Original Article

Online Sexual Activity among Iranian Clients with Borderline Personality Disorder and Its Correlation with Severity of Symptoms


Objective: Clients with borderline personality disorder (BPD) often engage in high-risk sexual behaviors. Online sexual platforms convey abusive and harmful themes, especially for this group of sexually impulsive patients. We hypothesized a correlation between their online sexual activities and the severity of BPD symptoms.

Method: Fifty clients with BPD who were referred to Iran psychiatric hospital and Tehran Psychiatric Institute in 2020 participated in this research. The Borderline Evaluation of Severity over Time (BEST) questionnaire was used to assess the severity of BPD symptoms, and the Internet Sex Screening Test (ISST) was used to evaluate online sexual behaviors. A psychiatric interview considered substance abuse and other confounding factors.

Results: The mean ISST and BEST scores were 7.82 ± 5.74 and 41.7 ± 12.5, respectively. There was a positive and significant correlation between the severity of BPD symptoms and online sexual activities (P < 0.001, r = 0.480). There was also a significant relationship between online sexual activities and a history of substance abuse (P = 0.003, F = 25.06).

Conclusion: Online sexual activity can harm clients with BPD who are more vulnerable to high-risk sexual behaviors. More severe borderline personality traits were associated with more online sexual activity, which underlines the importance of providing education about and managing such activities in clients with BPD.

1. Beckwith H, Moran PF, Reilly J. Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personal Ment Health. 2014;8(2):91-101.
2. Bazrafshan S, Eftekhar Ardebili M, Karim Zad N, Nohe Sara S, Ranjbar M, Mohammadsadeghi H. Borderline Personality Disorder Over Time: A One-Year Follow up Study. Journal of Iranian Medical Council. 2019;2(5):134-42.
3. Thompson KN, Betts J, Jovev M, Nyathi Y, McDougall E, Chanen AM. Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Interv Psychiatry. 2019;13(3):502-8.
4. Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M. Community and Clinical Epidemiology of Borderline Personality Disorder. Psychiatr Clin North Am. 2018;41(4):561-73.
5. Hafizi S, Tabatabaei D, Koenig HG. Borderline Personality Disorder and Religion: A perspective from a Muslim country. Iran J Psychiatry. 2014;9(3):137-41.
6. Frías Á, Palma C, Farriols N, González L. Sexuality-related issues in borderline personality disorder: A comprehensive review. Personal Ment Health. 2016;10(3):216-31.
7. Penner F, Wall K, Jardin C, Brown JL, Sales JM, Sharp C. A study of risky sexual behavior, beliefs about sexual behavior, and sexual self-efficacy in adolescent inpatients with and without borderline personality disorder. Personal Disord. 2019;10(6):524-35.
8. Sansone RA, Lam C, Wiederman MW. The relationship between borderline personality disorder and number of sexual partners. J Pers Disord. 2011;25(6):782-8.
9. Choukas-Bradley S, Hipwell AE, Roberts SR, Maheux AJ, Stepp SD. Developmental Trajectories of Adolescent Girls' Borderline Personality Symptoms and Sexual Risk Behaviors. J Abnorm Child Psychol. 2020;48(12):1649-58.
10. Sansone RA, Sansone LA. Sexual behavior in borderline personality: a review. Innov Clin Neurosci. 2011;8(2):14-8.
11. Abramov G, Miellet S, Kautz J, Grenyer BFS, Deane FP. The paradoxical decline and growth of trust as a function of borderline personality disorder trait count: Using discontinuous growth modelling to examine trust dynamics in response to violation and repair. PLoS One. 2020;15(7):e0236170.
12. Boies SC, Cooper A, Osborne CS. Variations in internet-related problems and psychosocial functioning in online sexual activities: implications for social and sexual development of young adults. Cyberpsychol Behav. 2004;7(2):207-30.
13. Döring N, Daneback K, Shaughnessy K, Grov C, Byers ES. Online Sexual Activity Experiences Among College Students: A Four-Country Comparison. Arch Sex Behav. 2017;46(6):1641-52.
14. Young KS. Internet sex addiction: Risk factors, stages of development, and treatment. Am Behav Sci. 2008;52(1):21-37.
15. Young KS, Griffin-Shelley E, Cooper A, O'mara J, Buchanan J. Online infidelity: A new dimension in couple relationships with implications for evaluation and treatment. Sex Addict Compulsivity. 2000;7(1-2):59-74.
16. Eissazade N, Hemmati D, Ahlzadeh N, Shalbafan M, Askari-Diarjani A, Mohammadsadeghi H, et al. Attitude towards migration of psychiatric trainees and early career psychiatrists in Iran. BMC Med Educ. 2021;21(1):502.
17. Mokhtari S, Shariat SV, Ardebili ME, Shalbafan M. Iranian students' attitudes toward premarital sex, marriage, and family in different college majors. J Am Coll Health. 2022;70(4):1186-94.
18. Azizi MR, Mohammadsadeghi H, Alavi K, Rasoulian M, Karimzad N, Eftekhar Ardebili M. Validity and reliability of Persian translation of the Borderline Evaluation of Severity over Time (BEST) questionnaire. Med J Islam Repub Iran. 2019;33:133.
19. Shalbafan M, Najarzadegan M, Soraya S, Rashedi V, Najafian R, Ahmadkhaniha H, et al. Validity and reliability of the Persian version of Internet Sex Screening Test in Iranian medical students. Sex Addict Compulsivity. 2019;26(3-4):361-70.
20. Mohammadkhani P, Forouzan AS, Hooshyari Z, Abasi I. Psychometric Properties of Persian Version of Structured Clinical Interview for DSM-5-Research Version (SCID-5-RV): A Diagnostic Accuracy Study. Iran J Psychiatry Behav Sci. 2020;14(2).
21. Buchheim A, Diamond D. Attachment and Borderline Personality Disorder. Psychiatr Clin North Am. 2018;41(4):651-68.
22. Schimmenti A, Passanisi A, Gervasi AM, Manzella S, Famà FI. Insecure attachment attitudes in the onset of problematic Internet use among late adolescents. Child Psychiatry Hum Dev. 2014;45(5):588-95.
23. Daneback K, Ross MW, Månsson S-A. Characteristics and behaviors of sexual compulsives who use the Internet for sexual purposes. Sex Addict Compulsivity. 2006;13(1):53-67.
24. Cooper A, Morahan-Martin J, Mathy RM, Maheu M. Toward an increased understanding of user demographics in online sexual activities. J Sex Marital Ther. 2002;28(2):105-29.
25. Ross MW, Månsson SA, Daneback K. Prevalence, severity, and correlates of problematic sexual Internet use in Swedish men and women. Arch Sex Behav. 2012;41(2):459-66.
26. Rosser BR, Noor SW, Iantaffi A. Normal, Problematic and Compulsive Consumption of Sexually Explicit Media: Clinical Findings using the Compulsive Pornography Consumption (CPC) Scale among Men who have Sex with Men. Sex Addict Compulsivity. 2014;21(4):276-304.
27. Wéry A, Deleuze J, Canale N, Billieux J. Emotionally laden impulsivity interacts with affect in predicting addictive use of online sexual activity in men. Compr Psychiatry. 2018;80:192-201.
28. Verduyn P, Gugushvili N, Kross E. The impact of social network sites on mental health: distinguishing active from passive use. World Psychiatry. 2021;20(1):133-4.
29. Black DW, Kehrberg LL, Flumerfelt DL, Schlosser SS. Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry. 1997;154(2):243-9.
30. Reid RC, Cyders MA, Moghaddam JF, Fong TW. Psychometric properties of the Barratt Impulsiveness Scale in patients with gambling disorders, hypersexuality, and methamphetamine dependence. Addict Behav. 2014;39(11):1640-5.
31. Reid RC, Carpenter BN, Hook JN, Garos S, Manning JC, Gilliland R, et al. Report of findings in a DSM-5 field trial for hypersexual disorder. J Sex Med. 2012;9(11):2868-77.
IssueVol 17 No 4 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v17i4.10688
Borderline Personality Disorder Internet Addiction Mental Health Sexual Behavior

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How to Cite
Mohammadsadeghi H, Rashedi V, Shahesmaeili A, Mirhaj Mohammadabadi MS, Hadi F, Boroon M, Shalbafan M. Online Sexual Activity among Iranian Clients with Borderline Personality Disorder and Its Correlation with Severity of Symptoms. Iran J Psychiatry. 2022;17(4):395-400.