Risky sexual behavior in women with and without borderline personality disorder (BPD)

Background. Women of color and women with mental illness are disproportionally burdened with sexually transmitted diseases (STDs).

Objective. The purpose of this study was to examine behavior associated with risk for STDs in women with Borderline Personality Disorder (BPD).

Methods. We enrolled 281 women aged 18-40 years (M=27.04, SD=6.60); 147 women with BPD and 134 women who met diagnostic criteria for a current, non-psychotic Axis-I disorder, primarily mood disorders. We oversampled African-American (AA) women (34%, compared to 13% in the Pittsburgh area) because little is known about BPD in AA women. All participants completed the Structured Clinical Interview for DSM-IV Axis I and II diagnoses (SCID-I and -II) and were interviewed about their reproductive health history and sexual, contraceptive, and substance use over the last 6 months.

Results. Regression analyses revealed that BPD symptoms predicted having had an unsafe sex partner (i.e., non-monogamous, intravenous drug user, MSM, bought or sold sex), more sex episodes with unsafe partners, and having sex under the influence of alcohol and/or drugs. There was also a significant interaction between BPD diagnosis and AA race for reporting sex with 2 or more casual sex partners. BPD diagnosis predicted 2 or more casual sex partners only in non-AA women.

Discussion. These findings provide converging evidence that women with BPD engage in risky sexual behavior. Risky sex partnerships and substance use during sex may help explain the greater prevalence of STDs among women with BPD.