Over 2% of the population have some degree of borderline personality disorder (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. 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 or help the ones we love cope with this severe mental disorder.

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

Colle and others (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, in comparison with an age-matched control group of 20 healthy individuals. A sense of agency was evaluated through The Sensory Attenuation Paradigm, a comparison with externally generated sensations. The results of this study suggests 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, an 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). 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), 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. These findings suggest that Positive Urgency may be the dimension of an impulsive predisposition to experience a positive sense of well-being by engaging in 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.

These studies indicate 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 of reality by exerting 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 fears. 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 might just be another way to harm ourselves.

My Five Suggestions for Borderliners

1. Recognize that you are in a struggle to avoid some pain, either through inflicting physical pain to replace the emotional pain or by substituting inappropriate forms of pleasure.

2. Recognize that these are traits deeply engrained within your neural pathways. Do not try to reason your way out of these situations. This is not just a mental process. If you get in the ring with the heavyweight champion of the world (BPD) you will not last one round. Down you will go and you will stay down for the count. Say no thank you to self-harm as an outlet. Most of the time these situations are accompanied by extreme anxiety. You may have to bring the anxiety levels down before you can make a good choice (for me it is a half hour of meditation or a mindful walk through an old growth forest).

3. When my new one year old granddaughter starts to cry because she just feels unhappy, we do not reason with her, we find something she likes like a toy or a candy to take her mind off her sorrows. As an adult, whenever you feel down, disciple yourself by providing an appropriate source of pleasure to reward yourself for your efforts to manage your own life.

4. If you are having difficulty settling your emotions down you may wish to contact a special partner or friend with whom you can process your negative feelings. Be specific. Let them know what you are feeling and thinking of doing. Their role is just to listen so you can work it out by talking to someone who cares. After you have stated your situation and you have made your own plan, they can comment on your choices. If possible, you may then want to do something together with your friend that is appropriate and enjoyable.

5. If these situations continue to occur you may wish to seek professional help. You may be going through a particularly difficult time and it’s okay to admit that you need help. I suggest a psychiatrist that can offer appropriate medication and other mental health resources to get you through these tough times.

 

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. https://doi.org/10.3389/fpsyt.2020.00449

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.