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Impulsivity Is The Crux Of The Matter

Posted Apr 17 2010 12:00am

I read once that experts believe that impulsivity is the most detrimental problem for people with borderline personality disorder – even more significant than the symptoms of emotional instability and impaired reasoning.

The individuals who are the most impulsive have the worse prognosis.

Impulsivity might be caused by an imbalance between neural systems, the pathways that control specific behaviors and regulate emotion impulses and reasoning. Research has been done on the prevalence and role of impulsive behavior in people with borderline disorder but little research has been done on the events and warning signs that lead up to such behaviors.

With my daughter, serious impulsive behavior usually follows an emotional crisis or a threatened abandonment. Maybe she constantly has a tendency towards impulsive behavior. It is hard to tell.

Binge eating and spending money recklessly are common impulsive behaviors. But, more significant impulsive acts like uncontrolled gambling, excessive drinking and drug abuse, sexual promiscuity and violent, aggressive behavior can be very threatening and disruptive. My daughter’s anxious shopping, binge drinking, sexual indiscretion, reckless driving, speeding - Have I mentioned how frightening it is to be in a car she is driving? Her ipod and cell phone take center stage. I sit with my legs straight, feet pressed hard on the invisible brakes on the passenger side, breathing deeply, feigning indifference. Curses for a  driver or pedestrian dawdling ahead of her. Wild screeching brakes and head-throwing surges in traffic jams. All the while, she is adjusting the volume or song choice on her ipod and asking me “What the fuck is your problem?”.

Her self-mutilating behavior also puts my daughter into the group of borderline patients who are considered “extremely” impulsive. We have reasoned that her self-harming might inadvertently be life-threatening but we also know that these acts are usually attempts to control a situation or cry for help. She has hit herself, cut and scratched herself, and taken overdoses of prescribed medications. We read these behaviors as impulsive but more as a undeniable way to grab someone’s attention.

If my daughter were less impulsive, she might have a better chance of fighting this illness and of staying alive.

Impulsivity seems to be the catalyst for other behaviors like the violent outbursts that appear out of nowhere. We see impulsivity in her choices of men in her life. Her black and white, all-or-nothing, logic then gets her into trouble. My daughter is quick-witted and often intuitive but rarely understands the odd thinking she suddenly adopts when someone she has been close to abruptly “changes”. She perceives a instantaneous, unexpectedly shift in another’s behavior. Unwisely and recklessly she hastily accuses that person of abandoning her.

It is impossible to understand why borderline patients act and react the way they do. It has been nearly impossible at times to respond in ways that validate our daughter’s feelings and help her regain or maintain control.

Dr. Marsha Linehan suggests that you try to validate the person’s emotional reactions, by saying, “I understand how you feel”,  to pay attention not to the situation but to the the emotion behind it.

More often than not, our family is so disoriented by the violent outburst or splitting behavior that we don’t get to Dr. Linehan’s recommendation until our daughter has suddenly resumed normal socializing. By then, we are so relieved that we wouldn’t bring up something that might tip the scales if our lives depended on it! We have made the mistake of pointing out that not everyone is out to get our daughter. Once the pendulum has swung, it gets stuck and she cannot believe that person ever cared about her.  She looks at us with suspicion.

It is no wonder to me that professionals shy away from treating people with BPD for self-protection reasons, not to mention the generally poor prognosis. A doctor once told me that my daughter should be seen by a team of people, not just one therapist.

“They burn out quickly.”

This advice felt impersonal. Like anyone could step in, an interchangeable roster of help, to manage my daughter’s illness. Would she have to bare her soul to each member of the team? How did that look from her point of view?

Never mind. She is not seeing a therapist now.

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