BPD & Sexuality: Understanding the Connection

What Is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental health condition marked by mood swings, poor self-image, and interpersonal relationship difficulties. BPD symptoms may manifest as hypersensitivity, fears of rejection, and chronic feelings of emptiness. However, everyone with the condition will experience BPD symptoms differently.¹

Common symptoms of BPD include:^1,2

• Fears of abandonment
• Unstable relationships
• Unstable sense of self
• Impulsivity
• Self-destructive behaviors
• Intense emotional mood swings
• Explosive anger
• Sensitivity to rejection
• Chronic feelings of emptiness
• Stress-induced paranoia
• Emotional dysregulation

How BPD Affects Sex & Sexuality

BPD symptoms can affect sexuality differently depending on the individual. Some individuals with BPD may use hypersexuality to cope with fears of abandonment, while others struggle with hypoactive sexual desire disorder due to certain medications. Regardless of these factors, common sexuality changes associated with BPD include risky sexual behavior, promiscuity, or decreased sexual interest. Sexuality changes are non-specific and can involve both promiscuity and decreased sexual interest.

Connections between BPD and sexuality may include:

Reckless & Impulsive Sex

Impulsivity is a known symptom of BPD that can influence the amount and type of sexual experiences one may have. Recklessness can lead to casual sex without consideration of possible consequences or risks. Unfortunately, this behavior may increase the risk of sexual coercion, date rape, and other forms of sexual abuse.³

Promiscuity

Individuals with BPD may also exhibit promiscuous behavior. Individuals experiencing BPD promiscuity may face increased risks of sexually transmitted infections.³ They are also more likely to experience early sexual exposure, sometimes due to a desire to alleviate feelings of emptiness or to feel wanted. For some, having a partner who wants them sexually can help temporarily fill a void.

Sex Avoidance & Loss of Interest in Sex

Some people with BPD, particularly women, may avoid sex. Research has indicated that women with BPD experience more sexual dissatisfaction and negative feelings about sexual relationships. They are also more likely to report feeling pressured to engage in sexual intimacy with partners, and some may even feel repulsed by sex.⁴

Intimacy Issues

Persons with BPD, women in particular, struggle with physical intimacy. Emotional intimacy is a significant area of concern as well. On both ends of the intimacy spectrum, persons with BPD will often misinterpret their partners expressions and actions. These misinterpretations can lead to the phenomenon of “splitting” and drastically shift the dynamics of the relationship, especially where intimacy is concerned.¹⁰ This looks like frequent shifts in the partners dynamics, increased insecurity, and waxing and waning from feelings of love to hate on the part of the person experiencing BPD.

BPD Sexuality in Men & Women

Men and women may experience sexual symptoms of BPD differently. Females are more likely to have internalized symptoms, such as mood instability and poor feelings of self-worth. These self-beliefs may manifest as risky or promiscuous behavior as they attempt to cope with abandonment issues or fears of rejection.

Research regarding BPD in men is less extensive than in women, but studies suggest males with BPD more often present with externalized symptoms and aggression.⁵ They may exhibit similar sexual behaviors as women, likely driven by different motives.

How BPD Sexuality Affects Relationships

Individuals with BPD often encounter relationship problems due to intense fears of abandonment. Many feel anxious when alone, making them more likely to rush into relationships and develop obsessive thoughts about their partners.⁶ For example, a BPD favorite person is a loved one the individual with BPD obsesses over, devotes their time to, and feels reliant on.

Treatment Options for BPD

Treatment for BPD often includes a combination of medication and psychotherapy to help improve relationships, mood, and sexual experiences. Psychotherapy can lead to positive and long-lasting results for those committed to developing insight and managing symptoms.

Treatment for BPD symptoms and sexuality changes may include:

Psychotherapy

Psychotherapy can be beneficial in helping those with BPD develop self-awareness and symptom management. Researchers agree that early treatment can help the prognosis and “prevent or minimize” BPD symptoms.⁷ Those struggling with risky sexual behavior, hypersexuality, or impulsivity may especially benefit from the tools and skills learned in therapy, including learning how to lower sex drive.

Therapies for BPD may include:

• Dialectical behavioral therapy (DBT): DBT for BPD helps clients learn skills to decrease the intensity of the symptoms experienced. These skills aid in emotional management and regulation.
• Cognitive behavioral therapy (CBT): CBT for BPD focuses on identifying the thoughts and triggers associated with BPD symptoms, hypersexuality, and the like. Creating greater awareness of these triggers can help individuals manage them.
• Schema-focused therapy: Schema-focused therapy encourages people with BPD to focus on recurring issues or concerns. Disputing and confronting these themes, or schemas, allows clients to improve their interpersonal relationships.⁸
• Humanistic approaches: Humanistic therapies focus on individual choice, values, and freedom and how these can help clients achieve relief from symptoms.
• Family therapy: Sometimes, family therapy is helpful because many individuals feel better with family support. Educating family members on BPD symptoms can improve the support system at home.
• Group therapy or peer support: Those with BPD can share their experiences with people with similar symptoms in group and peer support therapies.⁹
• Internal family systems: Internal family therapy accounts for inner child wounds and childhood traumas that may contribute to BPD symptoms.
• Eye movement desensitization and reprocessing (EMDR): EMDR is a type of therapy used to decrease the symptoms associated with traumatic experiences that may contribute to sexual symptoms associated with BPD.
• Acceptance and commitment therapy (ACT): ACT emphasizes that difficult feelings and emotions are an inevitable part of life, helping clients manage negative symptoms as they arise.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT helps people with BPD learn to manage the changes and fluctuations in their mood by learning how to recognize their biological rhythms.
• Psychoeducation: Psychoeducation provides information about BPD symptoms, helping clients feel empowered and more in control of their symptoms.

BPD Medications

Some people with BPD experience symptom relief when taking medications. Some common borderline personality disorder medications include antidepressants, mood stabilizers, and antipsychotics. These medications target specific symptoms such as depression, anger, anxiety, affective dysregulation, and mood swings. While these medications can reduce certain symptoms, there is no overarching medication for BPD. As a result, it is continually recommended for those with BPD to engage in both medication management and therapy.

When to Seek Professional Help

Many people may avoid professional support due to the stigma and shame associated with borderline personality disorder. However, a therapist who understands your symptoms can help you develop insight into how your symptoms affect your sense of self and sexuality.

To get started, choose a therapist, counselor, or psychologist who is trauma-informed and understands BPD. Online therapy options are also available, and using an online therapist directory can help you get started on finding the best treatment.