Borderline Personality Disorder and Sexual Masochism: Treating the Roots of Dysfunction

The relationship between borderline personality disorder (BPD) and sexuality is complicated. Sexual impulsivity and promiscuity can be a critical factor in BPD diagnoses—a fact that is not without controversy, as sexual impulsivity and promiscuity tend to be evaluated differently for men than for women. What may be defined as promiscuity in a woman may, for a man, be dismissed as simply sowing wild oats. But the important piece of the puzzle is not simply that sexual behavior is impulsive or promiscuous, but that it is potentially self-damaging. This is the nexus where BPD and masochism meet for so many.

Sexual masochism has long been anecdotally observed in people suffering from borderline personality disorder. This past April, however, the connection went beyond anecdote, entering the realm of empirical evidence. According to a study published in the Archives of Sexual Behavior, researchers found that “sexual masochism disorder was 10 times higher in BPD women than in women with other personality disorders.” Furthermore, those women who identified as masochists reported “more child sexual abuse, more hostile/dismissing attachments, higher sensation seeking, and more frequently exploratory/impersonal sexual fantasies than BPD without sexual masochism.” The findings reveal that women with borderline personality disorder are at significantly increased risk for participating in high-risk sexual activities that could compound existing suffering and lead to serious emotional and physical injury.

So what accounts for the relationship between borderline personality disorder and sexual masochism? The answers are complex and not fully understood. However, researchers believe that sexual abuse likely plays a significant role. Indeed, the connections between BPD and sexual trauma are undeniable; a study published last year in the Industrial Psychiatry Journal found that approximately 50% of people diagnosed with borderline personality disorder experienced some form of childhood sexual abuse and others have estimated the number to be as high as 75%.

While the exact causes of BPD remain elusive, it is believed that the condition often develops as a disordered way of coping with the overwhelming distress brought on by traumatic events. Becky Oberg writes, “BPD is a natural reaction to unnatural trauma.” As such, sexual trauma is often the nucleus of BPD itself; the fear of abandonment, fractured sense of identity, unstable relationships, and poor emotional regulation all germinate from the extraordinarily destabilizing events that disallow healthy psychological development. The emotional volatility, impulsivity, and self-injury so often present in those with BPD can then be understood as logical ways to modulate deep inner pain and exert control over a life in constant turmoil.

Self-injury can mean many things. Sometimes it comes in the form of cutting, sometimes it comes in the form of burning, sometimes it comes in the form of hitting. And sometimes it comes in the form of sexual masochism. Just as in the case of other self-injurious practices, physical pain during sexual activity can release endorphins that create a rush, a high, or simply a feeling of calmness. In this context, masochism provides a powerful coping mechanism to address what is experienced as unbearable emotional distress.

But sexual masochism is not solely a chemical experience. Rather, it can allow you to, in essence, recreate the dynamics of traumatic sexual experiences and reframe them within an ostensibly consensual context. This can help you achieve a sense of retroactive control over situations in which you experienced a loss of control. In some ways, this approach functions as a dysfunctional type of exposure therapy as you seek to counteract the damage of the original trauma. Ultimately, however, it doesn’t work; engaging in traumatic sexual practices does not erase past violations and it keeps your sexuality defined by trauma rather than authentic desire.

In other cases, sexual masochism evolves out of early conditioning; if your introductions to sex happened within a context of violence, degradation, and powerlessness, it is possible that your own sense of sexuality come to revolve around these qualities. Sex, violence, and victimization have become inextricably connected in your mind and in your physicality, preventing you from being able to feel desire for other types of sexual interactions. Even if you recognize the destructive nature of this phenomenon, you may feel powerless to change it.