Borderline Personality Disorder (BPD) is also often mentioned as a followup of sexual abuse. That there is some correlation appears convincing (Murray 1993). But a simple association between abuse and the disorder is an oversimplification (Paris 1992). Silk et al. 1995 show that "studies that attempt to understand the relationship between sexual abuse and borderline personality disorder symptoms need to examine not only the occurrence of sexual abuse but the nature and the severity of that abuse as well."
There are no results which establish a link between volitional sexual experiences and the borderline personality disorder.
Indirect evidence against such a link is the role of parental sexual abuse (Dubo 1997).
Other nonsexual but traumatic experiences also seem to be connected with BPD. Dubo 1997 has found a similar relation to self-mutilation for BPD patients for parental sexual abuse and emotional neglect.
In a study of 358 BPD patients and 109 patients with other disorders, Zanarini et.al. 1997 have found: "Of the 358 patients with borderline personality disorder, 91% reported having been abused, and 92% reported having been neglected, before the age of 18. The borderline patients were significantly more likely than the 109 patients with other personality disorders to report having been emotionally and physically abused by a caretaker and sexually abused by a noncaretaker. They were also significantly more likely to report having a caretaker withdraw from them emotionally, treat them inconsistently, deny their thoughts and feelings, place them in the role of a parent, and fail to provide them with needed protection. The borderline patients with a childhood history of sexual abuse were significantly more likely than those without such a history to report having experienced all but one of the types of abuse and neglect studied. See also Zanarini et al. 1989
Guzder 1996 conlude: "The risk factors that differentiated the borderline group were sexual abuse, physical abuse, severe neglect, and parental substance abuse or criminality. Sexual abuse and severe neglect were significant in multivariate analysis. Cumulative abuse and cumulative parental dysfunction scores were both higher in the borderline group."
Links & van Reekum 1993 also have found sexual abuse as significant even after controlling parental impairment.
Brown & Anderson 1991, considering physical and sexual abuse, have found: "Axis II diagnoses, particularly borderline personality disorder, were more frequent in abuse victims than in nonabused patients."
Westen et.al. 1990 have found that both types of abuse distinguish female adolescents with BPS from a control group. Their results point to "the impact of repeated trauma".
Thus, there is some relation between sexual abuse and BPD. Physical abuse seems to be less important, but neglect and sexual abuse seem to play a comparable role in BPD.
There are a lot of papers which mention BPD together with other psychiatric problems discussed in relation with sexual abuse: suicidal behaviour (Dubo 1997), alcohol abuse, (Ouimette et.al. 1996); dissociation (Sar et.al. 1996, Ouimette et.al. 1996); Post Traumatic Stress Disorder (Figueroa 1997, Ouimette et.al. 1996); eating disorders (Shearer et al. 1990)
This suggests high comorbidity.
Figueroa & Silk 1997, consider which types of sexual abuse experiences are thought to be most prevalent in patients with BPD. They categorize child sexual abuse as a trauma, and try to connect the biology of trauma and chronic stress with the biology of BPD.
Based on a comparison of BPD patient with patients with depression and a control group, Figueroa et.al. 1997 suggest "interpersonal sensitivity" as a constitutional variable which in interaction with trauma leads to BPD.
An explanation based on trauma and chronic stress is in good agreement with the previously listed results about an association with other forms of abuse and neglect, as well as with the comorbidity with PTSD. A key role of "interpersonal sensitivity" allows to explain also the importance of emotional aspects of the abuse.
I have seen no data about an association between volitional sexual contacts and BPD.
The previous hypothesis about the association between sexual abuse and BPD does not suggest any association between volitional sexual contacts and BPD.