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 and Episodal Dysphoria


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:

  1. We need to be more gentle with ourselves.
  2. 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.
  3. 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.
  4. We can learn to see ourselves as beautiful creatures with beautiful minds and beautiful souls.
  5. 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. 

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.

 

Impulsivity, Borderline Personality Disorder, and Bisexuality

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, and we have looked at three symptoms for BPD on the DSM4: symptom 1 –  fear of abandonment, symptom 2 – unstable relationships, and symptom 3 – identity disturbance or poor self-concept.)

Today we want to look at symptom 4, which is “impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating”). The DSM5 places impulsivity under pathological personality traits and under the subcategory of disinhibition. Some of the words used to define impulsivity are: “Acting on the spur of the moment; difficulty establishing or following plans; and self-harming behavior under emotional distress”.

When we look at the literature, stress seems to be the primary factor leading to impulsive behavior[1], especially among women with BPD[2]. A review of the literature by Gagnon[3] identified two neuropsychological diagnostic criterions: a preference for immediate gratification and discounting for delayed rewards, and a failure to properly process feedback information and to monitor action in decision making.

So what does this mean? In my case, stress was a huge factor in my life. Whenever I felt overwhelmed by circumstances, I would seek out excitement and pleasure, and preferably a combination of both. My outlet was gay sex. It was the only stimulus that could bring my anxiety to a climax and allow by body to get into the parasympathetic system again. This was the only way I could relax for a few moments and build up enough courage to go on living. During this time, I would shut down all my evaluation processes. I even preferred unsafe sex in unsafe places. It was like I needed the extra excitement provided by the dangerous behavior and perhaps I was unconsciously seeking death to end my anxieties once and for all. There was no thought of consequences. I just needed my fix.

Neurologically what was happening was that my brain was not necessarily making bad choices; it was making the only choice available at that time. It was either crash and die or take action to activate the pleasure center of my brain and restore the chemical balance needed to survive. So my impulsive behavior was very specific. It was the only area in my life that I took chances. For most people with BPD, impulse might be in other areas of risk but the process is probably the same. For us bisexuals with BPD, I would wager that most of our impulsive behavior is related to sex.

Here are my five suggestions for bisexuals:

  1. We need a life strategy for dealing with stress. What works for me is  usually a quiet time in my gardens, or a nature walk through the forest, or  some time on my bench by the sea. The key is to find our special place and plan to use it as needed.
  2. If we have difficulties with non-stress related impulsivity, we can try to build in a buffer between thought and action. We can learn to develop a warning sign system and employ it on a regular basis. We can practice asking these questions: Is this something I really want to do? Is it safe? Can I live with the consequences?
  3. We can try to take our partner into consideration. The second level of questioning should be to ask if our actions will harm or emotionally hurt someone else, especially someone we love and share our life with.
  4. We may wish to spend time with our partner or with a bisexual friend, trusting them with our desires, asking them for help in evaluating our  impulses,  and building our thought and behavior control mechanisms.
  5. Impulses are not necessarily bad. We have been given a spirit of adventure. If is safe, does not cause harm to anyone, and we can live with the consequences, we are free to enjoy.

 

[1] Cackowski, S.; Reitz, AC; Kliendienst, N.; Schmahl, C.; and Krause-Utz, A.; Impact of stress on different components of impulsivity in borderline personality disorder. Psychol Med. 2014 Nov;44(15):3329-40. doi: 10.1017/S0033291714000427. Epub 2014 Mar 6.

[2] Aquglia, A; Mineo, L.;Rodolico, A.; Signorelli MS; and Aquglia E. Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study. Int Clin Psychopharmacol. 2018 May;33(3):121-130. doi: 10.1097/YIC.0000000000000206.

[3] Gagnon, Jean. Review Article Defining Borderline Personality Disorder Impulsivity: Review of Neuropsychological Data and Challenges that Face Researchers. Department of Psychology, Journal of Psychiatry and Psychological Disorders. Volume 1, Issue 3. June 2017,

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 3

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

 

As we have seen in the studies quoted in past blogs, there is a definite connection between Borderline Personality Disorder (BPD) and Bisexuality. The first symptom listed on the DSM4 is Fear of Abandonment.

With bisexuals and other members of LGBQT community, this fear usually originates in childhood abuse or neglect. In the object (relations) constancy theory, the child develops a psychological representation of the parent that satisfies the need for contact when separated. With neglectful parents the child may not be able to develop relations constancy and therefore may suffer from separation anxiety that could eventually lead to fear of abandonment. The DSM5 defines this fear as “Separation Insecurity”. It includes “fears of rejection by – and separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy”. There are two significant aspects to this symptom, namely fear of rejection and dependency.

Some degree of abandonment fear can be normal, but when fear of abandonment is severe and frequent, it can lead to a whole host of problems. A person who has experienced abandonment may be more likely to have long-term mental health issues. They may have mood swings or be unable to control their emotions. Self-esteem can also be affected making it harder to feel worthy or to be intimate. These fears could make a person prone to anxiety, depression, co-dependency or other issues.

Abandonment fear usually affects a person’s ability to form, lasting relationships. They may feel “other” or disconnected from those around them. They may have difficulty trusting others, and in extreme cases, may exhibit some form of paranoia. Adults who are afraid of being abandoned may over work to keep their partner from leaving or, in the case of bisexuals, we may go to extremes to hold onto the relationship often abandoning our own physical and emotional needs. People with the fear of abandonment may tend to display compulsive behavior and thought patterns that sabotage their relationships. Any slight may be interpreted that their partner no longer loves them. From the partner’s point of view, the sudden personality shift seems to come from nowhere. She may be confused as to why her partner is suddenly acting clingy and demanding, smothering her with attention, or pulling away altogether.

If the fear is mild and well-controlled, one may be able to control it simply by becoming educated about their tendencies and learning new behavior strategies. For most people, though, the fear of abandonment is connected to deep seated issues. Therapy may be needed to build the self-confidence needed to truly change destructive thought and behavior patterns.

My five suggestions for bisexuals:

  1. We get in touch with our higher self and practice self-love and self-care and make sure our own wants and needs are met.
  2. It is important to talk about our fears. we need to have at least one significant other who is bisexual and who understands the issues we face.
  3. We may wish to be a part of a support group that deals with abandonment issues.
  4. We can become passionate about our own lives. We systematically build self-confidence and believe that we are strong enough to cope with whatever life throws our way.
  5. If we cannot control our fears we can seek therapy. We can search for therapists who use Dialectical Behavioral Therapy (DBT)  which is designed specifically to help those with BPD. Therapy sessions provide skills and practice focusing on stress management, emotion regulation, and interpersonal skills.

Bisexuality and Borderline Personality Disorder

ASHIRT & TIE [small] (final)s I was searching for something intelligent to write about, I revisited the research section on bisexuality. After reading yet another study on whether or not we exist, I asked myself why I was still looking at this stuff.  We know we exist, so where do we go from here? The answer, of course, is that we should be looking at the issues we face, so that we can somehow finally get past our sexual identity crisis and learn how to enjoy the lives we have been given.

Twenty years ago, I was having a mental meltdown, largely because of my bisexual orientation. I loved my wife and was very much attracted to her; we had a great sex life. But I also had developed an obsession and compulsion for engaging in gay sex. During one counselling session, my therapist conducted a survey in the DSM4 on Borderline Personality Disorder (the 5 had not yet come out). First of all, let me explain. Borderline Personality Disorder is not “borderline”; it is a dysfunction involving significant impairment of self-identity, the ability to relate to others, and difficulty with impulse control. When sexual identity issues are involved, self-loathing, feelings of emptiness and worthlessness, and unhealthy impulses are usually centered on our sexuality.  She looked up and said, “Amazing, you have all the symptoms except sexual identity issues.” She stared at me for a few seconds and said, “Oh my god, don’t tell me you are gay too.”  Well, I can now say I no longer have sexual identity issues. I know and understand my sexual orientation. I am not gay. I am bisexual.

Looking back, I think it is important to address the issue or borderline personality disorder.  In an analogue study[1], 141 psychologists evaluated a hypothetical client with problems that resembled borderline symptoms but were also consistent with a sexual identity crisis. In this study, client descriptions varied by sexual orientation and gender. Results revealed that male clients with bisexual attractions were more likely to be diagnosed with borderline personality disorder. Therapists were more confident and willing to work with female bisexual clients and gave them a better prognosis. In other words, the clinical community believes that we bisexual males have severe issues in dealing with our bisexuality resulting in Borderline Personality Disorder. This means that our belief system makes it difficult to make changes through traditional therapy, and difficult to function in our society. Women on the other hand seem to be able to assimilate their bisexual desires into normal life patterns with or without therapy.

If we have indeed overcome our identity issues and we know and understand that we are bisexual, than what comes next? I think the answer may lie is taking a closer look at the borderline personality symptoms. In my case, I may still have a Borderline Personality Disorder, but I now understand it and have learned to live with it. Somewhat like in the movie, The Beautiful Mind, I now know when my disorder is throwing false information at me, and I can simply reject it and function with the truth: I know who I am; I love and care for myself, and I appreciate my mind and body with their bisexual desires. But that was a long and painful journey. The next few blogs will be devoted to the steps we can take to overcome our borderline personality symptoms.

My five suggestions for bisexuals:

  1. We accept the fact that we are psychologically and biologically bisexual. If we are sexually attracted to both males and females, then we are bisexual.
  2. We get comfortable with it. We keep telling ourselves its okay to be bisexual.
  3. We recognize our negative feelings, enter into a state of mindfulness, and allow our higher self to soothe our mind until we begin to see the amazing qualities we possess because of our bisexuality. It is truly a gift.
  4. We deal with negative thoughts. We don’t suppress them, we convert them to positive thoughts. We can do this by simply taking a negative statement and turning it into a positive. For example “I cannot control my sex drive” becomes “I can control my sex drive”.
  5. We look for ways to appreciate our bisexual body and brain. We keep an ever growing list of things we are thankful for. When we have doubts, we simply check out list and recite all the things we like about ourselves.

[1] Eubanks-Carter, Catherine and Goldfried, Marvin  R. . The impact of client sexual orientation and gender on clinical judgments and diagnosis of borderline personality disorder. Journal of Clinical Psychology. March, 2006