Pathological personality traits in Disinhibition – Impulsivity: acting on the spur of the moment in response to immediate stimuli. (DSM5)

Joel Nigg in a comprehensive study on impulsivity(1) defined it as “a rash response in situations where considerate response is more appropriate”. Nigg identified three factors contributing to impulsivity: not planning and thinking carefully (non-planning), not focusing on the task at hand (inattentiveness), and acting on the spur of the moment (motor activation). In another review of the literature by Turner and others(2), they discovered that BPD patients demonstrated delays in discounting the dangers, an inability to make proactive adjustments, and evidence of altered brain activation patterns. However, according to Turner and others, there was less difficulty with motor activation unless influenced by high levels of stress.

So what do these studies tell us in plain English? As Nigg suggests, there appears to be little preplanning to avoid high risk behavior, and there seems to be an inability to attend to the potential danger factors. As a result, we go ahead and engage regardless of the dangers involved. Turner and others provided a direct link between BPD and impulsivity which included the tendency to not just ignore, but to actually discount dangers. This suggests that if there is any thought involved it is used to rationalize and discount the risks; however, there seems to be a mental buffer to actually engaging in the high risk activity itself.

Apparently under stress we may have an actual alteration in brain patterns, almost like something inside our BPD mind snaps and bypasses the control mechanisms of the frontal cortex and responds directly through the amygdala and the pleasure centers of our brain. It’s as if we actually gain a heightened sense of pleasure by shutting down our rational mind and setting fire to our nervous system through the engagement of our sympathetic system. In addition, we may actually seek out and create stress so it will trigger our heightened sense of pleasure (such as engaging in unsafe sex with strangers), perhaps to demonstrate to ourselves that we are in control of ourselves in spite of all the emotional downers we face each day that lead to feelings of hopelessness and helplessness.

This appears to result in some kind of fatalistic desire to engage in the activity knowing full well the dangers involved. It would appear that there may be a latent death wish. We seem to act upon a desire to experience the added rush from knowing that this activity may lead to death. For example, we may push the limits in drug use to higher and higher highs knowing it may result in drug overdose. It seems as though we may be nurturing a desire for suicide by risk.

My Five Suggestions for Borderliners

1. Be proactive. Realize that you have these tendencies and make a commitment to change them.

2. Practice sound mental and spiritual wellness. Meditate every day. During these times focus on love for yourself. Let the feeling of love, well-being, and gratitude flood your mind and soul. Keep telling yourself that you love yourself and you love the life you have been given. You can use these statements as a mantra during the day. When you feel one of your downers you can simply say “I love myself. I love my life”.

3. Do an assessment and make a list of the risk factors in your life. Then make plans on how to deal with each stress. When you find yourself involved with these stress circumstances and the feelings that go with them, activate your plan until you sense a change in your feelings.

4. Change your life patterns. See if there are ways to change your behavior patterns to avoid high risk situations. This may mean changing where you work and play.

5. Instead of trying to fix your old life, plan to build a new one. This includes creating a low stress life style and finding new friends who will support you in your positive choices.

En”joy” the day

 

[1] Nigg, Joel T.. Annual Research Review: On the relations among self‐regulation, self‐control, executive functioning, effortful control, cognitive control, impulsivity, risk‐taking, and inhibition for developmental psychopathology. The Journal of Psychology and Psychiatry. 2016. https://doi.org/10.1111/jcpp.12675.

[2] Turner, Daniel; Sebastian, Alexander; and Tuscher, Oliver. Impulsivity and Cluster B Personality Disorders. Springer Link; Current Psychiatry Reports volume 19, Article number: 15.  2017.