Borderline Personality and Sex Addiction – Interesting Bedfellows

The fields of psychiatry and psychotherapy are peppered with uninformed beliefs and misjudgments. For instance, individuals can be pejoratively diagnosed as borderline or, perhaps more accurately, viewed as exhibiting symptoms of complex traumatic stress. In cases of the latter, old unresolved traumas are reenacted in the here and now and, to say the least, are difficult to clinically modulate.

Betrayal is not Borderline

Nowhere is the borderline label less fitting but more frequently appended than in the case of a betrayed spouse. The label is applied to individuals who present in therapy as “help-me-no-don’t,” chronically angry, scared, defensive, and reactive. Unfortunately, the label is all too frequently applied by uninformed clinicians dealing with an angry, emotional, scared, “leave me-now-no-don’t” spouse who has learned of a partner’s sexual indiscretions, compulsivity, or addiction. Few spouses comport themselves with grace in the face of betrayal, yet the insinuation or diagnosis of borderline disorder is all too readily affixed. And by brandishing the borderline label, the clinical community serves to reactivate the emotional wounding and reinjure the person already reeling from betrayal and violation.  “Few spouses comport themselves with grace in the face of betrayal.”

Currently debated — and I might add not-so-nicely at times — is whether sex addiction is an addiction at all. Is it merely a hall pass for out-of-control behavior, or is it an addiction warranting legitimate attention? The psychiatric and psychological camps contend that it’s objectionable to label a behavior as an addictive disorder without rigorous scientific support. Assessment, diagnosis, and practice based solely on anecdotal experience may not be legitimate, yet the field of psychotherapy often treats issues and behaviors with modalities and techniques that have yet to be invited to the scientific table of clinical legitimacy.

Judge Not the Name…

So it makes sense that borderline personality disorder and sex addiction find their way into the same scrape. An individual who exhibits reactivity and another who exhibits out-of-control sexual behavior tend to face negative public reception, while the pain and wounding that drive the behaviors are overlooked. By brandishing a label, the professionals with whom the pain can be shared reinforce disapproval of the behavior and invalidate the pain.

The American Psychological Association determines what is included in the Diagnostic and Statistical Manual of Mental Disorders, the fifth edition of which is to be released any year now. The term “borderline personality disorder” is currently under reconsideration; it is quickly becoming a term of old to describe a cluster of symptoms driven by trauma-induced stress.

A more appropriate term is “complex traumatic stress,” which speaks to abuse inflicted by an attachment figure, the loss of the authentic self due to repeated trauma and abuse, or problems in regulating emotion. Whether that description finds its way into the upcoming DSM remains to be seen. So far the jury is out, and confusion still rules.

Clearly, this is not an exact science.

We must realize that an individual who struggles with a behavior by any name is an individual who suffers. As clinicians, we are at the forefront of healing and facilitating growth. Whether addictive behavior centers around sex, drugs, or rock-and-roll, it involves pain and suffering. To label the pain or question its legitimacy is to shut down an opportunity for growth and healing — for both the clinician and the client.