Borderline personality disorder (BPD) – pathological personality traits in disinhibition – difficulty establishing or following plans (DSM5).

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.  This blog is an attempt to understand the nature of one of the traits, disinhibition, so that we can survive and even thrive with BPD.

As a society we seem to feel the need to label mental disorders so we can understand them and provide a platform for funding and treatment. In my case a suitable diagnosis was needed before I would qualify for long term disability. The danger of course is that we begin to become our labels which may interfere with the treatment we are attempting to obtain. However, labels can be useful if they give us a clear description of our traits so that we can create strategies to cope with them. I want to be perfectly clear. I no longer have BPD because I no longer have a disorder. I still have traits because they are part of my mental circuitry, but I now control them; they do not control me. I have gotten to this position through hard work, consistent self-analysis, and forcing changes upon my reluctant brain.

BPD is such a difficult mental condition to define as it covers a whole spectrum of negative and harmful thought and behavior patterns. Since the DSM5 has been published psychologists have been scrambling to put the traits listed in measurable terms to define a condition that seems to be too broad to define. However, it is generally acknowledged that detailed definition is needed before we can identify the specific patterns in order to make specific strategies to change them.

One of the difficult areas to define is disinhibition, particularly being able to plan and live according to the plan. Whiteside and Lynam[1]  developed the UPPS-P Model of Impulsive Personality consisting of negative urgency, lack of premeditation, lack of perseveration, sensation seeking, and (lack of) positive urgency. The UPPS-P consists of 59 statements rated on a 1 to 4 scale from “agree strongly” to “disagree strongly.” In their attempt to establish reliability and validity they noted that lack of premeditation and lack of perseverance showed similar effect sizes across alcohol/substance use disorders, suicidality, and borderline personality disorder. Further research using the UPPS-P has indicated that lack of perseverance and lack of premeditation are considered key components of disinhibition[2].

So what does this mean in practical terms? Let’s assume for a moment (highly unscientific) that we all have the mental capacity to plan; then the question is “Why are those of us with BPD having difficulty creating a better life plan and making better choices?” Speaking on a personal level, I have no difficulty making five year plans, one year plans, and following daily objectives when it comes to my professional and financial decision making. I even have a daily to-do list for organizing my daily routines. Where it tends to breakdown is on the highly emotional personal level. In the distant past, when my emotions entered the equation, I tended to panic, believing that the worst was about to happen (again) unless I took immediate actions to prevent the catastrophe which was about to hit me.

Now that I live in a much better space, I see the roots of those negative patterns. BPD engages the amygdala and the sympathetic system releasing fight, flee, freeze, or fond (new one meaning trying to appease others) mechanisms. The strategy now is not based on clear thinking or planning but slipping into one of these patterns to escape the present situation. Once the amygdala is engaged the rational self is shut down, hormones are in control, and things appear to have to ride to conclusion before returning to rational and productive thinking and behavior patterns. When there seems to be no conclusion, and there seems to be no end to the emotions and the anxiety that goes with them, and no hope that things will ever get better, sometimes the only solutions seems to be suicide.

My Five Suggestions for Borderliners:

  1. Take control of your emotions. Whenever you lose control of your emotions and behave in a way you later regret, make a note of it, preferably in a
    journal, where you force yourself to process the failure rationally and thoroughly.
  2. Note the trigger and the emotion that led to the breakdown.
  3. Determine what would have been the appropriate action in that situation.
  4. Once you have clearly thought through the process, inform significant others involved of your problem and ask them to help you deal with these situation better in the future.
  5. Create a prosocial skill for that situation which includes a step by step process. For example:

Problem – I overreacted to a criticism from my partner.

Trigger – I picked up on some negative words – “you never, you always, you, you, you….”

Emotion – I felt offended leading to anger and then rage

Prosocial Skill for angry response to statements by my partner:

  1. Note these words immediately for what they are (ie: she is frustrated with me) and note how your body is reacting.
  2. Take a deep breath 4 seconds in, hold 4 seconds, deep breath out 4 seconds, and hold 4 seconds. Repeat until you feel calm.
  3. If your emotional response has already been triggered, inform your partner that you are experiencing an emotional reaction. Be sure to use “I”
    words, and then excuse yourself.
  4. When you have control, come back and discuss the problem with your partner. Apologize if necessary. Be sure to listen to his/her side of the
    situation without judgement or argument.
  5. Review your plan. Include your partner in the discussion and go over the desired role you wish your partner to play in the future. Accept
    suggestions and modify your plan as needed.
  6. Realize the progress you have made to this point and give yourself a pat on the back.

[1] Whiteside SP, & Lynam DR (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689. [Google Scholar]

[2] Vaidya JG, Latzman RD, Markon KE, & Watson D (2010). Age differences on measures of disinhibition during young adulthood. Personality and Individual Differences, 48, 815–820. [Google Scholar]