Friday, July 15, 2011

Sexual Deviation: A Diagnostic Criteria in BPD

I’ve been reading again. This time I found two articles discussing sexual behavior in those with a Borderline Personality.
I couldn't find good picture today

The first was Sexual Behavior in Borderline Personality: A Review by Randy A. Sansone, MD. And Lori A. Sansone, MD. According to the DSV-IV, various forms of impulsivity are associated with borderline personality disorder, including sexual impulsivity. The existing empirical literature indicates that patients with borderline personality disorder appear to differ from patients without this personality disorder in a number of relevant ways. Specifically, those with borderline personality disorder are more likely to exhibit greater sexual preoccupation, have earlier sexual exposure, engage in casual sexual relationships, report a greater number of different sexual partners as well as promiscuity, and engage in homosexual experiences. In addition, patients with borderline personality disorder appear to be characterized by a greater number of high-risk sexual behaviors; a higher likelihood of having been coerced to have sex, experiencing date rape, or being raped by a stranger. Overall, the psychological themes relating to sexual behavior in borderline personality disorder appear to be characterized by impulsivity and victimization.

Impulsivity is represented by: greater sexual preoccupation, earlier sexual exposure, more casual sexual relationships, a greater number of different sexual partners, promiscuity, and homosexual experiences.

Victimization is represented by: a greater number of high-risk sexual behaviors; a greater likelihood of being coerced to have sex, date rape, and/or rape by a stranger.

The authors created a compilation of 12 databases from both psychiatric and non-psychiatric sources and found that those with BPD reported approximately twice the number of different sexual partners. One clinician noted that more than 25% of his outpatients with BPD exhibited promiscuity which was decidedly uncommon from his non-BPD patients. In another empirical study it was shown that women with BPD showed evidence of greater sexual assertiveness, erotophilic attitudes, sexual esteem, sexual preoccupation, and sexual dissatisfaction. The article goes on to say that individuals with BPD reported earlier sexual experiences as well as a greater likelihood of date rape.  It also showed those with BPD as being significantly more likely to report having been raped by a stranger and having been coerced into having sex.

In reading this article I was amused that they described patients as “suffering” from promiscuity. Really? Because getting laid a lot really sucks. I was also fairly angry that it stated “patients with BPD exhibit heightened sexual impulsivity as well as a vulnerability to homosexual experiences”. Vulnerability to homosexual experience? As if it’s a bad thing? This article was written by a close minded bigot as far as I’m concerned. Clearly I’m not heterosexual. Frankly, I’m more vulnerable in heterosexual relationships than I am in homosexual ones. This makes me really furious that there would be such anti-homosexual sentiment in a recent medical publication. It’s 2011 for fraks sake! I think what they meant was ‘being more open to homosexual experiences’.

According to this article there are only 2 studies that seem to counter these trends. The only real conclusions that this article seems to draw are that people with BPD may have a higher risk for sexually transmitted disease. Well, sure, that follows, but it doesn’t get into any psychological reasoning for WHY this behavior seems so common.

In fact I think the last two sentences are the most relevant, “ In summary, the psychodynamic theme of impulsivity, as described in the DSM IV, appears to be a legitimate sub-criterion in many patients with BPD. What seems to be missing in the current descriptors is the undertones of victimization that also characterizes the sexual behavior of these patients.”


Basically it says that the criteria of impulsivity is a good indicator for BPD, especially in terms of sexual impulsivity, except it should also note that there is an increased risk of victimization and/or feelings of victimization. This at least I find useful.

I’m not going to lie. I think about sex a lot. And I do mean, A LOT. My sex drive is uncommonly high from my observations amongst my own friends and I often fantasize about seducing those around me. Not for any real attraction to them, often just out of curiosity to see if I could, though in my defense I very rarely act on this.

In another article by Sansone and Wiederman they assessed two types of sexual impulsivity 1) having sex with individuals whom respondents hardly knew (casual sexual relationships) and 2) promiscuity. Again, the goal seems to have been to determine if there was genuine empirical support for sexual impulsivity to be a diagnostic criterion. While many of the findings from the previous article supported this, findings from Dr. Zanarini found that 41% of  his BPD patients avoided sexual relationships entirely. So who do you believe? Well, that’s the point of this article.

The items for the current study relating to sexual impulsivity were as follows: 1) the Personality Disorder Questionnaires** item referring to casual sexual relationships: “I have done things on impulse that can get me into trouble…[such as] having sex [acts of a sexual nature] with people I hardly know”) and (2) Self Harm Inventory item 11: “Have you ever intentionally, or on purpose,…been promiscuous [i.e., had many sexual partners]?”.

Yes, and yes. Surprise. Now does having done these things mean you are one step closer to having a Borderline Personality Disorder? Not even close. Don’t forget you still need at least a couple more impulsive traits and 4 other DSM-IV diagnostic criteria. You may just enjoy sex.  Congrats. More power to you.

Promiscuous: I certainly am. I don’t seem to manage casual sexual relationships though. I’ve had many that I intended to be as such, but they always seem to progress and evolve into something long term so they’ve never ended up being truly casual. Even my promiscuity involves being in relationships of a significant duration. Sooo, what? I’m not as slutty as the stigma would have you believe.

Anyways, through all the technical jargon and statistics in these articles the general conclusion was this: The prevalence of these behaviors was approximately doubled among those with Borderline symptomology.  The data supports the concept that a substantial minority of patients with borderline personality disorder evidence casual sexual behavior as well as promiscuity and thereby supports the inclusion of this criterion in the assessment of Borderline Personality Disorder. 

These studies only compared those with Borderline impulsivity to those without a borderline diagnosis. I’d be curious to see how this compared to other personality disorders or personality types that were marked by impulsive behavior.

When I found these articles I was expecting something more along the lines of explaining and understanding why this phenomena is greater in those with BPD. Instead they were more a clinical study to justify the diagnostic criterion. So next I think I want to: Look at the study that provides counter evidence. Understand the ‘why’ behind this kind of behavior.

Going from my own personal experience I’m not going to argue their findings. I can’t. I have no reason to. The whole point of this blog is to be honest about my journey through this disorder after all and frankly, I’m not really ashamed of anything I’ve done in this arena. Have I had a lot of partners? Compared to some, sure. Am I impulsive and promiscuous? Well, yes. Am I preoccupied by thoughts of sex?  Definitely. Does that mean everyone with a Borderline Personality Disorder is? Not at all. However, now that we’ve determined that this is a valid diagnostic criteria, let’s look at why we crave this kind of attention. I know I have theories already.

My final question: How can two articles about BPD and sex be so bloody freaking boring. Yeesh.




** PDQ-R32 or PDQ- 48

4 comments:

  1. I would tend to disagree with that article. The same patterns they describe are also overriding trends among victims of childhood abuse, which according to the book I read on BPD recently, is a fairly common denominator among those who suffer from BPD.

    I drew many, many conclusions about my MIL over the past 19 years that were only confirmed when I read "Surviving A Borderline Parent." One of those was that her strange combination of being unable to live single and yet hating every man she has ever been with, was the result of her childhood trauma. She hates men, but can't be complete without one. And I really doubt it has anything to do with her BPD. I think, personally, that they both stem from the same place. But, I'm no expert.

    By the way, thankyou for blogging about this. I hope to read more in future.

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  2. I found both these articles dissatisfying in their incompleteness.

    There's a glaring lack of depth and reasoning into WHY sexual impulsivity is something that is common amongst BPD. I believe, at least in part, that childhood trauma and sexual abuse could certainly contribute. It might not be the BPD at all but the trauma or at least a co-occurence of these factors.

    Personally though, I didn't suffer from childhood abuse or trauma so there is the potential that it is it's own thing. Or one of the many things that comprise BPD. Because let's face it, noone with BPD is going to present exactly the same, and what may afflict some won't aflict others and vice versa.

    Thank you!

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  3. One has to excuse my lack of knowledge of how to use web pages properly. I have commented on this web site on a couple of occasions now and so far I have't seen any replies to my comments nor for that matter have I seen my comment once I have posted it. Please forgive my total ignorance in this matter. I feel that I have found a home here some were I can come and converse with my fellow B.P.D,s I really love what people have to say on here. Because I have been trying to hopefully get to speak to some one and not getting any response my rejection schema is kicking in sorry about that its just that I have been so inspired by what I have read here that I have responded a few times now and I don't know if any one has picked up on what I have asked about I am dyslexic and it can take me a lot longer to write I have to spell check all most every word. So by the time I have written what I wanted to say I am fairly knackered (tired) So I hope that by some miracle what I wrote before has gotten through but just in case it has't I would very much like to ask peoples permission to use some of their words for the work that I am doing with the K.U.F. Please can you look that up as I am extremely tired and need to go to bed I will elaborate next time I am on.

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  4. Dyslimbia hello! I"m sorry if I haven't responded to your comments, I may have missed them in all the mail. Please, feel free to contact me directly at havennyx@gmail.com and that way I won't miss anything you have to say!

    I looked up KUF. Is that a Personality Disorder sort of Research and Awareness organization in the UK?

    Yes, please feel free to use whatever you find here to help in your work! It would be wonderful if you could site me as a source, but if not that's ok too. I would love to hear more about your work. Again, please don't hesitate to contact me directly at my e-mail =)

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