What is Borderline Personality Disorder with… Impulsive Features?
Friday, January 5, 2024 .
What is Borderline Personality Disorder with…Impulsive Features?
Borderline Personality Disorder (BPD) is a complex and multifaceted mental health condition characterized by pervasive patterns of instability in relationships, self-image, and emotions. I’ve described it in more detail in my previous posts.
Within the spectrum of BPD, humans may display various subtypes. In my previous efforts, I've covered the Petulant, and Discouraged subtypes. But the most charismatic of all the Borderline subtypes is the Impulsive subtype.
This particular expression of BPD is marked by impulsive behavior. This often leads to significant, recurring issues in personal, social, and professional domains.
Understanding the impulsive subtype is crucial for therapists, caregivers, humans with BPD, and the people who love them.
In this post, I’ll discuss the unique characteristics, challenges, and potential treatment approaches associated with the Impulsive BPD subtype.
How to Spot the Impulsive Subtype:
The impulsive subtype of BPD is characterized by sudden, rash, impulsive actions and decisions.
Humans with this subtype may engage in reckless behaviors without fully considering the consequences, ranging from mundane issues such as tying one on, to reckless driving, and, of course, unsafe sexual practices.
These impulsive acts are often driven by a desperate need for immediate gratification or a means of coping with intense emotional turmoil.
Properly identifying and diagnosing BPD has long been a hot mess…
Ever since the term was first unfortunately coined in 1938 by Adolf Stern, the mental health community of practice has valiantly struggled to define the terms of diagnosis and treatment for those with Borderline Personality Disorder.
There are so many issues that obscure the nature of BPD.
Perhaps the greatest challenge is the absurdly high rate of comorbidities among BPD sufferers.
By that, I mean that many humans who suffer from BPD also suffer from major depression, anxiety disorders, substance abuse, antisocial personality disorder, and eating disorders, among other conditions.
These additional conditions (comorbidities) can make it difficult for someone to see BPD as a discrete disorder, and some of these behaviors, such as substance abuse, can greatly impair cognitive function, and consequently stall progress.
Impulsive Behaviors: Individuals with the Impulsive subtype frequently engage in impulsive acts without careful thought. This may include excessive spending, substance abuse, binge eating, or risky sexual behaviors.
Difficulty in Delayed Gratification: There is a notable struggle in delaying gratification, as humans with this subtype may be driven by an intense desire for immediate pleasure or relief from emotional distress.
Emotional Dysregulation: Impulsive actions are often closely tied to emotional dysregulation. Intense emotions, such as anger, sadness, or anxiety, can often trigger impulsive behaviors as a way of managing or escaping these intense and overwhelming feelings.
Relationship Instability: The Impulsive subtype may experience difficulties in maintaining stable relationships due to impulsive decisions and actions. This instability can strain personal and professional connections, leading to a sense of isolation.
Challenges and Consequences:
The Impulsive subtype of BPD poses unique challenges, both for the sufferers themselves, but also for those around them.
The impulsive behaviors can result in a sh*t show of chaos; financial difficulties, legal consequences, damaged relationships, and compromised physical health. Moreover, the cycle of impulsive actions may contribute to a negative self-perception, reinforcing the sucky feelings of inadequacy and worthlessness.
Impulsive behavior is one of the overall hallmarks of borderline personality disorder.
But BPD humans with the Impulsive subtype tend to act in particularly impulsive and dangerous ways. More often than not, they behave this way with little or no regard for other humans or possible legal, personal, or professional consequences.
Humans with BPD with Impulsive features may seem:
Energetic
Charismatic, they enjoy the energy exchange in seduction.
Detached or Mysteriously evasive. They seek to allure.
Motivating, Engaging, and Instigating
Flirtatious, sometimes so automatically and reflexively, they seem to have no “off” button.
Here are the kinds of Saturday nights BPD Humans with Impulsive features consistently enjoy:
Aggressive behaviors: bar fights, heckling at a comedy club, verbal outbursts, hitting or breaking things, raging fits. etc. Saturday Night’s alright for fighting… get a little action in!
Bingeing behaviors: impulsive spending, binge eating, bingeing on sex with strangers, etc…
Self-destructive and risky behavior: driving under the influence, sex with multiple partners, unprotected sex, gambling, doing illicit drugs, and excessive consumption of alcohol. In other words, bad boy behaviors.
Treatment Approaches for Borderline Personality Disorder with Impulsive Features
At this point in time, mental illnesses are seen as the result of multiple factors, none of which we know to necessarily be more impactful than others.
Some of these causes include childhood trauma, neurobiological factors, brain abnormalities, genetics, environmental factors, social factors, and psychological factors. A lot of research is still underway in regard to BPD and the Impulsive subtype and the causes and correlations for both.
Addressing the Impulsive subtype of BPD requires a reliance on best practices. A combination of psychotherapy, medication, and support, if possible, from loved ones is typically recommended.
Dialectical Behavior Therapy (DBT): DBT is particularly effective in treating BPD, including its impulsive subtype. It focuses on enhancing emotional regulation, distress tolerance, and interpersonal effectiveness, providing practical skills to manage impulsive behaviors.
Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and challenge dysfunctional thought patterns and behaviors. It can aid in developing healthier coping mechanisms and reducing impulsive actions.
Medication: In some cases, medication may be prescribed to manage symptoms associated with impulsivity, such as mood stabilizers or antidepressants.
Impulsivity has a significant neurological trajectory, and targeted medications are in the pipeline to help curb the scourge of “why not!!!…WTF?”
Borderline Personality Disorder and Gender…
Gender differences in humans with Borderline Personality Disorder can be quite important in shaping effective treatment.
Research has been conducted on BPD in regard to gender differences. The earliest research concluded that a higher proportion of women suffer from borderline personality disorder than men.
But, better, more recent research has found no significant differences in prevalence by gender.
But wait.. there’s more. There may also be no significant gender differences in Borderline Personality Disorder with respect to specific types of self-harm behavior, such as self-cutting, or levels of psychological distress at clinical presentation.
However, current evidence indicates that there are notable gender differences in Borderline Personality Disorder with regard to personality traits.
With regard to personality traits, men with Borderline Personality Disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking than women with borderline personality disorder. So much for the ridiculous notion that brains have no gender…
It’s also true that men with BPD are more likely to evidence substance use disorders whereas women with BPD are more likely to evidence eating, mood, anxiety, and posttraumatic stress disorders.
Here’s what we do know about gender and BPD; men with BPD are more likely to have treatment histories relating to substance abuse, whereas women are more likely to have treatment histories replete with pharmacotherapy and psychotherapy.
That might tend to suggest that the Impulsive subtype might be where the boys are…
Saturday Night’s All Right For Fighting…
It's getting late have you seen my mates
Ma tell me when the boys get here
It's seven o'clock and I want to rock
Want to get a belly full of beer
My old man's drunker than a barrel full of monkeys
And my old lady she don't care
My sister looks cute in her braces and boots
A handful of grease in her hair
Oh, don't give us none of your aggravation
We had it with your discipline
Oh, Saturday night's alright for fighting
Get a little action in
Get about as oiled as a diesel train
Gonna set this dance alight
'Cause Saturday night's the night I like
Saturday night's alright alright alright, ooh
Well they're packed pretty tight in here tonight
I'm looking for a dolly who'll see me right
I may use a little muscle to get what I need
I may sink a little drink and shout out she's with me
A couple of the sounds that I really like
Are the sounds of a switchblade and a motorbike
I'm a juvenile product of the working class
Whose best friend floats in the bottom of a glass, oh
Don't give us any of your aggravation
We had it with your discipline
Saturday night's alright for fighting
Get a little action in
Get about as oiled as a diesel train
Gonna set this dance alight
'Cause Saturday night's the night I like
Saturday night's alright alright alright, ooh
Oh, don't give us none of your aggravation
We had it with your discipline
Saturday night's alright for fighting
Get a little action in
Get about as oiled as a diesel train
Gonna set this dance alight
'Cause Saturday night's the night I like
Saturday night's alright alright alright, ooh
Bernie Taupin & Elton John
Be well, Stay Kind, and Godspeed.
REFERENCES:
Adler DA, Drake RE, Teague GB. Clinicians' practices in personality assessment: does gender influence the use of DSM-III axis II? Compr Psychiatry. 1990;31:125–133. [PubMed] [Google Scholar]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC: American Psychiatric Association; 2000. Text Revision. [Google Scholar]
Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69:533–545. [PMC free article] [PubMed] [Google Scholar]
Giacalone RC. A study of clinicians' attitudes and sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder. Diss Abstr Int. 1997;57:7725B. [Google Scholar]
Henry KA, Cohen CI. The role of labeling processes in diagnosing borderline personality disorder. Am J Psychiatry. 1983;140:1527–1529. [PubMed] [Google Scholar]
Strain BA. Influence of gender bias on the diagnosis of borderline personality disorder. Diss Abstr Int. 2003;64:2941B. [Google Scholar]
Woodward HE, Taft CT, Gordon RA, Meis LA. Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder. Psychol Trauma. 2009;1:282–290. [Google Scholar]
Davis SG. Gender bias and diagnosing: an examination of clinician gender bias in borderline and antisocial personality disorders. Diss Abstr Int. 2010;70:5813B. [Google Scholar]
Skodol AE, Bender DS. Why are women diagnosed borderline more than men? Psychiatr Q. 2003;74:349–360. [PubMed] [Google Scholar]
Bjorklund P. No man's land: gender bias and social constructivism in the diagnosis of borderline personality disorder. Issues Ment Health Nurs. 2006;27:3–23. [PubMed] [Google Scholar]
Simmons D. Gender issues and borderline personality disorder: why do females dominate the diagnosis? Arch Psychiatr Nurs. 1992;6:219–223. [PubMed] [Google Scholar]
Barnow S, Herpertz SC, Spitzer C, et al. Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account. Psychopathology. 2007;40:369–378. [PubMed] [Google Scholar]
Zanarini MC, Frankenburg FR, Dubo ED, et al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155:1733–1739. [PubMed] [Google Scholar]
Zlotnick C, Rothschild L, Zimmerman M. The role of gender in the clinical presentation of patients with borderline personality disorder. J Pers Disord. 2002;16:277–282. [PubMed] [Google Scholar]
Johnson DM, Shea MT, Yen S, et al. Gender differences in borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorders Study. Compr Psychiatry. 2003;44:284–292. [PubMed] [Google Scholar]
Tadic A, Wagner S, Hoch J, et al. Gender differences in Axis I and Axis II comorbidity in patients with borderline personality disorder. Psychopathology. 2009;42:257–263. [PubMed] [Google Scholar]
Zanarini MC, Frankenburg FR, Dubo ED, et al. Axis II comorbidity of borderline personality disorder. Compr Psychiatry. 1998;39:296–302. [PubMed] [Google Scholar]
Marchetto MJ. Repetitive skin-cutting: parental bonding, personality, and gender. Psychol Psychother. 2006;79:445–459. [PubMed] [Google Scholar]
Zlotnick C, Rothschild L, Zimmerman M. The role of gender in the clinical presentation of patients with borderline personality disorder. J Pers Disord. 2002;16:277–282. [PubMed] [Google Scholar]
Goodman M, Patil U, Steffel L, et al. Treatment utilization by gender in patients with borderline personality disorder. J Psychiatr Pract. 2010;16:155–163. [PubMed] [Google Scholar]
Sansone RA, Sansone LA. Gender patterns in borderline personality disorder. Innov Clin Neurosci. 2011 May;8(5):16-20. PMID: 21686143; PMCID: PMC3115767.
