Impulsivity and Borderline Personality Disorder

Continuing my series of Mental Health Monday and BPD DSM IV diagnostic criteria posts today we look at Criteria 4

4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

source: BPD Today

*Warning* Do not read this post if you are disturbed by discussions of sexual promiscuity!

I have covered many of the elements of this criteria my earlier post about self-harm (What is Self-harm?) where I listed a number of self-harming behaviours to demonstrate that ‘cutting’ is just one of many forms of self-harm, and not necessarily the most dangerous of them.

Now I’m going to look in more detail at impulsivity and how I am affected by this particular criteria…

The DSM criteria explains that to meet this criterion an individual will exhibit at least 2 areas of impulsive self-damaging behaviour NOT included in criterion 5 – which refers to suicidal intentions and self-mutilation.  So to be diagnosed with BPD someone could be exhibiting any combination of two or more of the following (although this list is not exhaustive, there are other impulsive behaviours one could be exhibiting that are not listed here)

• gambling
• substance abuse
• driving recklessly
• irresponsible spending
• engaging in unsafe sex
• binge eating

For me the impulsiveness has touched on a number of these and other behaviours. Examples of how it has affected me in it’s simplest (least harmful?) forms are:

Behaviour	Results
Binge Drinking	Hangover, hospital/paramedics
Spending	Same item (clothes) in EVERY available colour, large credit card bill
Binge Eating	Weight gain, nausea
Substance Abuse	Seizures

But by far the largest impact has been with engaging in unsafe sex.

To be honest I kind of expect a few hate mail/nasty comments as  result of this post as I know how a lot of people feel about people who cheat in relationships.

Of course this is a difficult subject for me to talk about, as it has involved other people (who shall not be named) and it has impacted on relationships.  The truth of the matter is that my BPD impulsivity has made me cheat in relationships and clearly talking about that, never mind any of the other implications, proves awkward and brings old wounds to the surface…

Still, the whole point of this blog (in particular the BPD) posts is to be honest and provide information that may help people understand BPD better; so talk about it I must.

Now let me just point out that not all BP’s will cheat on their partners, and also cheating on a partner is not a wholly BPD experience – people do it all the time without BPD as an excuse/reason.

For me it is about several things

• An unusually high sex-drive
• Abandonment issues (criteria 1)
• Craving inappropriate attention, excitement
• Crisis – especially triggered by boredom phases, abandonment and many other emotional triggers (criteria 6)
• Feeling unworthy, unwanted and general low-self esteem that makes any level of attention so much more than it may really be (criteria 2)
• Self-harm (criteria 5)
• Identity (criteria 3)

I’m sure that is not an exhaustive list, but those things are part of why I can go off the rails with impulsiveness. As you can see they mainly relate to other BPD criteria as well – as all these things that make us BPD are a package that is hard to separate into it’s constituent parts…

Most of all though I think it’s about filling the emptiness that I have in me (the subject of the next of my DSM IV criteria posts, criteria 7 ).

Okay I can see I’m struggling with this as I haven’t really explained much yet have I!?

Let’s try to get this down…

So, whatever the underlying cause (another of the BPD symptoms) I will be feeling high levels of frustration; with myself or my partner or both, or I will be feeling bored, numb, empty.

These feelings, unchecked, will grow creating a desire to ‘do something’ anything to relieve the intense feelings – or to ‘feel’. This may lead to self-harming, but that may not be enough.

What starts as an innocent night out (as many are) can be overwhelmed by these feelings and knowingly or not ‘crisis mode’ will have kicked in with a massive desire to be outrageous, ‘have fun’ and indulge cravings for excitement. Reckless behaviour begins, heavy drinking and heavy flirting – with people I know or strangers – begins.  This can still be harmless, nothing has to happen, no harm need be done… but sometimes things go to far…

Nothing but an empty house to return to, now feeling sexually needy, the flirting grows. Like a teenager with no ties, obligations or concerns, all that matters is here and now.

Pubs and clubs close, not wanting the night to end an invitation is extended – ‘let’s go back to mine, drink some more’. People dwindle away until eventually there’s just the two. Me and this guy (he may be a friend or a guy I’ve met that night), we go back to my place. The thrill is everything… desire, feelings, passion all heightened to extremes.

The inevitable occurs – no consideration of protection, ‘hell,’ the mind says ‘It’s not like you can get pregnant’. Sometimes it can be wild, rough and dirty, which just increases the level of enjoyment – things that you shouldn’t enjoy, wouldn’t normally do, hurting and being hurt – all part of the self-harm cycle.

Next morning, everything is the same as it was before – you need more, that was awesome but again, again, but that isn’t happening, it’s over done. Then the guilt, self-hatred and feelings of abandonment kick in again – a vicious circle. You may or may not want to see this guy again, but that experience – the excitement of the ‘first time’ is something you want, need to relive time and again.

But life goes on, you have to return to reality, and nothing has changed – all that has been achieved was a brief reprieve; on top of which you now have the concern’s of discovery. Sometimes you just outright admit what you have done, other times you just leave it, say nothing and hope it will never be questioned. You know that if asked you would admit it straight away, lying is not something you are capable of (except by omission) so if questioned you spill you guts, that’s what you do. Until then it’s another dirty secret in your closet. Until the next time…

Such behaviour can be addictive, hence the repetition. It may be about needing to feel ‘good’ about yourself or to ‘get even’ with your partner for real or perceived injustices, mistreatment or abandonment of you.

There may be warning signs that precede an impulsive episode – extremes of emotion, separations in a close relationship (perceived as abandonment) or there may be none. Either way it can be very destructive and make a crisis period worse as more emotions (the very thing we were struggling with in the first place) are triggered. Then it can also lead back to other criterion, such as unstable relationships – idealizing the ‘one-night stand’ guy, becoming the obsessed freak chasing a repeat performance; devaluation of your partner who is no longer your idol.

Regardless of the outcomes; which are almost always negative for the BP, the whole cycle begins again…

According to everything I have read about BPD to date impulsivity is one of the strongest markers of a poor prognosis for recovery from BPD – not a good sign for someone like me, for whom impulsivity is a major factor in her diagnosis and ongoing problems. Yet, even promising myself to fight it is not enough, like with other forms of self-harm – the compulsion is just too strong to ignore sometimes I guess that is why I have this diagnosis! And of course then that plays into my feelings of being undeserving of my partner – unable to reassure him I will not cheat again; I told he as fairly and honestly as I could I will try but I will not make a promise I cannot necessarily keep – what more can I do? I gave him plenty of opportunity to break it off, especially given the weight of this burden – why would anyone want to stay with someone who may repeatedly cheat on them? :’(

Related articles

• Boredom and Borderline Personality Disorder (showard76.wordpress.com)
• Splitting – Unstable Relationships in Borderline Personality Disorder (showard76.wordpress.com)
• Abandonment and the Borderline Personality (showard76.wordpress.com)
• Paranoia, Delusions and Dissociation in Borderline Personality Disorder (showard76.wordpress.com)
• Borderline personality disorder – PubMed Health (bipolarmuse.com)
• Anger and Borderline Personality Disorder (showard76.wordpress.com)
• Real life experience of a BPD crisis – and the application of the DSM IV criteria (showard76.wordpress.com)
• Help! I’ve just been diagnosed with Borderline Personality Disorder… A reference list (showard76.wordpress.com)
• Why is sexual acting out common in people with borderline personality disorder (wiki.answers.com)
• Book Review: Stop Walking On Eggshells (showard76.wordpress.com)

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