Today’s Ask About BPD question is:
My son has blackouts very frequently after he has a violent episode. He sometimes doesn’t remember it either. He tells me when he is raging he looses his eyesight and hearing too and sees only black and hears only ringing in his ears. Can you explain this?
First, I would like to say thank you for asking a question about this very important, yet rarely spoken of, facet of BPD. There are a few things that occur when we have these types of episodes and your son may be experiencing one or more of the following:
- Flight or fight response that may be disproportionate to the situation
- Panic attacks/Panic disorder
- Episodes of dissociative amnesia.
I will explain all three.
The Fight or Flight Response.
Most people know of this response as our body’s primitive, automatic, inborn response that prepares the body to “fight” or “flee”. This response is often caused by feelings of excessive stress either from internal or external circumstance.
The fight or flight response bypasses our rational mind and moves us into attack mode. This causes a state of hyperawareness that leaves us to perceive almost everything in our world as a possible threat to our survival. In these moments we tend to see everyone and everything as an enemy.
When living a life with active BPD our mind is often already living at a max stress level and one small addition can push us over the edge into full flight or fight mode. When we are triggered may go into attack mode where we can become aggressive, hyper-vigilant and over-reactive. This may be what your son is experiencing in his episodes.
This type of reaction is usually treated with a combination of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). These therapy types build skills that help us reconnect with ourselves, the present moment, and our environment.
The DBT skill that addresses our tendency for disproportioned reactions is known as the wise mind. It is an exercise that attempts to balance the emotional and rational mind to prevent us from automatically jumping into flight or fight mode. The wise mind brings together the logic of our reasonable mind and the sensitivity of our emotional mind to create a serene state of mind.
There is no one tried and true way to learn how to use your wise mind. It is best to work with a trained CBT/DBT therapist to learn how to apply this skill to your life.
Panic Attacks/Panic Disorder
People with panic disorder have sudden and repeated attacks of fear that last for several minutes. These are called panic attacks. Panic attacks, also known as anxiety attacks, are periods of intense fear or apprehension. They occur without warning and are a more intense experience than the flight or fight response. Panic attacks often begin in late adolescence or early adulthood. Not everyone who experiences panic attacks will develop panic disorder.
People with panic disorder may experience:
- Sudden and repeated attacks of fear.
- Feelings of being out of control during the attack
- An intense worry about when the next attack will happen
- A fear or avoidance of places where panic attacks have occurred in the past
When people experience panic attacks they also experience many symptoms in their body. These include, but are not limited to:
- Shortness of breath or hyperventilation.
- Heart palpitations or a racing heart.
- Chest pain or discomfort.
- Trembling or shaking.
- Feeling of being choked or unable to breathe.
- Feeling unreal or detached from their surroundings.
- Tunnel vision.
- Hearing impairment.
Panic attacks can last from a few minutes to a few hours, but tend to peek within 10 minutes of onset.
Panic disorder is often co-morbid, or co-occurring, with BPD. In fact, nearly 75% or more of those living with BPD meet the criteria for an anxiety disorder. Our ability to feel every emotion to its max can send our system into overload. Panic attacks mainly occur when we feel we are being personally criticized, rejected, or during periods of separation from people who are very important to us. They also occur at places where we have experienced, or are reminded of experiences, of abuse or neglect.
Panic disorder is one of the most treatable of all the anxiety disorders. With a combination of medication and cognitive behavioral therapy, which works to change the patterns of thinking that lead to these attacks, many have learned to overcome this disorder.
The CBT/DBT skill that addresses panic attacks is known as AWARE.
Acknowledge & Accept that you are having a panic attack.
Wait & Watch. Step back for a moment, count to ten, observe your surroundings, then make a decision on how to act.
Actions. Utilize tried and true skills. Deep breathing. Self Affirmations. Exercise. Etc.
Repeat steps as necessary
Episodes of Dissociative Amnesia.
What is dissociative amnesia?
Dissociative amnesia is an extreme coping mechanism used by the brain to block out stressful or traumatic incidents and memories. With dissociative amnesia, a person is not able to remember important personal information or periods of time that are too extensive to be explained by ordinary forgetfulness. Dissociative amnesia is unlike minor dissociation in that it causes a major disruption to life.
Dissociative amnesia involves disruptions or breakdowns in:
- Consciousness or awareness
- Identity and/or perception
Dissociative amnesia is not the same as common amnesia, which involves a loss of memory as the result of a disease or an injury to the brain. With dissociative amnesia, the memories still exist but are buried within the person’s mind and cannot be recalled. With time or certain triggers the memories might resurface.
There are also micro-amnesias where the content of a conversation is forgotten from one moment to the next. Micro-amnesia often makes people feel jumbled and they are left to figure out what the conversation was about while trying not to let the person with whom they were talking realize they haven’t a clue as to what was said.
Dissociative amnesia subtypes:
- Localized amnesia. Having no memory of a specific event that took place, usually one that is traumatic. Localized amnesia is usually limited to a specific window of time. An example would be a survivor of an auto accident who has no memory of the experience until two days later.
- Selective amnesia. This type of amnesia occurs when a person can recall only small parts of events that took place in a defined period of time. An example would be a victim of abuse (physical or sexual) who can only remember snippets of the events around the abuse.
- Generalized amnesia is when a person’s amnesia encompasses their entire life.
- Systematized amnesia. This type of amnesia occurs when a memory for a specific category of information is missing. An example would be of a solider that does not remember battles that were fought.
Dissociation disorder and BPD are often co-morbid illnesses. Dissociation is a coping mechanism that is utilized by our mind to help reduce the powerlessness we feel in stressful situations. We often developed this skill to be our primary coping mechanism in childhood as a result of abuse or neglect.
Dissociative disorders are typically treated with CBT/DBT therapy.
To gain a better understanding of what your son is experiencing, speak with him about the three possibilities I have provided. In each of these the treatment is the same, reducing home stressors combined with CBT/DBT therapy. With proper treatment your son can overcome his blackouts and not experience the gaps in memory he is experiencing now.