Overview of Personality Disorders

The term personality refers to patterns that characterize how a person thinks, feels, and behaves. Personality is what makes each person unique. Personality disorders occur when certain personality traits are too rigid or compulsive. As defined by the American Psychological Association (APA), personality disorders are a group of mental illnesses that are characterized by long-term patterns of maladaptive thoughts and behaviors. These unhealthy and abnormal traits can put a serious strain on people’s personal relationships, impair their ability to function normally in society, alienate them from others, and decrease their satisfaction with life.¹ While the exact causes for these disorders are not well known, scientists believe that they are the result of both genetic and environmental factors. Some common personality disorders include the following:

• Borderline Personality Disorder
• Antisocial Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Schizoid Personality Disorder
• Paranoid Personality Disorders
• Obsessive-Compulsive Personality Disorder
• Schizotypal Personality Disorder

According to the APA, these personality disorders are diagnosable disorders for which a person can seek treatment. Each is characterized by uniquely maladaptive patterns of behavior, which can also affect sexual expression. A few of the most prevalent personality disorders are Obsessive-Compulsive Disorder, Antisocial Personality Disorder, and Borderline Personality Disorder.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder, commonly known as OCD, is recognized as one of the most serious causes of disability and impaired quality of life (QoL) amongst all psychiatric disorders. OCD is a chronic mental health condition characterized by unwanted recurring thoughts or mental images, known as obsessions. These obsessions are accompanied by repetitive behaviors called compulsions, which are used as a coping mechanism, though the relief created by these mechanisms is often short-term. Ultimately, compulsions can lead to feelings of anxiety, disgust, or guilt. There are certain treatments to cope with OCD, such as serotonergic medications and cognitive behavioral therapy (CBT), yet OCD can become resistant to these treatments.

Evidence from community and clinical research indicates that OCD is associated with poor sexual functioning, especially in females. Ghassemzadeh and colleagues found that sexual dysfunction was present in 80.6% of women and 25% of men with OCD. In terms of specific sexual issues present in those with OCD, anorgasmia has frequently been reported by women, while premature ejaculation and erectile dysfunction have been reported by men.²

There are many reasons why people with OCD may have impaired sexual functioning and overall dissatisfaction. First, patients with OCD commonly take antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), which can delay ejaculation in males and orgasm in females. Research suggests that the incidence of SSRI-associated sexual dysfunction is significant – 30-50% of those who have OCD report experiencing it. Another reason why those with OCD may have impaired sexual functioning is due to the nature of some of their uncontrollable obsessions, specifically those relating to contamination with diseases, religious and moral themes, and unwanted sexual or aggressive thoughts.²

Antisocial Personality Disorder

Those who have Antisocial Personality Disorder (ASPD) are commonly referred to as psychopaths or sociopaths. However, psychopaths and sociopaths are not actually the same. Psychopathy is primarily a genetic or inherited condition, whereas sociopathy is often caused by negative childhood experiences, such as physical or emotional abuse. In short, psychopaths are born with the condition, while sociopaths are created by their environment.

People with Antisocial Personality Disorder often lack empathy and remorse, which can cause them to violate the rights of others by using manipulation and compulsive lying without regard for the effects of their behavior. They can be impulsive and may often partake in risky or dangerous behavior. They may also not be motivated to follow society’s rules and norms, which sometimes results in criminal activities.³

Those with ASPD may have difficulty forming and maintaining intimate relationships since they often demonstrate symptomatic maladaptive behaviors with their partners. Many people with this disorder engage in unusually early aggressive or sexual behavior, which can cause them to struggle with having loving, lifelong, monogamous relationships.

ASPD may cause people to be goal-oriented and motivated by power dynamics, and they may view everything as a means to an end. As a result, sexual behavior is often viewed as a game or accomplishment, rather than as a reflection of intimate feelings. People with this disorder may engage in sex in order to boost their ego or to take advantage of a partner in an intimate and vulnerable state.

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is characterized by significant swings in mood, emotions, and behaviors, usually starting in the teenage years or early adulthood. People with this disorder often have issues regulating their emotions and thoughts and may experience intense episodes of anger, depression, and anxiety that can last from hours up to several days. They might engage in impulsive, self-damaging behavior including alcohol and drug use, overeating, excessive spending sprees, rebound sex, and self-mutilation or cutting. People with this disorder can also have deep abandonment depression, separation anxiety, and an intolerance of being alone. Many of these symptoms are similar to those of Bipolar Disorder, including idealization/devaluation, a relationship pattern in which emotions shift from extreme closeness and love (idealization) to extreme dislike or anger (devaluation).⁴

Sexual behavior in people with Borderline Personality Disorder is often characterized by impulsivity and victimization. Specifically, BPD affects sex in several ways. In regards to attitudes about sex, women with BPD report more negative attitudes about sex and more general sexual dissatisfaction.⁵ Additionally, people with BPD may experience a great deal of conflict in their relationships, which naturally leads to negative experience or feelings towards sex.⁵ Finally, people with BPD often engage in impulsive behaviors, partly due to their intense emotional responses (anger, fear, love, loneliness, jealousy, emptiness), and are often victimized. BPD can also cause people to be more likely to engage in higher-risk sexual behaviors, such as casual sex and having multiple sexual partners due to their impulsivity. Those with BPD are also more likely to be victims of sexual victimization, possibly by being coerced into having sex or having date rape experiences.⁶ Additionally, these situations put people with BPD at risk of contracting STIs.

Treatments for Personality Disorders

As with all forms of mental illness, personality disorders can be difficult to treat. Finding a treatment that works for an individual patient involves a lot of communication between patients and their doctors. Both medication and various forms of therapy can help people cope with these disorders and doctors often suggest a combination of medication and therapy for the most effectiveness.

Medication

Medication for personality disorders can be very complex, but generally, the type of medication someone receives is dependent upon the symptoms they are experiencing. People with any of these personality disorders may be prescribed anti-manics (for symptoms of mania), antidepressants (for symptoms of depression), anxiolytics (for symptoms of anxiety), or antipsychotics (for symptoms of psychosis). While medication may be beneficial for people with certain disorders, it is often used to help alleviate more short-term symptoms that are severe or life-threatening. Once a person is out of any immediate danger, their doctor will add therapy to their treatment regimen; therapy often proves to be more effective for the long-term maintenance of a disorder

Therapy

Therapy can be an effective method for helping patients learn to regulate their emotions and improve their coping skills. It can also help patients to both improve their ability to form interpersonal relationships and to improve the quality of those relationships.

Various forms of therapy can be administered in either a one-on-one setting between the therapist and patient or in a group setting. Additionally, it may be beneficial for family, friends, or loved ones of the patient to participate in the therapy sessions as well. Studies show that including family members in therapy can improve both the patient’s treatment and the family members’ ability to cope with the condition and to support the patient.⁴

Psychotherapy is a common treatment for people with personality disorders. Psychotherapy can include various practices, such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). CBT involves identifying and changing core beliefs or behaviors that underlie inaccurate perceptions of the person and of others.⁴ DBT teaches skills to control intense emotions, reduce self-destructive behaviors, and improve relationships. This therapy often incorporates elements of mindfulness training, and it differs from CBT in that it seeks a balance between both changing and accepting beliefs or behaviors.⁴

Therapists will meet with a patient and develop a personalized plan for them, adapting various forms of psychotherapy to meet the needs of the specific patient. Often, therapists will mix techniques from different types of therapy or use some combination of therapies, depending on what they think will be most beneficial to the patient’s particular case. We recommend people with personality orders to seek out treatment because, when left untreated, these disorders can sometimes lead to very negative and dangerous consequences.

Treatments’ Effects on Sex Life

Medication used to treat personality disorders may have negative side effects, some of which can affect a person’s sex life. As mentioned above, the types of medication used to treat personality disorders can include anti-manics, antidepressants, anxiolytics, or antipsychotics. Antidepressants can cause sexual problems. Anti-anxiety medication can cause changes in sex drive or ability to perform in a sexual situation. Antipsychotics can have sexual dysfunction side effects, such as erectile dysfunction.⁷ However, while some specific medications can have negative sexual side effects, the benefits of treatment may far outweigh the costs.

Concluding Remarks

Personality disorders are lifelong, pervasive mental health illnesses that can impact a person’s personal and professional life, reducing their overall quality of life. These disorders can also affect sexual behavior in a variety of ways, creating challenges for people with these conditions to have satisfying sex lives. Treating personality disorders is especially important, as these disorders can lead to a variety of negative life outcomes. Medicine and therapy are both used as treatment options and are sometimes used in combination. These therapies can assist people with personality disorders by improving their relationships with others, their ability to communicate with their loved ones, and their life satisfaction overall.

References

1. “Personality Disorders.” MedlinePlus. U.S. National Library of Medicine, Web. 16 Dec 2020.
2. Pozza, A., Veale, D., Marazziti, D., Delgadillo, J., Albert, U., Grassi, G., Prestia, D., & Dèttore, “Sexual dysfunction and satisfaction in obsessive compulsive disorder: protocol for a systematic review and meta-analysis.” National Center for Biotechnology Information, Oct. 2020.
3. “Antisocial Personality Disorder.” Harvard Health Publishing. Mar. 2019. Web. 19 January 2021.
4. “Borderline Personality Disorder.” National Institute of Mental Health. National Institutes of Health, n.d. Web. December 2017.
5. Bouchard S, Godbout N, Sabourin S. “Sexual Attitudes and Activities in Women with Borderline Personality Disorder Involved in Romantic Relationships.” Journal of Sex & Marital Therapy, 35:106-121, 2009.
6. Sansone, Randy and Sansone, Lori. “Sexual Behavior in Borderline Personality: A Review” PubMed.gov. 8 Feb. 2011.
7. “Mental Health Medications.” National Institute of Mental Health. National Institutes of Health, Web. October 2016.

Last Updated: 11 February 2021