Category: Transgender

Impulsivity, Borderline Personality Disorder, and Bisexuality

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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,

Bi-gender and Transsexual Procedures

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SHIRT & TIE [small] (final)In a recent article in Newsweek[1], Borreli noted that sex change increased by 20 percent from 2015 to 2016 in the U.S., with more than 3,000 operations performed in 2017. She also reported that some male to female transsexuals felt they would never be liked or accepted as real women. Borreli also reported that there is a lack of pre and post counselling, and that a significant number of male to female trans wanted to reverse the procedure.

A group of researchers in Sweden[2]discovered that the mental health of transsexuals after surgery was not what we would expect it to be. In a follow-up survey of 324 sex-reassigned persons (191 male-to-females, 133 female-to-males), they discovered that the overall mortality, particularly death from suicide, for sex-reassigned persons was higher during follow-up than for controls of the same birth sex. Sex-reassigned persons also had an increased risk for suicide attempts and psychiatric treatment. They concluded that physically changing the birth sex may not be sufficient for treating transsexualism, and advocated for improved psychiatric care after sex reassignment.

With the increased frequency of sexual reassignment and the data on mental wellbeing after transition, one must take a long serious look at this life-changing procedure. Many of the people involved in sex reassignment have been previously married and in a heterosexual relationship. In my mind this makes them bisexual, or to put it more accurately, bi-gender. Many do not make the transition for sexual reasons with little or no desire to experience sex in their new sexually reversed bodies. Most of the issues are gender related not sexual. As we have seen, gender feelings come from a genetic predisposition and then shaped and molded by life and cultural experiences. Perhaps it is enough to be like the hijra and just take on the clothing and gender roles without the sex change.

More and more of the sexually reassigned are young people, many of them in their teens. This may not be a good time for a sex change. Sexuality seems to be quite fluid at this age with many, especially women, experimenting with bisexuality. They may need to resolve these feelings and explore their gay or lesbian nature before deciding on a sex change. They may also want to experiment with gender role change before starting hormone treatments.

Sexual reassignment begins with hormone treatment. One person Borreli interviewed felt it was the hormones that made him act impulsively and go for the surgery that he later regretted. Hormone treatments affect the whole body not just the genitals. They also serve as neuromodulators thus affecting the neural circuits of the brain causing a major shift in mental functioning. These dramatic physical and mental changes may lead to massive confusion in the creation and changing of neural pathways. This may lead to depression, anxiety, and suicidal thoughts.

 

My five applications for bisexuals:

  1. Look for clarity in our sexuality. We can define ourselves sexually as heterosexual, bisexual, gay or lesbian. We can then seek sexual gratification based on this knowledge.
  2. Look for clarification in our gender roles. Are we masculine, or feminine, or are we bigender with fluid flow from male to female feelings of orientation? If we feel we are a man in a woman’s body, or a woman in a man’s body, or if we alternate from one gender role to another, we can explore and enjoy same sex and opposite sex relationships by changing our gender roles without hormones or sexual reassignment.
  3. If we truly want and need to experience sex, not as gay or lesbian, but truly as our transgender nature, than proceed with the sex change.
  4. If we are in a love relationship or we want to experience a love relationship according to our transgender nature, then have a sex change.
  5. Give it time. Be absolutely sure that this is how you want to live the rest of your life. Seek pre and post transition counselling. Make sure you have a professional and personal support system in place before starting the hormone transition.

 

[1] Borreli,Lizette. Transgender Surgery: Regret Rates Highest in Male to Female Reassignment  Operations. Newsweek. April, 2018.

[2] Dhejne, Cecilia; Boman,Marcus; Joohansson,Anna l.; Langston,Niklas; and Landen, Mikael. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. Plos. February 22, 2011.

 

Bisexuality and the Third Gender

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SHIRT & TIE [small] (final)Even though this post is primarily for bisexuals, we should never lose track of the fact that we belong to a broader community, namely, the LBGQT community. Our LGBQT family is not just about sexual preference, but really includes people of a wide variety of gender expressions.  Granted we have genetic predispositions, but these predispositions are then nurtured by a variety of community and cultural norms and practices thus  providing us with a variety of gender variations. These variations ultimately are a blend of the feminine and the masculine.

The one that I find particularly fascinating is the Hijra communities of India. In the year 2014, India’s Supreme Court declared that the Hijra constituted a “legal” third gender  considered neither completely male nor female[1]. Hijras have been noted in recorded history dating back to the Kama Sutra period often associated with castration and the creation of eunuchs. Today they retain their male genitalia, but otherwise take on the female gender role.  They live together in self-sustaining communities, often with a guru. These communities are recognized as a loving and caring society which have been known to attract straight as well as trans gender people.  They  have sustained themselves over generations by “adopting” boys who are in abject poverty and rejected by their family of origin.[2] The are recognized as having special spiritual gifts and make a living by performing “blessing ceremonies” at events such as births and weddings.

The hijra do not consider themselves as male or female but as an entirely different third gender that combines both male and female psychological characteristics. They refer to themselves in gender rather than sexual terms, and in fact, many of them choose to live asexual lives. This bears similarities to us bisexuals who do not consider ourselves as gay or lesbian who restrict themselves to same sex relationships, but as bisexuals opening the door to all forms of sexual expression. But perhaps what we are seeking is at a much deeper level. Perhaps we should view ourselves not only as bisexual but as bigender.  If we dig a little deeper, perhaps what we really want (particularly the men who enjoy the feminine role, and the women who enjoy the masculine role) is the ability to express both our feminine and masculine sides without the sexual baggage that goes with it. Many bisexuals are cross dressers enjoying the feelings that come not only from wearing female apparel but all the walk and talk that goes with it, but they do not want to cross over completely. They still enjoy their masculine side with the plaid shirt and cowboy boots and the swagger.

My friends, it’s time to recognize ourselves as not only the third sexual orientation but perhaps as the third gender. And perhaps it is time to realize that we have spiritual gifts that we can offer to our gay, lesbian, and straight brothers and sisters.

[1]  Nanda, S. “Hijras: An Alternative Sex and Gender Role in India Third Sex, Third Gender: Beyond Sexual Dimorphism in Culture and History. Zone Books; 1996.

 

[2] Hossain, Adnan. The paradox of recognition: hijra, third gender and sexual rights in Bangladesh. Published on line; May, 2017.