Thursday, October 4, 2012

Borderline Personality Disorder, Sexual Orientation, and Relationship Choices


Today, and again starting Monday (because tomorrow is Lucid Analysis) I’m going to be talking about a subject near and dear to my own relationship preferences: 

Sexual Orientation and Borderline Personality Disorder. 

I’ve been asked many times if people with BPD are confused about their sexual orientation. I will answer this question, but not today. Today I want to present a study published by Dr. Reich and Dr. Zanarini. Here is the link tothe actual article. For the sake of easy readability I’ve omitted things like testing methodologies and data collection methodologies (Which I think were done very nicely so be sure to check them out at the source, blind studies, videotaped, consistent, and neutral!). My one qualm is that it only directly dealt with comparisons between Borderline Patients (Axis II),  and other non- Borderline Axis-1 and Axis-II type patients (Depression, anxiety, etc), though it does compare to statistically accessible information on sexual orientation and gender preference of the population in general. I do approve of this method as a way of sufficiently isolating the BPD population from other populations though.  When you get to the discussion aspect I’ve interjected some of my own thoughts and experiences because as you know I do not identify as heterosexual, but I’ve also never considered my sexual or gender identity to be a product of my BPD. So this is something very interesting for me to consider from a different perspective.


Sexual Orientation and Relationship Choice in Borderline Personality Disorder over Ten Years of Prospective Follow-up


Abstract

The purpose of this study was to assess the prevalence of homosexuality/bisexuality and same-sex relationships in a sample of 362 hospitalized subjects, 290 with borderline personality disorder (BPD) and 72 comparison subjects with other personality disorders. At baseline and at five contiguous 2-year follow-up intervals, subjects meeting DIB-R and DSM-III-R criteria for BPD or at least one other personality disorder were interviewed using a semi-structured interview about their sexual orientation and the gender of intimate partners. Subjects with BPD were significantly more likely than comparison subjects to report homosexual or bisexual orientation and intimate same-sex relationships. There were no significant differences between male and female borderline subjects in prevalence of reported homosexual or bisexual orientation or in prevalence of reported same-sex relationships. Subjects with BPD were significantly more likely than comparison subjects to report changing the gender of intimate partners, but not sexual orientation, at some point during the follow-up period. A reported family history of homosexual or bisexual orientation was a significant predictor of an aggregate outcome variable assessing homosexual/bisexual orientation and/or same sex relationship in borderline subjects. Results of this study suggest that same-gender attraction and/or intimate relationship choice may be an important interpersonal issue for approximately one-third of both men and women with BPD.

{This is where the testing methodologies and data collection information would be}

Discussion

In this study, patients with BPD were over 75% more likely to report homosexual/bisexual orientation than comparison subjects with other personality disorders. This is consistent with results from previous studies in finding higher rates of reported homosexual/bisexual orientation among male borderline subjects than those reported by nonborderline comparison subjects and by the general population (Laumann et al., 1994Mosher et al., 2005). Moreover, it is consistent with two of three previous studies in finding higher rates of homosexual/bisexual orientation among female borderline subjects than in the general population (Laumann et al., 1994Mosher et al., 2005). This finding is clinically important in that it suggests clinicians should be sensitive to the probability that nonheterosexual orientation is more common in patients with borderline personality disorder than in patients with other personality disorders.

To our knowledge, this is the first study to focus on the prevalence of same-sex relationships in addition to the prevalence of homosexual/bisexual orientation in patients with BPD. The study found that patients with BPD were approximately twice as likely to report having a sexual relationship with a same-sex partner as comparison subjects with other personality disorders. In addition, it found that the percentage of both male and female borderline patients reporting same-sex intimate relationships (with partners) was higher than the percentage reporting homosexual or bisexual orientation. Twenty-seven subjects with BPD in our study (9% of BPD subjects overall) reported having intimate relationships with a same-sex partner without identifying themselves as homosexual or bisexual. This suggests that patients with BPD may choose intimate partners of the same sex, even if they do not report a homosexual or bisexual orientation. For borderline patients, the choice of an intimate partner may be more partner-specific than gender-specific. Alternatively, borderline patients with same-sex partners may be more reluctant to label themselves bisexual or homosexual. In either case, choosing a partner of the same gender still carries with it a social stigma in many settings, a stigma that may reinforce a sense of alienation.


A second way in which this study differed from previous studies is that it assessed change in sexual orientation and gender of intimate partners over time. Although borderline subjects were not significantly more likely to report a change in sexual orientation than comparison subjects, they were significantly more likely to report a change in the gender of intimate partners. This suggests that for borderline patients, changes in sexual orientation and gender of intimate partners are not a unitary process. For subjects with BPD, choice of gender of intimate partners appears to be more fluid than for comparison subjects. This is consistent with the notion that patients with BPD may choose intimate partners more on the basis of individual factors aside from gender.

In this study, male and female patients with BPD were equally likely to report homosexual/bisexual orientation and having a sexual relationship with a partner of the same gender.

These results differ from those reported previously. Whereas earlier studies had reported rates of homosexuality/bisexuality only in the range of 1.4-16% for female subjects, this study found that 26.6% of female borderline patients reported their sexual orientation to be nonheterosexual at some point in time. Whereas two of three previous studies had reported rates of homosexuality among male borderline subjects of 48% or more, this study found only 29.8% of male borderline subjects reported a homosexual/bisexual orientation even though subjects were followed for 10 years. One reason for these differences may be that previous studies assessed sexual orientation differently.

**As our knowledge and understanding of sexuality and gender identification has evolved, it makes sense that there would be a clearer understanding of how to assess this in later studies.

In this study, a reported family history of homosexual/bisexual orientation predicted homosexual/bisexual orientation and/or same-sex relationships in borderline subjects. This is consistent with research in the general population indicating that sexual orientation is related to familial factors, which are at least partly genetic (Kendler et al. 2000Bailey et al. 2000). As with our results, research in the general population has not been able to specify the nature of these factors. It is noteworthy, however, that genetic research in community samples has dealt only with sexual orientation; it has not dealt with same-sex intimate relationships as an independent variable.

** As far as I know, no one in my family has had same-sex relationships before me (or my sister). Certainly neither of my parents, brother, aunts, uncles, or grandfathers. If my grandmothers did, they never relayed this information, but also as one was bipolar and the other schizophrenic they wouldn’t be eligible for comparison in this type of study.

In this study, there was a trend toward a reported history of childhood sexual abuse predicting homosexual/bisexual orientation and/or same-sex relationships. This is consistent with clinical experience that some female borderline patients may identify themselves as homosexual or may choose female sexual partners because of histories of childhood abuse by men. In these cases, choice of sexual partner may have less to do with sexual attraction than with establishing an intimate relationship that provides a sense of safety. The relationship between childhood sexual abuse and homosexual/bisexual orientation or same-sex relationships in male borderline subjects remains less clear.

** For me, I do feel a greater sense of safety with women now. I have dealt with sexual abuse in my past, but this was after it was apparent to me that I was attracted to women, and years after I had already begun dating members of my same gender. It’s more a matter of feeling an emotional connection, and not just a physical one (which tends to be the case when I date men).

Taken together, the results of this study suggest that homosexual/bisexual orientation and same-sex intimate relationships are common among both male and female borderline patients.

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Interesting, no? I’ve said for years. Years, and years, and years: I prefer to choose my partners for who they are, and anatomy does not necessarily contribute to that.

If you’re like me, and believe everyone has the right to their own sexual identity and preference, then it looks like people with Borderline Personality Disorder are more open minded to the idea that relationships should not have to be limited based on a predetermined norm. As a whole we’re more likely to be attracted to a person for who they are without feeling the need to limit ourselves to a sexually normative binary. 

1 comment:

  1. your last comment on this study is awesome!!! :)Kim

    ReplyDelete

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