Bisexuality, Borderline Personality Disorder (BPD) and At-Risk Behavior

(Over 2% of the population have some degree of BPD. Of this population 8 to 10% commit suicide – this rate is more than 50 times the rate of suicide in the general population and ten times the rate of suicides due to depression alone. Approximately one-third of people with BPD also identify themselves as bisexual. The number of bisexuals who have BPD traits I believe would be much higher.  This blog is an attempt to understand the nature of one of the sub traits of disinhibition – risk-taking.)

Pathological personality traits in Disinhibition – Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences (DSM5).

                One of the sub traits of borderline personality disorder is risk-taking without regard to consequences. This trait shows up in several areas including drug abuse and at-risk sexual behavior. First of all let’s look at substance abuse.  Using a longitudinal study involving 1280 female adolescent twins from age 14 to 18, Bornovalovato and others[1] examined the developmental, genetic, and environmental factors underlying the co-occurrence of BPD traits and substance use. Shared environmental factors accounted for the association between BPD traits and substance use at age 14, but genetic factors accounted for the association at age 18.

                Looking at at-risk sexual behavior, Northey and others[2] asked 955 college students to fill out a questionnaire involving four BPD symptoms: affective instability, identity disturbance, negative relationships, and the tendency to self-harm. They then looked at the correlation of these four sub traits with sexual sensation seeking, sexual compulsivity, and sexual risk-taking. Sexual compulsivity was positively predicted by all four BPD symptoms. Sexual sensation seeking was positively predicted by negative relationships and self-harm. Sexual risk taking was not significantly predicted by any BPD symptoms. 

                So in plain English, what do these two studies tell us about risk taking for those of us with BPD. First of all we see that drug abuse seems to evolve during adolescence. Childhood is essentially a latent peaceful period with few outside traits or symptoms. However in adolescence we do not seem to have the eternal resources needed to withstand peer pressure – in this case, as it refers to drug use. In other words we use drugs because our friend use drugs. However by our late teen years when our friends are moving on, we seem to be stuck in drug use and drug abuse patterns because of our genetic predisposition. We use drugs perhaps because drugs fulfill an internal need for pleasure soothing and anxiety relief.

                When we look at sexual behavior, a similar pattern seems to exist. Because of our lack of self-esteem, we are vulnerable to the desire for the anxiety soothing and anxiety release provided by sexual pleasure and orgasm. This creates a situation where if it feels good we compulsively let ourselves become engaged without any concerns for the consequences often leading to risky casual unsafe sex. This also seems to be related to seeking the pleasure sensations as a kind of distraction from our inner turmoil rather than just for the excitement of risk taking itself. Once engaged, it appears that we may neglect the consequences simply because we feel we deserve to be treated badly and we may engage as a means to punish ourselves.

                When we look at us bisexuals with BPD, certainly at risk sexual behavior can be a major problem. There is still this desire out there for male bisexuals to have random sex without any condoms which can result in STD’s and even HIV and AIDS. Female bisexuals are not immune to unsafe sex either (particularly with males) but they do tend to listen to their brain and not just their genitals.

                These two studies indicate that some of our difficulties dealing with drug use and at-risk sexual behavior are related to genetic predisposition and our response to internal signals rather than external ones. Both drugs and sex appear to be our outlet for dealing with low self-esteem and the anxieties related to childhood issues. These behaviors appear to be impulsive because we either cannot or do not want to deal with the consequences because the pleasure involved is considered essential to our emotional survival, and we don’t give a damn if we die in the process.

My five suggestions for borderliner bisexuals:

1. We have to learn to deal with our compulsive behavior patterns by building in a reality check. I came across an experiment done a few years ago (sorry can’t find the reference) where overweight people tended to eat more shelled peanuts than non-overweight while waiting for an appointment, but the difference disappeared when the peanuts were still unshelled. This shows that compulsive behavior may be compulsive simply because it’s compulsive. For example I like to snack at night so I made a pact with myself to brush my teeth immediately after dinner and then remind myself that I should not snack because I would have to brush my teeth again. Sounds simple but it works. If we can build in a safety valve to give us time to think it through, and then make a conscious decision, then it is no longer compulsive.

2. We have to learn to care for ourselves including our beautiful brain. Drugs, even Maryjane, are mind-altering drugs. That means they alter the functioning of the brain by artificially changing the neurotransmitters and the neural circuits to the pleasure centers. If we love ourselves we will not do anything to harm our beautiful mind that is so well designed to find real ways to enjoy real pleasure.

3. Casual sex may provide a need for emotional and physical release and we can certainly make a case for allowing ourselves a little pleasure. However, this kind of behavior is usually based on not caring for ourselves and believing that no one truly could love us. This is not true. We can search for good sexual partners, either through partnership or on-going relationship, where we respect our sexual partner and we know they respect us (besides, the sex then is a hundred times better). Again this is a conscious decision which frees us from compulsive behavior.

4. Our sense of self-worth has to come from within. We can develop this like any other belief. We work at it. We make deals with ourselves. We recognize our achievements and our talents and gifts. We tell ourselves we love ourselves over and over again until we actually believe it. Then we start making conscious decisions based on that love.

5. We learn to love life, to get pleasure and satisfaction from the beauty of the world around us instead of drugs. We develop a true appreciation of the pleasures provided by wholesome sex with sexual partners who treat us as whole beings rather than just bodies or body parts.

Please Note: If you are serious about developing the skills needed to life a life free of anxieties that leads to at risk behavior, try my program – The Grounding Virtue – a Path to Self-Actualization.

[1] Bornovalova, M. A., Hicks, B. M., Iacono, W. G., & McGue, M. (2013). Longitudinal twin study of borderline personality disorder traits and substance use in adolescence: Developmental change, reciprocal effects, and genetic and environmental influences. Personality Disorders: Theory, Research, and Treatment, 4(1), 23–32.

[2] Northey, Lynnaea; Dunkley, Cara R.; Klonsky, David e.; and Gorzalka, Boris b.. Borderline personality disorder traits and sexuality: Bridging a gap in the literature. August 2016.

Bisexuality and Borderline Personality Disorder and Self-Harm Urgency

View Post

Over 2% of the population have some degree of (BPD). Of this population 8 to 10% commit suicide – this rate is more than 50 times the rate of suicide in the general population and ten times the rate of suicides due to depression alone. Approximately one-third of people with borderline personality disorder (BPD) also identify themselves as bisexual. The number of bisexuals who have BPD traits I believe would be much higher.  This blog is an attempt to understand the nature of one of the traits, disinhibition, so that we can survive and even thrive as bisexuals with BPD.

Pathological personality traits in Disinhibition -Impulsivity: A sense of urgency and self-harming behaviour under emotional distress (DSM5)

                Colle and other[1] looked at the relationship between self-harm and a sense of agency (feeling in control of the environment) in a small group of 20 BPD patients, nine of whom presented self-harming behaviors, and compared them with an age-matched control group. A sense of agency was evaluated through The Sensory Attenuation Paradigm, a comparison with externally generated sensations. The results of this study suggest that self-injurious actions constitute a coping strategy for increasing the sense of perceived control of the environment. The idea is that by inducing physical pain, patients may regulate feelings of distress related to loss of control, estrangement from reality, and experiences of numbness. Self-harm actions appear to enable a new set of emotional and physical sensations which allow the individual to feel alive or in control again by making a plan and carrying out an intentional action. However, the study suggests that the temporal relief afforded by NSSI behaviors is not effective for the long-term reduction of dissociative symptoms.

                 Fossati and others[2] looked at the relevance of emotion with negative and positive urgency (impulsivity) as it related to self-harm activities.  In their study involving 1,157 adolescents who were attending public high school in Italy, they used the Borderline Personality Inventory (a 53–item self–report questionnaire), the Difficulties in Emotion Regulation Scale (DERS), and the UPPS-P Impulsive Behavior Scale (a 59-item self-report measure designed to assess five impulsivity-related traits). Their findings provide support for the tendency for adolescents to act impulsively when experiencing heightened emotional arousal, both negative and positive.  Negative urgency frequently led to self-harm activities. Their findings also suggest that Positive Urgency may be the dimension of an impulsive predispositionto experience a positive sense of well-being by engaging in reckless behaviors such as heavy drinking or sexual promiscuity “just to celebrate” or “just to have fun”. These results suggest that both negative and positive urgency may be emotion-driven based on underlying fears related to BPD.

                These studies indicate that there are several factors involved in self-harm activities stemming from the disinhibition trait for people with BPD. The first is a sense of dissociation from reality. According to Cole and others self-harm activities may be an attempt to get back into a sense control over our own bodies and therefore a sense of control over our lives in general. The study by Fossati and others suggests that disinhibition may also be due to a sense of negative (to avoid) or positive (to pursue) urgency and this sense of urgency appears to be created by out of control emotional forces. The goal is either to fight or flee in the case of a negative impulsive drive or to experience pleasure in the case of a positive one. It may be that the urge to experience pleasure could be to find an outlet to experience something positive in an otherwise negative world. However, we also realize that this source of high risk pleasure is just another way to harm ourselves.

                When it comes to us bisexuals with BPD, we may be using our sexuality as a means to break out of our otherwise cold and impersonal perceived reality. This positive urgency or impulsivity may be the result of pent up negative emotion, pain, or just a need to break out of the often restrictive heterosexual lifestyle we have created. We set out to supercharge our feelings so that we can feel real again. Our same-sex self then becomes our reality and our heterosexual life becomes some kind of trap that we have created to help us survive. However, once we come down from that high, we realize that our heterosexual self is our real self and the life we truly want to hang on to.  Once in this state the same sex excursion can become a kind of self-harm activity where we continue our dishonest behavior in the hopes of destroying the lives we can no longer maintain. If we are not honest with our partners and live in an honest relationship this duality can lead to a breakdown where suicidal thoughts may appear to be the only solution.

My Five Suggestions for Borderliners

1. Recognize that you are in a struggle to avoid some pain by substituting forms of pleasure that are tainted by inappropriate motivation. You do not necessarily have to change the behavior but you will have to change the motivation. If you are engaging in sex to escape pain or a perceived negative dissociative reality it can become a compulsive addictive pattern.

2. Make a conscious decision to seek pleasure just for the sake of pleasure rather than letting it take over subconsciously. Once in a conscious state your sexual pursuits become a matter of choice rather than a compulsion. You are now free to enjoy your sexual experiences without shame or guilt.

3. Honesty is always the best policy and that has to start with being honest with yourself. If bisexual experiences are important to you and you are not in a relationship then by all means engage and enjoy. No shame. No guilt.

4.  If you are in a relationship you will have to make a conscious decision on whether or not to tell your partner. But be honest with yourself. If you are just hanging on to the relationship because you feel co-dependent or are relying on them and your relationship to escape fears of abandonment then this is not the reason to stay together. You may choose to make a conscious decision to keep your two lives separate and secret but this seldom works.

5. If you are genuinely in love with this person you are now free to make a conscious decision to stay with this person in a monogamous relationship or to explain your need for bisexual experiences with the realization that it may result in the end of the relationship. Either way make the decision consciously, don’t just let it happen.

[1] Colle, Livia; Hilvio, Dize; Rossi, Roberta;  Garbarini, Francesca; and Fossataro, Carlotta.  Self-Harming and Sense of Agency in Patients With Borderline Personality Disorder. ORIGINAL RESEARCH ARTICLE Front. Psychiatry 2020.

[2] Fossati, Andrea; Gratz, Kim L; Maffei, Cesare; and Borroni, Serena. Impulsivity dimensions, emotion dysregulation, and borderline personality disorder features among Italian nonclinical adolescents. Borderline Personality Disorder and Emotion Dysregulation. 2014.