Borderline Personality Disorder and Dissociative States

shirt-tie-w-out-white-background-final-10We have come to the last, (and perhaps most difficult to describe and comprehend) symptom on the DSM IV, namely: “transient, stress-related paranoid ideation or severe dissociative symptoms”. The DSM 5 includes it under significant impairments in personal function with a similar descriptor of: “Dissociative states under stress”. When we see this definition we immediately think of two severe disorders, paranoid schizophrenia and dissociative identity disorder; however Borderline Personality Disorder (BPD), although having some similarities, is essentially quite different.

First the semantics. Transient merely means that the symptom is not continuous but comes and goes depending on the levels of stress and subsequent anxiety. The term ideation refers to negative mind states or thinking patterns involving negative past experiences that, again, may come to the surface under stress.  Paranoia here is much gentler than the kind of paranoia that we see in Paranoid Schizophrenia. By my own experience, I would describe it as a feeling that I do not belong, and the world out there is a dangerous place that required that I was always perfect, vigilant, and careful in my interactions with people. This leaves us with the term dissociative that we will examine more closely in the rest of this blog.

One study, although quite different in design, seems to bring what is happening into focus.  Ludascher et al (2007) applied electric stimulation on the right index finger with twelve female patients with BPD and twelve healthy controls. They found significantly elevated pain thresholds in patients with BPD, with a significant positive correlation between pain thresholds and dissociation, as well as between pain thresholds and aversive arousal. In a follow-up study, Ludascher et al (2010) using script-driven imagery, produced dissociative states in participants with BPD. These states on fMRI’s were characterized by decreased pain sensitivity and significantly increased activity in the left inferior frontal gyrus (part of the OFC) which is at least partially responsible for empathy, processing pleasant and unpleasant emotions, self-criticisms, and attention to negative emotions.  From these two studies we see suppression of emotional pain and interference in the functioning of some of the sections of the orbitofrontal cortex (OFC).

Typically when an emotional situation takes place (usually involving intimate relationships or high self-worth activities like work and some sports), the OFC and amygdala are activated, thus empowering us to take action and resolve the situation. Once it is resolved, these impulses are then channeled through the pleasure center of the brain producing a sense of joy and accomplishment. Serotonin and endorphin neural circuits are then activated giving us a sense of peace and euphoria.  However, if the emotional situation is too intense (such as a break-up), we will eventually but a block in place along those neural circuits connected to the images and thoughts and feelings.  This is a natural body function that is usually put in place to block the neurotransmitters that are coming from intense pain. The neurons simply withdraw their receptor docks, thereby preventing the messages from proceeding from the painful neural pathways to the OFC of the brain. Out of sight, out of mind. Works for most people.

But if this process has been corrupted by severe emotional problems during childhood such as emotional neglect, coupled with a supersensitive genetic predisposition, the OFC will not be able to process any additional emotional insult. The whole emotion processing system gets shut down. This theory is supported by Jones et al (1999). They assessed twenty-three patients with BPD, and 23 matched controls, with the Autobiographical Memory Test (AMT) and self-report measures. As expected, participants with BPD scored significantly higher than the control group on measures of depression, anxiety, and trait anger. However, they also scored higher in dissociative experiences that appear to be connected to general memories on the AMT. They concluded that patients with BPD had difficulty in recalling specific autobiographical memories, perhaps related to their tendency to dissociate, which may help them to avoid reliving memories that may have been emotionally painful.

These studies suggests that under stress, we lost souls with BPD tend to shut down emotional pain sensations because of our past painful experiences. Again, in my own case, whenever I was personally or professionally challenged by someone, and I felt my self-worth was at stake, I could actually feel a sense of numbness flowing through my brain and through the rest of my body. Quite simply, this suggests that some of us with BPD may have developed some kind of defense mechanism to interrupt the flow of pain within our brain. Because this pain is emotional in nature, it might indicate that we bypass our amygdala thus having an interrupted or numbing response when faced with an emotional situation.

Now this sounds like a perfectly good way to deal with overwhelming emotional situations, but there is a major drawback, which brings me to the last study in this section.  Ebner-Priemer et al (2009) used an aversive differential delay conditioning procedure with 33 unmediated patients with BPD and 35 healthy controls. They discovered patients that BPD with high state dissociative experiences and showed impairment in responding to emotional learning. They concluded that emotional, amygdala-based learning processes, may be inhibited in acquisition and extinction processes in therapy and should be closely monitored in exposure-based psychotherapy. It would appear that we do not respond well to traditional therapy methods. The amygdala, and parts of the OFC mentioned in these studies, are designed to provide the plan and the power to solve problems, including highly emotional ones. It is part of a circuit that leads to resolutions, a trip through the pleasure center of the brain, and to a nice comforting flow of serotonin. When we shut down these mechanisms, we shut down our ability to solve problems and to feel the joy and contentment of growing through our experiences.  And, unfortunately, we do not respond well to therapy.

So what is the answer? Again, I can only refer to my personal experience. I underwent an extensive  therapy including group, cognitive, and an assortment of other strategies, with only limited success. My true healing took place when I begin to see myself as a higher self in conflict with a mind self (talk about dissociative disorder). Only then, with the support of my higher self, was I able to explore my past emotions, cry with some, yell and scream at others, and feel the hurt and loss with the rest. It allowed me to  accept them, be thankful for their part in making me strong, and put them behind me. Then when old feeling returned, and I felt the numbing sensation coming on, I would connect to my higher self, and allow it to flood my mind and soul, cry, and move on.

Here are my five suggestions for those of us with a dissociative element in our BPD:

  1. We face our emotions. We notice that numbing sensations when we begin to shut down. We seek a quiet moment and allow the feelings to surface.
  2. We call upon our higher self to give us courage and strength to face them, deal with them, cry if we have to, or be angry with the people involved. We then allow the higher self to complete the circuit as the serotonin pathways are activated and endorphins are released.
  3. We continue to process these past emotions through contemplative therapy. In my case, I entered a state of meditation where I become aware of my higher self. I then allowed my mind to bring up past pains and deal with them. I did this on consecutive days until all the old wounds were healed. It took me several weeks before I felt the issues had been resolved.
  4. Whenever they resurface, I thank my mind for bringing it to my attention. If the time and space are appropriate, I give it permission to experience the old emotions. I soothe it with my higher self. “There, there it’s okay to feel this way. It’s okay to cry.  it’s okay to be angry.”
  5. If the timing is not appropriate or if an emotional reaction might lead to further conflict and pain, I allow my mind to suppress the emotion with the promise to resolve the issue and the emotions behind it during the next day’s meditation. Once I feel comfortable with, and in control of my emotions, I will bring it up at the next opportunity with my intimate friends and family. If it just an acquaintance from work or community, I may just let it pass and chalk it up to experience.

 

 

 

 

 

 

Ludascher, Petra; Valerius, Gabriele, Stiglmayr, Christian; Mauchnik, Jana; Lanius, Ruth A; Bohus, Martin; and Schmahl, Christian. Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study. J Psychiatry Neurosci. 2010.

 

Ludascher, Petra; Valerius, Gabriele, Stiglmayr, Christian; Mauchnik, Jana; Lanius, Ruth A; Bohus, Martin; and Schmahl, Christian. Elevated pain in thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. 2007.

 

Jones, B; Heard, H; Startup,M; and Swales, M. Autobiographical memory and dissociation in borderline personality disorder. Psychol Med. 1999. Psychiatry Research. 2007.

Ulrich W. Ebner-Priemer, PhD, Jana Mauchnik, PhD, Nikolaus Kleindienst, PhD, Christian Schmahl, MD, Martin Peper, PhD, MD, M. Zachary Rosenthal, PhD, Herta Flor, PhD, and Martin Bohus, MD. Emotional learning during dissociative states in borderline personality disorder. Journal of Pschiatry and Neuroscience. 2009.

 

Borderline Personality Disorder and Anger

shirt-tie-w-out-white-background-final-13

We now move on to Symptom eight on the DSM IV, namely, “Inappropriate, intense anger or difficulty controlling anger.” On the DSM 5, it is listed under pathological personality traits in antagonism and includes “persistent or frequent angry feelings”, and “anger or irritability in response to minor slights and insults.” Some articles describe this out of proportion anger as “BPD rage”. There is a relatively small sample of research on the topic, but I have located two well designed projects that should shed some light on the topic.

Cackowski et al, in a small sample of twenty-nine female BPD patients, 28 ADHD patients and 30 healthy controls, found that BPD patients reported higher trait aggression and hostility, a stronger tendency to express anger when provoked, and a tendency to direct anger inwardly. They concluded that there may be a significant impact of stress on anger in BPD patients; however, it appears to be directed towards the self rather than to others.

Krauch et al used functional MRI to observe brain scans when twenty BPD and twenty HC adolescent participants were exposed to scripted imagery. They found that adolescents with BPD showed increased activity in the left posterior insula, the left dorsal striatum, and the left inferior frontal cortex. The insula is connected to our old friends the amygdala and the thalamus and is part of the limbic system involved in processing emotions. It is also believed to be involved in the processing of physical and emotional pain in an attempt to create homeostasis or balance during interpersonal relationships.  The striatum is part of the forebrain that is believed to be involved in the reward system, inhibitory control, and impulsivity. The inferior frontal cortex is, of course, our administration center that employs mind states to solve problems.

So what does this mean in layman’s terms? Quite simply, it shows that we unfortunate souls with BPD have overactive brains in the areas involving negative emotions and subsequent behavior. When our emotions are activated by minor conflicts, we have a difficult time processing the information and calming our overactive brain. We tend to react with frustration and anger, but since we are so dependent on our relationships with other for our sense of self-worth, we direct this overcharged anger against ourselves. This often shows up in self-harm activities and suicidal behavior.

So what does all of this mean? First of all, let’s deal with the data from these studies. Even though Cackowski et al’s study was carried out with women, I think we can safely employ these results to men. We have a tendency to experience the same emotions but deal with them in different ways. We tend to suppress causing an increased buildup of negative energy. When we reach our boiling point, we explode more violently than women. Therefore, even though women have more suicidal attempts than men, we tend to be more successful at killing ourselves, because we use more violent means like jumping off tall building or using a gun to blow our brains out (interesting-one way to stop the over active and pain-filled brain). Women on the other hand use peaceful means such as overdosing which, by the way, leaves a possible back door to escape.

When we look at the brain scans, they are just that. It is not definitive. It just shows what parts of the brain are active. The old orbital frontal cortex is just searching vainly for solutions from past experiences. If we believe this part of the brain is “us”, then we have a problem. However, if we believe that we are something beyond the electrochemical impulses, neural pathways, and mind states, than there is hope. If we defer to the Higher-Self, we can begin to see solutions beyond the mind states and schemas of the OFC, stop all the turmoil and impose a homeostasis or balance on the insula, and nudge the dorsal striatum to let go and complete the happy pleasure route by choosing to smile at our absurd reaction to a minor conflict. We use our higher self to pat ourselves on the back and say “there, there” and we begin to see solutions where there did not appear to be any. We can then experience an amazing surge of positive power and energy to forge a new path, not only to create balance, but to carry on with the expansion and growth of our being.

Here are my five suggestion for people with BPD and anger and impulse control problems:

  1. We recognize that we have anger issues. And we thank the universe (and yes I mean thank) that we still have the ability to have an emotional response to the feeling of rejection and interpersonal disagreements. If we ever lose that, it means we have quit trying to interact and may now be vulnerable to the second and more dangerous cause of suicidal behavior – hopelessness and helplessness. We always look for something to be thankful for. It gets us in touch with our higher self.
  2. We let the people who are important in our lives know that we have a “rage” problem. We alert them that we may have to tell them from time to time that we are experiencing a rage episode and may have to excuse ourselves from a situation with a promise to come back and resolve the issue once we have ourselves back under control.
  3. When confronted with a conflict, we take a deep breath and smile (if appropriate – does not work with partners during an argument) rather than responding to our brain’s emotional reaction.
  4. Whenever we feel the conflict beginning to turn into the rage, we remove ourselves (if we can) from the situation before it blows up to unmanageable proportions and additional shame inducing behavior that will complicate our ability to resolve the conflict. If we can’t leave the scene, we may have to eat crow (amazing birds) and shut up and take it. It helps to say “yes madam” to the boss and “yes dear” to our partners.
  5. We refuse to turn the anger against ourselves. We keep it objective. We find a quiet spot and employ deep breathing and self-talk. We analyse the situation and our over-heated response. We make a plan to resolve the conflict. If we have followed steps 1 to 4, we pat ourselves on the back and say, “Well done”.
  6. If we lose it and blow up again, we are kind to ourselves and recognize that this is part of a bigger problem. We analyze the situation to see what we can do better in the future. We apologize and restore the relationship. This should be easy to do  if  we have done step 2.

 

Cackowski, Sylvia; Krause-Utz, Annegret; Van Eijk; Klohr, Julia; Daffner, Stephanie; Sobanski, Ester; and Ende, Gabriele. Anger and aggression in borderline personality disorder and attention deficit hyperactivity disorder – does stress matter? Borderline Personality Disorder Emolt Dysregul, 2017. 17.

Krauch, Marlene; Ueltzhoffer, Kai; Brunner, Romuald; Kaess, Michael; Hensel, Saskia; Herpertz, Sabinen C; and Bertsch, Katja. Heightened Salience of Anger and Aggression in Female Adolescents With Borderline Personality Disorder—A Script-Based fMRI Study. Front. Behav. Neurosci., 26 March 2018 | https://doi.org/10.3389/fnbeh.2018.00057

Borderline Personality Disorder and 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.

  •  

 

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, 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, 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,

The Power of Belief

img_1394-1

 

I Believe in Life after Death

 

So many of us have stopped seeing the world as the beautiful place it really is. Our words and thoughts are filled with negativity. Having lost our Spiritual roots, we see death as final and tragic and something to be feared. It is all a matter of perspective. Yes there is pain, and the pain is real, but we can still heal our pain through the power of the belief – the belief that we have the ability to create and live a life of peace and joy.

I recently attended a Life Celebration for a ninety year old friend who had lived a full and rich life. As in so many funerals, thoughts turned to a hoped for afterlife. We all wished that he would fulfill his dream to rejoin the love of his life, his wife of sixty-two years. I know that beliefs in a heaven and hell are based on Christian mythology, but myths are just stories that reveal a hidden truth. I believe that this body is mortal but we also have an essence that is pure energy. We are spiritual beings cloaked in a human body. Since this energy can never be lost, I believe it is simply transformed into pure spirit.

I believe that death is not to be feared. There is no hell. I believe that there is an afterlife or another life, and this life will be free of pain and suffering. I believe that the power of belief is a gift from the source. It is the essence of faith and hope. It is the essence of out being.  It is the shoulder we can lean on when life seems too hard to bear.

 

     I Believe In Life after Death

 

Knowing all there is to know and being all there is to be,

It is now time to celebrate the last day of the last life

That I will ever live.

 

However, there are still these last few years to savor,

The thrill of sensing all that my eyes can see,

And hearing all my ears can hear.

 

And as I caress the substance of all my hands can touch,

My soul transforms all these gifts of my senses

Into feelings that expand into ecstasy.

 

As my souls captures the joys of this divine present,

It molds this ever expanding divine source of energy

Into a shape I know will last forever.

 

 

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.

.