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

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          Abstract

          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.

          Trial registration

          This analysis is part of a larger ongoing study and was registered prior to accessing the data (Registration trial DRKS00029716).

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40479-024-00251-6.

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          Most cited references51

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          The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD.

          M Cloitre, M Shevlin, C R Brewin … (2018)
          The purpose of this study was to finalize the development of the International Trauma Questionnaire (ITQ), a self-report diagnostic measure of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), as defined in the 11th version of the International Classification of Diseases (ICD-11).
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            Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype.

            Ruth Lanius, Eric Vermetten, Richard Loewenstein … (2010)
            In this article, the authors present evidence regarding a dissociative subtype of PTSD, with clinical and neurobiological features that can be distinguished from nondissociative PTSD. The dissociative subtype is characterized by overmodulation of affect, while the more common undermodulated type involves the predominance of reexperiencing and hyperarousal symptoms. This article focuses on the neural manifestations of the dissociative subtype in PTSD and compares it to those underlying the reexperiencing/hyperaroused subtype. A model that includes these two types of emotion dysregulation in PTSD is described. In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative subtype of PTSD is described as a form of emotion dysregulation that involves emotional overmodulation mediated by midline prefrontal inhibition of the same limbic regions. Both types of modulation are involved in a dynamic interplay and lead to alternating symptom profiles in PTSD. These findings have important implications for treatment of PTSD, including the need to assess patients with PTSD for dissociative symptoms and to incorporate the treatment of dissociative symptoms into stage-oriented trauma treatment.
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              Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population.

              D Bernstein, T Ahluvalia, D L Pogge … (1997)
              To present initial findings on the validity of a recently developed maltreatment inventory, the Childhood Trauma Questionnaire (CTQ), in a sample of adolescent psychiatric patients. Three hundred ninety-eight male and female adolescents (aged 12 to 17 years) admitted to the inpatient service of a private psychiatric hospital were given the CTQ as part of a larger test battery. Structured interviews were also conducted with the primary therapists of 190 of the patients to obtain ratings of abuse and neglect based on all available data, including clinical interviews with patients and their relatives and information from referring clinicians and agencies. Principal-components analysis of the CTQ items yielded five rotated factors-emotional abuse, emotional neglect, sexual abuse, physical abuse, and physical neglect-closely replicating the factor structure in an earlier study of adult patients. The internal consistency of the CTQ factors was extremely high both in the entire sample and in every subgroup examined. When CTQ factor scores were compared with therapists' ratings in a series of logistic regression analyses, relationships between the two sets of variables were highly specific, supporting the convergent and discriminant validity of the CTQ. Finally, when therapists' ratings were used as the validity criterion, the CTQ exhibited good sensitivity for all forms of maltreatment, and satisfactory or better levels of specificity. These initial findings suggest that the CTQ is a sensitive and valid screening questionnaire for childhood trauma in an adolescent psychiatric inpatient setting.
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                Author and article information

                Contributors
                Sarah V. Biedermann: s.biedermann@uke.de
                Journal
                Journal ID (nlm-ta): Borderline Personal Disord Emot Dysregul
                Journal ID (iso-abbrev): Borderline Personal Disord Emot Dysregul
                Title: Borderline Personality Disorder and Emotion Dysregulation
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2051-6673
                Publication date (Electronic): 19 March 2024
                Publication date PMC-release: 19 March 2024
                Publication date Collection: 2024
                Volume: 11
                Electronic Location Identifier: 8
                Affiliations
                [1 ]Social and Emotional Neuroscience Group, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg- Eppendorf, ( https://ror.org/01zgy1s35) Martinistraße 52, 20246 Hamburg, Germany
                [2 ]Department of Psychiatry and Psychotherapy, Psychiatric Clinic of LMU, Munich Ludwig Maximilians-Universität München, ( https://ror.org/05591te55) München, Germany
                [3 ]Institute for Clinical Psychology and Psychotherapy, Department for Psychology, Medical School Hamburg, ( https://ror.org/006thab72) Hamburg, Germany
                [4 ]Oberberg Fachklinik Bad Tölz, Bad Tölz, Germany
                [5 ]Department of Psychotraumatology, Clinic St Irmingard, Osternacher Strasse 103, 83209 Prien am Chiemsee, Germany
                [6 ]Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, ( https://ror.org/04mz5ra38) Essen, Germany
                Article
                Publisher ID: 251
                DOI: 10.1186/s40479-024-00251-6
                PMC ID: 10949637
                PubMed ID: 38500169
                SO-VID: 5155d6d9-7b6e-4c6e-9dcd-f4721e833d8d
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 16 November 2023
                Date accepted : 5 March 2024
                Funding
                Funded by: Universitätsklinikum Hamburg-Eppendorf (UKE) (5411)
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                Keywords: borderline personality disorder,dissociation,posttraumatic stress disorder,child sexual abuse,sexual risk behavior
                Data availability:
                Keywords: borderline personality disorder, dissociation, posttraumatic stress disorder, child sexual abuse, sexual risk behavior

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