Borderline personality disorder and sexuality: causes and consequences of dissociative symptoms

Background Sexual risk behavior in patients diagnosed with borderline personality disorder (BPD) is supposed to be
associated with traumatic experiences and dissociative symptoms. Nevertheless, scientific research thereon is scarce
which might be due to the high prevalence of sexual trauma and fear of overwhelming patients with explicit sexual
content.
Methods We investigated a clinical sample of patients diagnosed with BPD (n=114) and compared them
to a sample of matched healthy controls (HC) (n=114) concerning the dissociative symptoms derealization,
depersonalization, and conversion in sexual situations. In a subgroup of patients with BPD (n=41) and matched HC
(n=40) dissociative symptoms after exposure to an acoustically presented erotic narrative were assessed in the lab.
Regression analyses were used to examine the associations between sexual trauma, post-traumatic stress disorder
(PTSD), dissociation in sexual situations, and risky sexual behavior.
Results Patients diagnosed with BPD endorsed higher dissociative symptoms in sexual situations retrospectively and
in the lab compared to HC. Regression analyses revealed that depersonalization and conversion symptoms in sexual
situations were explained by severity of BPD, while derealization was explained by PTSD symptomatology. Impulsive
and sexual behavior with an uncommitted partner were higher in the BPD group and explained by derealization,
while conversion showed an inverse association.
Conclusion Our findings highlight the importance of addressing distinct dissociative symptoms in sexual situations
when counselling and treating women with BPD. In the long term, this could contribute to a reduction in sexual risk
behavior in patients with BPD