling comes from; we just acknowledge it and let it go. It’s okay for us men to cry.
  4. We begin to search for and recognize our inner voice. We choose to silence the voice of our mind and welcome the voice of our spirit. It will always say I love you in a thousand different ways.
  5. We recognize that we are in essence love and that love starts with love for our self. We tell ourselves that we are proud that we have survived the pain and we give our self a hug.

[1] Brodsky, Beth S.; Malone, Kevin M.; Ellis, Steven P.; Dulit, Rebecca A.; and Mann, Hohn J..

Characteristics of Borderline Personality Disorder Associated With Suicidal Behavior. Am J Psychiatry 1997; 154:1715–1719)

 

 

Borderline Personality Disorder, Childhood Sexual Abuse, and Suicidal Behavior Behavior

SHIRT & TIE [small] (final)(This is the second in the series linking BPD with Suicidal Behavior)

The DSM 4 lists “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior” under symptom 5 for Borderline Personality Disorder; however it is listed as a separate category under Axis 6 in the DSM 5. Granted, suicidal behavior does indeed merit a separate category; however, we should be aware that people with BPD are at higher risk for suicide attempts.

Research suggests that suicidal behavior is a consistent possible threat when combined with BPD, PTSD, Clinical Depression, and Bipolar Disorder; however, it would appear that people with BPD are at a greater risk. In a study by Yen et al[1] involving 621 patients with a variety of psychological disorders, they concluded that only BPD and Childhood sexual abuse predicted suicidal behavior. The risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode. Other studies indicate that there is a definite correlation between suicide attempts and some BPD personality traits such as poor or no sense of self, hopelessness, and impulsivity.

Today, we want to look at the other aspect of the Yen et al study, namely the relationship between BPD, childhood sexual abuse, and suicidal behavior. Even though Childhood sexual abuse is not listed as a symptom, it is definitely related to suicidal behavior when combined with other BPD symptoms. Soloff et al.[2] in a study of 61 criteria-defined BPD patients concluded that with the occurrence and severity of childhood sexual abuse, patients with BPD were over 10 times more likely to attempt suicide. The study accounted for other variables such as neglect and other types of childhood trauma. It was definitely sexual abuse that seemed to be the most important determining factor.

It would appear that the risk for suicidal behavior is somehow related to negative coping mechanisms involved in BPD and that these symptoms are common in people who have suffered from childhood sexual abuse. If childhood trauma is treated and handled wisely and compassionately, the child may be able to learn to deal with the trauma and live a healthy and successful life. However, if they also have, or develop, other BPD personality traits, it can lead to self-doubt, self-blame, self-loathing and hopelessness, all symptoms of BPD and potential precursors  to suicidal behavior.

Just about everyone I know with BPD has entertained thoughts of suicide sometimes in their lives. When we are looking at diagnoses of BPD, we cannot overlook the possibility of suicidal behavior.  However, if the BPD symptoms also include childhood sexual abuse,  extra precautions need to be put in place. We can explore these possibilities as we go through the process of mental and emotional healing.

My five suggestions for bisexuals with BPD:

  1. If we ourselves have been diagnosed with BPD, and we have experienced childhood sexual abuse, we must be honest with ourselves to see if we have latent suicidal thoughts that could come to the fore if our life circumstances deteriorate.
  2. We need to build a safety net that will serve as a buffer between suicidal thoughts and suicidal attempts. We can share these thoughts with friends and loved ones on a regular basis.
  3. If our friends or loved ones demonstrate  symptoms of BPD, they are at a very high risk for suicidal behavior. We need to support them in any way we can.
  4. We should explore their history with them in a caring and loving manner and make sure they are not entertaining suicidal thoughts. If they are, we can help them build a safety net of people they love and trust. We let these people know that our loved one is at risk and together we set up a support schedule and set of activities to help them get through the rough times.
  5. If our loved one has experienced sexual abuse  and is still exhibiting symptoms of BPD, they will probably need professional help to deal with the issues involved. We can get them to commit to seeking help and then arrange for professional intervention.
[1] Yen, Shirley; Shea, Tracy M.; Sanislow, Charles A.; Grilo, Carlos M.; Skodol, Andrew E.; Gunderson, John G.; McClashan, Thomas H.; Zenarini Mary C.; and Morey, Leslie C.. Borderline Personality Disorder Criteria Associated With Prospectively Observed Suicidal Behavior. The American Journal of Psychiatry. 2004.
[2] Soloff, Paul H.; Lynch, Kevin J.; and Kelly, Thomas M.. Childhood Abuse as a Risk Factor For Suicidal Behavior in Borderline Personality Disorder. Journal of Personality Disorders. June 2002 .
Read More: https://guilfordjournals.com/doi/abs/10.1521/pedi.16.3.201.22542

 

 

Borderline Personality Disorder, Bisexuality, and Suicidal Behavior

SHIRT & TIE [small] (final)In previous blogs, we have established the highly significant link between Borderline Personality Disorder (BPD) and Bisexuality. Due to the epidemic of suicidal behavior and related drug overdose, in the next five blogs, we will try to explore the links between BPD, suicidal behavior, and risk taking. Today we want to explore the association with BPD in general.

At first glance, there appears to be a conflict between the DSM 4 and the DSM 5 on the inclusion of Suicidal Behavior as a symptom for BPD. The DSM4 includes it as the fifth symptom, “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.”  However, it only appears in the DSM5 under the broader title of Disinhibition – Topic B – Risk Taking – which includes “Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences, lack of concern for one’s limitations, and denial of the reality of personal danger.”

First, let’s be clear about the connection between suicidal behavior and BPD. Black et al (2018) [1] discovered that at least three-quarters of people diagnosed with BPD have attempted suicide, and approximately 10% have died tragically. These are truly significant figures. If we recall that patients have to have five significant traits for diagnosis, even if one of these was suicidal behavior, there is still enough evidence that BPD people are definitely at risk. Borderline sufferers (and believe me, we do suffer) at greatest risk include those with prior attempts, an accompanying major depressive disorder, or a substance use disorder. Each of these by themselves are a major concern for suicide, but taken together with BPD, they seem to create the perfect storm. Other BPD personality traits that are associated with Suicidal Behavior are hopelessness, impulsivity, and a turbulent early life. They further conclude that clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates attention seeking or a call for help. According to Black et.al, this behavior is a genuine attempt to end life.

I think to clearly understand the thoughts and emotions that lead to suicide, we have to take a closer look at the definition above that includes gestures, threats and self-mutilation. For today, let’s take a closer look at gestures and threats. From my personal experience, almost everyone with BPD has entertained thoughts of suicide sometime in their life. In my own case, I struggled with the usual feelings of helplessness and self-loathing, especially when connected to my bisexual desires. It was not until I decided to inform my wife about my struggles, and the subsequent divorce, that I entertained suicidal thoughts, but unlike 75% of my fellow BPD sufferers,  I still could not pull the trigger. Instead, I engaged in all kinds of reckless behavior with the thought that I would welcome death if it happened. I also  made threats to myself and informed others that I was having suicidal thoughts but never reached the point of an actual attempt.  So what is the difference between thoughts and actions?

Again we need to look at the old formula – beliefs beget thoughts, thoughts beget feelings, and feelings beget actions. In my case, I think I shared the same beliefs with my suicide- attempting brothers and sisters. We believed that we were failures; we hated ourselves; and we no longer wanted to live out our painful lives. I think we probably shared the same thought patterns. That leaves feelings as the major component in the difference between thinking suicidal thoughts and actually carrying them out. And again, I think we probably shared the same feelings, but it was the depth of the feelings that made a difference. For these souls, hopelessness became despair; self-loathing became indifference; wanting to end the pain became the only solution, which was, of course,  the final solution. In my case, I was willing to ride it out, not believing that any good could come out on my life, but simply deciding to go through the motions and continuing in high risk behavior. Fortunately, in my case, time, the ultimate healer, eventually made the pain more bearable, and I waited around on this planet long enough that I began to sense that perhaps life was not so bad after all.

In my review of the literature, I have found some of the causes of the deeper feelings of hopelessness. The links between suicidal behavior and other factors such as childhood sexual abuse, depression, and substance abuse will be clearly defined in future blogs. For the time being, I think it is safe to say that BPD has several causal or at least correlational factors that may lead to suicidal behavior. We need to take steps that might help these people go through their life and death struggles.

Here are my five suggestions for bisexuals with BPD:

  1. We never give up. When life gets too hard to bear, we seek help.
  2. While we are still functioning, we find a kindred spirit, preferably someone who has been there, or we make a pact with a fellow sufferer that we will not go ahead with the final solution until we have sat down and talked and cried together one last time. Just expressing the negative feelings is the first step to accepting them as part of our lives that are painful but not necessarily hopeless.
  3. If there is no light at the end of the tunnel, we create one, be it ever so small, such as we wait for some event in the future that we can look forward to such as a graduation or our grandson’s birthday, something that we can celebrate.
  4. We begin to rebuild our belief system by finding and focusing on some positives in our life such as, perhaps, our creative abilities. I knew I was a good writer, and writing poetry was a way for me to survive the night and wake up the next day and start over again.
  5. We recognize that we have a higher self that is powerful and beautiful. And when life is just too difficult, we spend a few moments seeking out the person within, and we cry together.

 

[1] Black, Donald W.; Blum, Nancee; Pfohl, Bruce; and Hale, Nancy. Suicidal Behavior in Borderline Personality Disorder: Prevalence, Risk Factors, Prediction, and Prevention.  Journal of Personality Disorders > Vol. 18, Issue 3. 2018.

 

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 and the Missing Self

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.

During the 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.

 

What can we take from this? Most of us bisexuals with BPD have had to survive with a wounded child, often because of childhood neglect or abuse. Because of that we have experienced psychological shame causing us  to avoid and neglect our inner child. We need to revisit those days again and do some healing; we need to give ourselves the attention we all had deserved. Above all we need to play. We need to learn to enjoy being with ourselves.

.

 

Borderline Personality Disorder and Bisexuality 4

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

In the previous blogs, we have established a significant correlation between bisexuality and BPD. In the last blog, we looked at the first symptom for BPD from the DSM4 which was, “Frantic efforts to avoid real or imagined abandonment”. Today we want to look at the third symptom, “identity disturbance: markedly and persistently unstable self image or sense of self”.

The DSM5 describes self-identity under “Significant impairments in personality functioning”. The markers are “Markedly impoverished, poorly developed, unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; and dissociative states under stress.” The key here is self-identity. There was a catch phrase in the 1980’s that said, “he is trying to find himself”. For us bisexuals, this can be a lifetime pursuit. Not only do we often have to deal with BPD, but we also struggle with our sexual identity.

In my definition, there are two aspects to self-identity; namely, how I present myself to others, and how I view my own sense of being. The first is usually defined by occupation, family roles, and societal roles. People with BPD usually try to be everything to everybody in order to please. Unfortunately, we lose our sense of our inner self. When our outer self is threatened, we have nothing to fall back on so we crash.

When we look at some of the other descriptors, we see “impoverished and unstable self-image”. There is no, or only a limited, sense of inner self. As seen in a previous blog, these feelings usually originate due to abuse or neglect during childhood. The bonding with our parents gives us a foundation, a sense of having a loving bond that we can build on during childhood, teen years, and early adult life. We gradually sort it out and come up with a feeling of who we are and what we stand for. However, without this firm foundation, the self-structure is limited and usually lacks confidence and a sense of what it feels like to be loved.

The next descriptor is “chronic feelings of emptiness”. We lack confidence in our self and have difficulty building on past successes. We reject positive compliments and focus on  the negative.  The result is that we go from moment to moment looking for affirmation but never really digesting it. We look for love but never really accept that we are indeed lovable and worthy of being loved.

The last point is “dissociative states under stress”. This is the one where our bisexuality really complicates the matter. Because we lack a sense of self, we tend to have difficulty dealing with stress, especially when it comes to our sex life. It seems that in order to function as heterosexuals, we have to create a heterosexual identity, and when we enter the gay or lesbian world, we create a significantly different persona. Bisexual men tend to seek love and intimacy and bisexual women tend to seek and protection and security in the heterosexual relationships, and when we want power and passion, we go gay or lesbian. When we are under stress and need to restore our chemical balance by going from the sympathetic to the parasympathetic system, we usually go for same-sex erotica. This helps us escape anxiety for a few precious moments, and also stimulates the pleasure centers or our brain.  We then form a dissociative relationship between the two identities to cope with the stress and avoid guilt and shame. This works for awhile, and then we will inevitably crash.

Let’s face it, there are a significant number of bisexuals who have to deal with the BPD component of their psychological makeup. The key is to bring the two sexual identities together. We can do this by creating neural pathways involving feelings of acceptance and gratitude to replace the feelings of guilt and shame.

My five suggestions for bisexuals:

  1. If you are bisexual and have no self-identity issues and no BPD problems – enjoy.
  2. If we struggle with self-identity, 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. We become our own parent.
  3. We flood our self with self-love from the higher self. We practice looking in the mirror and seeing the higher self within. We tell our selves we love our self over and over again until we believe and feel the higher self healing and cleansing the neural pathways of our brain.
  4. When confronted with a moment of self-hate, self-loathing, or self doubt we stop it. We tell ourselves that we are better than that; in fact, we are beautiful, powerful, and in complete control of our emotions and feelings. We make a conscious decision to let go of the negative feelings of self-loathing and shame and embrace the positive feelings of love from our higher self.
  5. We bring the two sexual identities together and accept our bisexuality as part of our self, and yes, even, or especially, a part of our higher self. We release the power of our sexual identity and sexual passion  as a motivator for loving our self and sharing our love with others.