Sexual Delay Discounting und zwanghaftes Sexualverhalten bei Frauen mit Borderline-Persönlichkeitsstörung

Abstract

Sexual risk behavior is a clinically relevant issue that has frequently been reported in individuals with borderline personality disorder (BPD), particularly women. Risky sexual decisions, such as unprotected intercourse, can have serious physical and psychological consequences. Despite this, the mechanisms underlying sexual risk-taking in women with BPD are not yet well understood. This thesis therefore aimed to examine sexual decision-making using a behavioral delay discounting task. Additionally, the relationship between sexual delay discounting, compulsive sexual behavior (CSB) and potentially related traits was investigated in both clinical and non-clinical populations. Sexual impulsivity was assessed using the Sexual Delay Discounting Task (SDT), which measures a person's preference for immediate unprotected sex over delayed safer sex. Two studies were conducted. The first examined sexual delay discounting and CSB in women diagnosed with BPD, comparing them to healthy controls. The second study employed the same task with a larger non-clinical online sample, also assessing sexual sensation seeking (SSS) and BPD symptoms. In the first study, women with BPD showed a stronger tendency to discount protected sex and were less likely to use immediately available protection compared to healthy controls. Women with BPD also reported higher levels of CSB, although sexual delay discounting and CSB were not directly associated within the clinical group. In the non-clinical sample, sexual delay discounting was meaningfully associated with CSB, especially among women. SSS was closely related to both sexual delay discounting and CSB, indicating that excitement- or pleasure-seeking tendencies play an important role in sexual risk behavior in the general population. Given the high risk of sexually transmitted infections unprotected sex is an important target for health intervention. Clinicians should be aware of possible co-occurring sexual risk behaviors, such as unprotected sex, in individuals with BPD or CSBD and address these within psychological treatment as well as through appropriate sexual health education. In addition, sensation seeking and subclinical compulsive sexual behavior appear to be relevant factors in sexual risk behavior in the general population and should therefore be considered in public health education.