Women with a mental disorder are more sexually active than their male counterparts, and characteristics of antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are a predictor for risky sexual behavior for women but not men, according to a study published in Behavioral Medicine.

Cathryn H. Mainville, MSEd, LMHC, from the Division of Psychiatry at the Boston University School of Medicine, and colleagues conducted a randomized clinical trial examining HIV prevention in a mentally ill and homeless or marginally housed population. Eligibility criteria included persons aged 19 years or older; a lifetime history or current symptoms of serious mental illness including ASPD or BPD; mental status sufficient for providing informed consent; and self-report of 1 or more HIV risk behaviors in the previous 90 days.

HIV risk behaviors included condomless oral, anal, or vaginal intercourse with a nonmonogamous or HIV-positive partner; sharing intravenous drug needles without using recommended cleaning procedures; and/or engaging in any sexual behavior while under the influence of alcohol or drugs.

Continue Reading

Participants included 103 adults (64% male). On average, participants reported engaging in nearly 25 discrete sexual acts per month during the past 3 months, including approximately 10 vaginal sex acts (85% condomless), 13 oral sex acts (97% condomless), and 1 anal sex act.

To examine the relationship between personality characteristics and risk, the authors constructed a risk index comprising key symptoms of antisocial and borderline personality disorders: impulsivity, affective instability, and disregard for safety of self/others. The personality risk index score did not independently predict levels of engagement in protected or condomless oral, anal, or vaginal sex, nor did it independently predict frequency of intravenous drug use during the target 90-day period.

Exploratory analyses revealed that women engaged in significantly more risk behaviors than men and that risk scores were a significant predictor of total sex acts for women but not men. In addition, increased emotional dysregulation was a significant predictor of condomless sex acts for women but not men. Recent alcohol use and increased impulsivity were associated with more condomless oral sex for men and women.

“Substance use and mental illness affect a disproportionate number of those with elevated risk for exposure to HIV and other STI, including adults living with residential instability and those with significant trauma histories,” the authors concluded.


  1. Mainville CH, Richardson MA, Brady SM, et al.  HIV risk, substance use, and personality characteristics among adults with history of serious mental illness. Behav Med. 2 August 2017. http://dx.doi.org/10.1080/08964289.2017.1301874