AAPEL
BPD and impulsive disorders like
gambling, kleptomania, spending (compulsive buying), reckless driving (road rage), trichotillomania, shoplifting
Introduction:
Connection between borderline personality and impulsive disorders. A lot of BPD people have some of theses addictions and or impulsives behaviors. At the point that some of them are directly noticed in the DSM IV. There is some studies about this but once again the goal is not to stigmatize but understand why. You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering
Meme page en Francais / Same page in french
Data, studies
What they say ?
Aapel view
.
Data, studies (statistics, prevalence, comorbidity, co-occurency)
* DSM, point 4 of BPD: impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).

* Schlosser S, Black DW, Repertinger S, Freet D. - Dept. of Psychiatry, University of Iowa College of Medicine
1994 Gen Hosp Psychiatry. - Compulsive buying. Demography, phenomenology, and comorbidity in 46 subjects.
"Nearly 60% of compulsive buyers were found to meet criteria for a DSM-III-R personality disorder, most commonly the obsessive-compulsive, borderline, and avoidant types"

* Penas-Lledo E, Vaz FJ, Ramos MI, Waller G. - Dept. of Pharmacology and Psychiatry, Medical School, University of Extremadura, Badajoz, Spain
2OO2 Int J Eat Disord. - Impulsive behaviors in bulimic patients: relation to general psychopathology.
"While general psychopathology was associated with internally directed impulsive behaviors (e.g., self-harm), bulimic pathology was more specifically linked with externally directed impulsivity (e.g., theft; reckless driving)

* Blaszczynski A, Steel Z. - University of New South Wales, The Liverpool Hospital, Liverpool, Australia
1998 J Gambl Stud - Personality Disorders Among Pathological Gamblers.
"Results indicated that the majority of subjects with pathological gambling met diagnostic criteria for at least one Personality Disorder (93%), with an average of 4.6 personality disorders per subject
The majority of gamblers evidenced personality disorders from the Cluster B grouping with particularly high rates of borderline, histrionic, and narcissistic personality disorders

* Ibanez A, Blanco C, Donahue E, ... - Dept. of Psychiatry, Hospital Ramon y Cajal, Madrid, Spain
2OO1 Am J Psychiatry. - Psychiatric comorbidity in pathological gamblers seeking treatment.
"A comorbid psychiatric disorder was present in 43 (62.3%) of the gamblers. The most frequent diagnoses were personality disorders (N=29 [42.0%])"

* Pacan P, Kantorska-Janiec M, Kiejna A. - Katedry i Kliniki Psychiatrii AM we Wroclawiu
1998 Psychiatr Pol - Trichotillomania
"Trichotillomania (an irrepressible need to pull out one's own body hair) can occur as an isolated symptom or may be associated with other disorders like ... the borderline disorder"

* Swedo SE, Leonard HL. - Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland.
1992 Psychiatr Clin North Am. - Trichotillomania. An obsessive compulsive spectrum disorder?
"Trichotillomania : Lifetime prevalence of axis II disorders in 38% of patients. With Borderline Personality Disorder (BPD) 18%"

* Boughn S, Holdom JJ.- School of Nursing, College of New Jersey, Ewing, USA
2OO3 J Nurs Scholarsh. - The relationship of violence and trichotillomania.
Findings: 91% of the 44 women with TTM reported some form of trauma or violence occurring during their lives and 38 (86%) reported a history of violence concurrent with the onset of TTM.
Conclusions: These women with trichotillomania experienced a disproportionate number of traumatic or violent episodes in childhood.

Please read data "bulimia and bpd" and also "suicide and bpd" as well as "PTSD, traum and bpd"


Impulsive disorders and BPD, what they say
"Shoplifting has long been known to be one of the self-destructive, impulsive behaviors borderlines do to make dysphoria - anxiety, rage, depression, despair - go away. It's similar to reckless driving, binge eating, binge shopping, etc" (Dr heller)

"Many BPDs evidence binge drug abuse that alternates with periods of intensified compulsive behaviors, e.g., shopping, impulsive and unsafe sexual behavior, etc" (Sharon C. Ekleberry - http://www.toad.net/~arcturus/dd/ddhome.htm)

"People with BPD may also try to fill the emptiness and create an identity for themselves through substance abuse, bingeing and purging, indiscriminate sexual activity, shoplifting, compulsive shopping, drinking, or substance abuse.
Does this person act impulsively in ways that are potentially self-damaging, such as spending too much, engaging in dangerous sex, fighting, gambling, abusing drugs or alcohol, reckless driving, shoplifting, or disordered eating ?" (bpdcentral)

"They are impulsive, reflected in behavior such as binge eating, gambling, substance abuse, promiscuity, or reckless driving" (bpd sanctuary)

"Most patients with kleptomania report urges to steal. Some of these patients may have comorbid depression; for them, stealing makes them feel less depressed. Anger or irritability may point to borderline personality disorder" (http://www.currentpsychiatry.com)

"I feel better while I am stuffing my mouth with food but the feeling quickly turns to self-hatred for not controling myself . I also go shopping to help to fill my emptiness inside. When I buy ... whatever the empty feeling subsides for a while until the guilt sets in. Then I feel more self hatred for being selfish and purchasing somethinig for myself." (from www.borderlinepersonality.ca)

"Let's see...
Spending. I declared personal bankruptcy 12 years ago, I refinance every few months trying to keep ahead of the bills. So far, I've managed to keep them all paid, but my whole paycheck goes to paying bills. Then I have to scrape to eat... If I work the rest of my life, I still won't be able to pay it all off - and no matter how hard I try, I can't seem to will myself to stop spending.
Reckless driving. Does chasing a car at high speeds through a residential neighborhood with my sister and our three children in the car count ? The other driver cut me off at an intersection or I imagined he did..." (from www.mental-health-today.com)


Aapel view of impulsive disorders and Borderline Personality Disorder
Here is our feeling.

Do BPD people have impulsive disorders ?
yyes, it is a common behavior, especially for "acting out borderlines"

Why ?
As many borderline have problems to deal with impulsivity, there are prone to act, immediatly and then think about their act... but after.
Don't forget that their main problem is their emotion, so that emotion and impulsivity are interconnected

Another reason ?
Yes. As usual, BPD people are very anxious and or experiment emptiness, dysphoria. Spending, Gambling, Pulling hairs, bulimia, etc... are ways to provisionally stop his / her suffering.
A last could be "give a meaning to their life", "keep themself busy"

Is it dangerous ?
Yes of course but it depends. Pulling hair is not (really) dangerous, but for example, road rage is very dangerous for the BPD people but also others persons.
It has be proven that suicide in borderline disorder is often impulsive. Please read "suicide and borderline disorder"

Are medication helpful ?
Yes, some drugs can help to control impulsivity (but some can increase impulsivity especially during the begining of the treatment or the weaning period). Please read "pharmacotherapy vision of the APA"

AAPEL - Back to BPD summary page

Warning:
All the informations on this site are with an aim of helping to understand a "particular" disease at the very least and puzzle
But more especially to support peoples who suffer, sick or not.  In all cases, it is ESSENTIAL to have recourse to a therapist specialized in the disease to confirm or to cancel a diagnosis
Though it is the name doesn't much matter, which is important, it is to apply "the right" treatment to each patient
 
 

last update  2008