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

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

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

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

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

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

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

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

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

 

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

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

Borderline Personality Disorder and Chronic Feelings of Emptiness

 

shirt-tie-w-out-white-background-final-13As we continue on with our investigation into Borderline Personality Disorder and its relationship to bisexuality, we arrive at symptom seven on the DSM IV: chronic feelings of emptiness. On the DSM5 it is listed under: Significant impairments in personality functioning manifest by:

“Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.”

When we seek to define emptiness, we come up with adjectives such as hopelessness, loneliness, and isolation.

In a study by Klonsky[1], he concluded that emptiness is characterized more by low positive affect rather than high negative affect. In layman’s terms, it is not so much having negative thoughts and feelings related to negative events, but rather just being empty of, or having a lack of, positive aspects to our lives. Klonshy came up with some interesting observations. As expected, he noted a substantial overlap between emptiness and hopelessness, a subsequent robust relationship with depression, and an important relation to suicidality. By including a sub study on self-harm through self-cutting, he noted a pattern that suggested that chronic emptiness contributes to the development of suicidal thoughts and feelings, but may not predict progression to an actual suicide attempt.

This brings out an interesting point about the progression of BPD symptoms to suicide and other self-harming activities. It would appear that there may be two aspects to poor self-image that may lead down two different paths. As we have seen in past blogs, there is a strong correlation between BPD, anxiety, depression, and suicide. Traits such as self-criticism and dissociative states may lead to chronic anxiety and down the path to suicide; whereas the emptiness trait may lead to a form of self-harm where one is attempting to create some feelings to jar them back to a functional reality. And then, because no two people are exactly alike, there are numerous combinations of traits.

Back to my case study of my “self”, I had continuous feelings of emptiness as well as self-criticism. Therefore I had one foot on the path of anxiety and suicidal thoughts but the other on the path of hopelessness. To resolve my problem, I shut down my own wants and needs and stubbornly plowed forward trying to cure and heal anyone I could get my hands on, never getting any real satisfaction for doing any good for anybody. During profound periods of emptiness, I tried to fill it up with dangerous, risk taking gay sex. It worked for me for twenty-five years until my mind became overwhelmed and crashed. Even though I had suicidal thoughts, I never really took any steps to actually doing away with myself. I just grinned and bared and waited for the shoe to fall.

Looking back here is what I should have done. My five suggestions for bisexuals with BPD and with symptoms of emptiness:

  1. We find some way to fill up the emptiness and the way to do that is to simply remove the veil that is keeping us from seeing that we have a higher self.
  2. We simply shut down the noise of our wounded ego, the woe is me voice, and open our mind to the always present presence and power of out higher self.
  3. We wait for the emptiness to be replaced by a sense of this presence. We will always feel a sense of joy when our higher self sends an impulse through the pleasure centers of our brain.
  4. Whenever we feel down we repeat this process until we sense our higher self.
  5. We fill up and expand our sense of fullness on a daily basis. We spend fifteen minutes a day in mediation by focusing on the power and beauty of our higher self.

[1] Klonsky, David E. WHAT IS EMPTINESS? CLARIFYING THE 7TH CRITERION FOR BORDERLINE PERSONALITY DISORDER. Journal of Personality Disorders, 2008.

Mixed anxiety/depression disorder and Borderline Personality Disorder

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This is the fifth and last in the series on exploring anxiety dysfunctional traits for  Borderline Personality Disorder (BPD) on the DSM 5, and symptom six on the DSM IV. Today we will look at mixed anxiety/depression disorder (MADD).

Although I was unable to find research into a direct link between BPD and MADD, I did find some interesting information and have taken the liberty to employ the blogger’s freedom to draw a few unsubstantiated conclusions. Fava et al in their investigation into the frequency of anxiety disorders in 255 outpatients with depression, concluded that anxiety disorder diagnoses were present in 50.6% of these patients[1]. Moreover, they discovered that an anxiety disorder preceded depression in about sixty five percent of the time. The obvious conclusion is that these two major disorders often occur together and that clinical anxiety usually precedes and may potentially be a significant factor in the onset of depression.

Based on past blogs, I think we can safely extrapolate that people with BPD frequently suffer from MADD symptoms. Because of our fragile egos and our tendency to feel excessive amounts of shame, we are constantly having to deal with anxiety related to the overreaction of the sympathetic system and the hypersensitivity of the reticular system. Because of this constant battlefield in our minds, ninety percent of the time we develop an anxiety disorder. Consequently, this constant battle with anxiety frequently causes a breakdown in the nervous system resulting in clinical depression.

Living with BPD is definitely a difficult path, but it is not hopeless. Neither is living with MADD hopeless; although, it may seem that way when we are in the middle of it. Therefore, I think it is important to recognize our BPD symptoms and predispositions and put safety mechanisms in place before we go MADD.

Here are my five suggestions for bisexuals with, or have the potential for, MADD:

  1. We hang in there. The depression is just a reaction to a buildup of our anxiety. It is a call to slow the world down and get off the treadmill for a while. We accept out present state of depression, acknowledge that it is a natural outcome of our BPD, and seek professional help. MADD can be complex; therefore, when we go to our family doctor, we go to the top and ask for an appointment with a psychiatrist. A combination of anti-depressants and anti-psychotic medication will restore our chemical imbalance and get us back on track.
  2. Counselling now can become effective. We seek out a counselor (or stay with our psychiatrist if she is available) and begin the process of coming to terms with our BPD. We explore the original causes of our anxiety and begin to deal with them one at a time. 
  3. We do not let our sexuality be the cause of anxiety. It is one of the best ways of getting rid or stress, anxiety, and anxiety residue. We want it to work for us not against us, so we make sure we have a healthy attitude before and after sex. No blame, no shame. 
  4. If we know we have BPD, we make sure we have a plan in place to prevent common stresses from becoming causes of an anxiety attack and/or another anxiety disorder. This includes a support person or group to help process common issues, a diet to keep our body healthy, and an exercise program to burn off the residue of our anxieties. We can then return to the parasympathetic system and gain relaxation and regeneration.
  5. We carefully monitor our reticular system. We note when it is becoming engaged. We will usually feel a sense of fear, anger, or shame followed by physical symptoms. We learn to soothe ourselves by breathing exercises and self-talk – there, there – it’s okay – we can handle this.

 

[1] Fava, Maurizio; Rankin, Meridith A.;  Wright, Emma C. ; Alpert, Jonathan E. Nierenberg, ; Andrew A.; Pava, Joel, and Rosenbaum, Jerrold F.. Anxiety Disorders in Major Depression. Comprehensive Psychiatry· March 2000.

 

 

 

 

New Year’s Resolutions for Bisexuals

shirt-tie-w-out-white-background-final-13 The best advice I can give regarding New Year’s Resolutions is, “Don’t do it!” If you are striving and hoping to change your sexual behavior, “Stop trying!” Why? Because our brains do not work that way.
       Let me explain. Our brains are designed to avoid pain and seek pleasure, and seeking pleasure is ten times (I made that up) more powerful than avoiding pain. But it does not stop there. There are two kinds of pleasure: the activation of the quick route through the pleasure system of the brain, and the process of setting goals and achieving them.  They both go through the same pleasure system, but one is short term and leads to pleasure, and the other is long term and leads to happiness. 
       So what is the difference between pleasure and happiness? Pleasure is easy to define; it is biological; more specifically, it is chemical. It has two purposes: to excite and then to soothe, thus completing the pleasure circuit of the brain. Our bisexual brains have decided that the quickest and most powerful way to activate the pleasure system is gay or lesbian sex. This is how it works. We are feeling down and need a fix; we need to get a high to escape the low. All drugs work this way including that wonderful hormone mix of testosterone, estrogen, oxytocin, epinephrine, and adrenalin. Together they not only  excite the body, but they  also serve as neuromodulators to excite the brain. Now the combined hormone/dopamine rush is on with the goal of a pleasure bath through sex. There is one other thing to consider. Having sex with our life partner is great and usually provides a high; however, if we are really down, we may need a greater high. This is where going out on the hunt, or to a lover on the side, comes into play. You see, the novelty of finding a new partner or the feeling of crossing a forbidden boundary actually adds to the charge – namely a more intense flow of dopamine and a greater adrenalin rush. At this point, desire becomes an obsession, an intense dopamine and hormone flow that can only be alleviated by accomplishing our goal – new and exciting sex. Unfortunately, there is usually no soothing after we literally come back to our senses. There is usually pain in the form of guilt and shame. Oops, no soothing. Back to anxiety.
       Now let’s look at happiness which is much more complex and almost impossible to define because it means different things to different people. The closest we can get to universal agreement on happiness is intimacy. This is where sex with a life partner comes in. We look across the room and see our lover and our neurons begin to fire. We are not likely looking just for a fix. Usually, the goal is intimacy. Whenever we feel a little down or we have a hard time seeing the connection with our partner, within ourselves, with life, the world (whatever), we can connect all those dots with sex with our partner (a very clever design because it has the potential to create one more human being and save the human race one more time). This type of sex in usually slower, seeking connection as well as pleasure. This combination of connection and pleasure creates intimacy and intimacy is a form of happiness. To celebrate this reconnection with our partner, our world, and our self the brain now releases a flow of serotonin creating a soothing type of contentment and quiet pleasure; in other words, happiness. The circuit is now complete.  No anxiety.
       Which brings us back to New Year’s Resolutions. They simply do not work. Our brain will refuse to abandon its favorite sources of pleasure without a very good reason. So all the “I will stop” resolutions are worse than useless. They create anxiety, and unsoothed anxiety is a form of pain which the brain wants to avoid. These types of resolutions are doomed to fail, and repeated failure is another form of anxiety and pain. What about the “From now on I will…” resolutions? In this case, the brain has another objection. You see, the pay-off or reward has to be perceived as attainable and perceived as a significantly greater source of pleasure. In other words, we have to firmly believe that being “happy” will be a greater reward than the sought after pleasure. The second factor is that we also weigh the amount of effort (employed anxiety) it will take to achieve the goal. If the cost is too great the brain will not engage the dopamine achievement pleasure system. It takes a strong dopamine charged circuit to change a behavior, and the brain simply does not want to expend the energy it takes to prune and develop the circuits needed to change the behavior.
So what is the alternative? Here are my five suggestions for bisexuals:
  1. We do not make any New Year’s Resolution. We do not try to change our behavior. Instead, we aim to evolve into higher human beings. If we can learn to appreciate and enjoy who we are, we will be “happy”, and as long as we are happy, we will no longer have out of control anxiety, and we will no longer have the need for a sexual high to counterbalance our emotional lows.
  2. We can do this by awakening our higher self. It takes no effort, so our brain will be happy. We simply change our paradigm. We simply choose to accept ourselves and love ourselves just the way we are, with all our flaws. This includes our sexual orientation and our sexual desires and behaviors.  They are what they are. There is no blame there is no shame.
  3. We continue to seek pleasure. It is a wonderful gift from the universe. Whenever we have sex we enjoy every minute of it. Every smell, every touch, every taste, every “I love you”, and how beautiful our partner is. We plan to indulge all our senses. No blame no shame. After sex, we stick around and come down together, thus releasing all our tensions and enjoying our body’s serotonin bath.
  4. We do not stop at pleasure, we seek happiness.  This means getting rid of guilt and shame once and for all. If we have a partner, we work things out together. It will mean honesty and compromise. If we cannot work it out, we may have to make plans to part. Whatever path we choose, we have to free our sexual behavior from the guilt and shame pattern. Sex was meant to be enjoyed and to be a part of our pleasure and happiness circuits. It is too powerful a force to have working against us, and it is too precious a gift not to be enjoyed.
  5. We seek deeper and deeper levels of intimacy. Good sex with a partner leads to bonding, intimacy, contentment, purpose, and to feelings of control rather than helplessness. It establishes a firm base. It is that one guiding principle that our brain can understand. It is willing to try anything, any new adventure or risk as long as it adds to its feelings of intimacy and contentment.

Borderline Personality Disorder and Social Adjustment Disorder

As we have worked our way through the nine symptoms of Borderline Personality Disorder (BPD) on the DSM IV and the personality traits of the DSM 5, we have encountered a major section, and perhaps the core issue, on symptom six, anxiety. Deeper investigation into the relationship between anxiety disorders and BPD, led us to the discovery that 90% of people with BPD suffer from one or more anxiety disorders.  In past blogs, we have looked at the impact of Generalized Anxiety and Anxiety Attacks. Today we want to take a look at Social Adjustment Disorder (SAD).  

A study by Kelly et al[1] led to a startling conclusion. Patients diagnosed with BPD who scored low on overall social adjustment were over 16 times more likely to have attempted suicide than patients diagnosed with major depression. They concluded: “Recent life events may elevate suicide risk in groups already at high risk for suicide completion, whereas high levels of social adjustment may be protective against stress-related suicidal behavior.”

So what exactly is Social Adjustment Disorder? There are two factors involved in SAD – social adjustment abilities or disabilities, and adjusting to a major event. First let’s look at social adjustment. Social adjustment by definition is: “an attempt made by an individual to address the standards, values and desires of a society so as to be accepted.” People with SAD experience more stress than would normally be expected because of a history of difficulty adjusting to family and other social patterns. For example, risk may be increased by experiencing significant stress in childhood, by having a number of difficult life circumstances happening at the same time, or by experiencing a series of minor difficulties collectively over a prolonged period.

The second factor is the ability to adjust to specific life circumstances. Usually stressors are temporary and we learn to adjust over a three month period. However, people with SAD will experience ongoing difficulty lasting up to six to nine months or even longer if the cause is prolonged such a divorce or being fired and not being able to find a job in our area of expertise.

Most of the symptoms listed for SAD can be evidenced by any or all of the anxiety disorders; however here are some of the more unique ones:

  • Feeling overwhelmed
  • Feeling sad, hopeless or not enjoying things you used to enjoy
  • Withdrawing from social supports
  • Avoiding important things such as going to work or paying bills
  • Suicidal thoughts or behavior

Most significantly, as noted by Kelly et al, we may be looking at the major cause of suicidal behavior, not only as related to anxiety, depression, and BPD, but perhaps the major cause overall.

The key then is to develop some strategies to get through those three to nine months. Developing healthy coping skills and learning to be resilient before hand may help during times of high stress.

Here are my five suggestions for bisexuals with Social Adjustment Disorder:

  1. We can call upon our higher self for guidance and strength. We remind our self that this distress is usually time-limited and that we can get through it. We recognize that even though these events are painful, they may also be a gateway for change, a time for awakening our higher powers, and a chance to seek a better life.
  2. We increase our health habits like diet and exercise thereby providing the oxygen and nutrients needed by a healthy brain.
  3. We rally our social supports. We develop a network of supportive people and groups to assist us in time of need. When we feel overwhelmed, we do not hesitate to use their services. There is a reason they made a commitment to help us. They love us.
  4. We check in with our doctor or mental health professional to review healthy ways to manage our stress and deal with the current problem.
  5. If we know that a stressful situation is coming up — such as a move or retirement — we prepare ourselves for it by making a plan for orderly transition. For example, if we have difficulty being alone during the Christmas season, we arrange to take part in some Christmas charities such as volunteering to work in the kitchen preparing meals on Christmas day – by the way, merry Christmas – thus taking our mind off our own problems and experiencing joy through someone else’s eyes.

[1] Thomas M. Kelly, PhD1; Paul H. Soloff, MD1; Kevin G. Lynch, PhD1; Gretchen L. Haas, PhD1; J. John Mann, MD2. Recent Life Events, Social Adjustment, and Suicide Attempts in Patients with Major Depression and Borderline Personality Disorder. Vol. 32, Iss. 6. Dec. 2000.

 Read More: https://guilfordjournals.com/doi/abs/10.1521/pedi.2000.14.4.316

The Power of Belief

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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.

.

 

Borderline Personality Disorder and Bisexuality 4

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

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

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

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

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

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

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

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

My five suggestions for bisexuals:

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