Abstract
Adolescence is a developmental period during which youth tend to initiate sexual behavior, which may include sexual risk behavior. Symptoms of borderline personality disorder (BPD) are associated with increased rates of risky behaviors. However, little is known about longitudinal associations between BPD symptoms and sexual risk behaviors during adolescence. This study examines developmental trajectories of adolescent girls’ BPD symptoms and sexual risk behaviors in a community sample of Black and White girls from the Pittsburgh Girls Study (n = 1620). Dual trajectory modeling provided insights into the temporal precedence and co-development of BPD symptoms and sexual risk behaviors from ages 14 to 18. In order to examine the unique association between BPD symptoms and sexual risk behaviors, analyses controlled for symptoms of depression and conduct disorder, as well as race, sexual orientation, and pubertal development. Girls with more BPD symptoms at age 14 showed steeper growth over time in sexual risk behaviors from ages 14 to 18. Additionally, adolescents who showed steeper increases in BPD symptoms over time also showed steeper increases in sexual risk behaviors across adolescence. Notably, however, sexual risk behavior at age 14 was not significantly associated with longitudinal trajectories of BPD symptoms. Results suggest that adolescent girls with early symptoms of BPD are at heightened risk for the development of sexual risk behaviors during adolescence, while the reverse association does not hold. Implications for adolescent development and sexual risk behavior are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
For more information about data-sharing procedures for the Pittsburgh Girls Study, see http://www.lifehistorystudies.pitt.edu/pittsburgh-girls-study
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington: American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.
Baams, L., Dubas, J. S., Overbeek, G., & Van Aken, M. A. G. (2015). Transitions in body and behavior: A meta-analytic study on the relationship between pubertal development and adolescent sexual behavior. Journal of Adolescent Health, 56(6), 586–598. https://doi.org/10.1016/j.jadohealth.2014.11.019.
Brinkley, D. Y., Ackerman, R. A., Ehrenreich, S. E., & Underwood, M. K. (2017). Sending and receiving text messages with sexual content: Relations with early sexual activity and borderline personality features in late adolescence. Computers in Human Behavior, 70, 119–130. https://doi.org/10.1016/j.chb.2016.12.082.
Brown, L. K., Houck, C., Lescano, C., Donenberg, G., Tolou-Shams, M., & Mello, J. (2012). Affect regulation and HIV risk among youth in therapeutic schools. AIDS and Behavior, 16(8), 2272–2278. https://doi.org/10.1007/s10461-012-0220-3.
Centers for Disease Control and Prevention (CDC). (2017). HIV and youth. Atlanta, GA: U.S. Department of Health and Human Services.
Centers for Disease Control and Prevention (CDC). (2018). Youth risk behavior surveillance 2017. Atlanta: U.S. Department of Health and Human Services.
Centers for Disease Control and Prevention (CDC). (2019). Sexually transmitted disease surveillance 2018. Atlanta: U.S. Department of Health and Human Services.
Chanen, A. M., Jovev, M., Djaja, D., McDougall, E., Yuen, H. P., Rawlings, D., & Jackson, H. J. (2008). Screening for borderline personality disorder in outpatient youth. Journal of Personality Disorders, 22(4), 353–364. https://doi.org/10.1521/pedi.2008.22.4.353.
Chanen, A. M., Jovev, M., & Jackson, H. J. (2007). Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. The Journal of Clinical Psychiatry, 68(02), 297–306. https://doi.org/10.4088/JCP.v68n0217.
Charnigo, R., Noar, S. M., Garnett, C., Crosby, R., Palmgreen, P., & Zimmerman, R. S. (2013). Sensation seeking and impulsivity: Combined associations with risky sexual behavior in a large sample of young adults. Journal of Sex Research, 50(5), 480–488. https://doi.org/10.1080/00224499.2011.652264.
Chen, S., Lin, C., Wang, L., Hsu, C.-Y., & Shen, Y. C. (2019). Borderline personality disorder is associated with an increased risk of sexually transmitted infections: A nationwide population-based cohort study in Taiwan. Sexually Transmitted Infections, 95, 529–533. https://doi.org/10.1136/sextrans-2018-053812.
Cottler, L. B. (2000). Composite international diagnostic interview—Substance abuse module (SAM). St. Louis: Washington University School of Medicine.
Dahl, R. E., Allen, N. B., Wilbrecht, L., & Suleiman, A. B. (2018). Importance of investing in adolescence from a developmental science perspective. Nature, 554(7693), 441-450. https://doi.org/10.1038/nature25770.
Daley, S. E., Burge, D., & Hammen, C. (2000). Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: Addressing issues of specificity. Journal of Abnormal Psychology, 109(3), 451–460. https://doi.org/10.1037//0021-843X.109.3.45l.
Donahue, K. L., Lichtenstein, P., Långström, N., & D'Onofrio, B. M. (2013). Why does early sexual intercourse predict subsequent maladjustment? Exploring potential familial confounds. Health Psychology, 32(2), 180–189 http://dx.doi.org.pitt.idm.oclc.org/10.1037/a0028922.
Donenberg, G., Emerson, E., Mackesy-Amiti, M., & Fletcher, F. (2018). Sexual risk among African American girls seeking psychiatric care: A social-personal framework. Journal of Consulting and Clinical Psychology, 86(1), 24–38. https://doi.org/10.1037/ccp0000270.
Edwards, G. L., & Barber, B. L. (2010). The relationship between rejection sensitivity and compliant condom use. Archives of Sexual Behavior, 39(6), 1381–1388. https://doi.org/10.1007/s10508-009-9520-8.
Frías, Á., Palma, C., Farriols, N., & González, L. (2016). Sexuality-related issues in borderline personality disorder: A comprehensive review. Personality and Mental Health, 10(3), 216–231. https://doi.org/10.1002/pmh.1330.
Gadow, K. D., & Sprafkin, J. (1997). Child/adolescent symptom inventories manual. Stony Brook: Checkmate Plus.
Gunderson, J. G. (2011). Clinical practice: Borderline personality disorder. New England. Journal of Medicine, 364, 2037–2042.
Gunderson, J. G., & Links, P. (2008). Borderline personality disorder: A clinical guide (2nd ed.). American Psychiatric Publishing.
Gutnik, L. A., Hakimzada, A. F., Yoskowitz, N. A., & Patel, V. L. (2006). The role of emotion in decision-making: A cognitive neuroeconomic approach towards understanding sexual risk behavior. Journal of Biomedical Informatics, 39(6), 720–736. https://doi.org/10.1016/j.jbi.2006.03.002.
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., Dawson, D. A., Pulay, A. J., Pickering, R. P., & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 69(4), 533–545. https://doi.org/10.4088/JCP.v69n0404.
Guttmacher Institute. (2019). Unintended Pregnancy in the United States, https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states
Hansen, W., Paskett, E., & Carter, L. (1999). The adolescent sexual activity index (ASAI): A standardized strategy for measuring interpersonal heterosexual behaviors among youth. Health Education Research, 14, 485–490. https://doi.org/10.1093/her/14.4.485.
Harden, K. P. (2014). A sex-positive framework for research on adolescent sexuality. Perspectives on Psychological Science, 9(5), 455–469. https://doi.org/10.1177/174569161453593.
Harden, K. P., Mendle, J., Hill, J. E., Turkheimer, E., & Emery, R. E. (2008). Rethinking timing of first sex and delinquency. Journal of Youth and Adolescence, 37(4), 373–385 http://dx.doi.org.pitt.idm.oclc.org/10.1007/s10964-007-9228-9.
Hipwell, A. E., Loeber, R., Stouthamer-Loeber, M., Keenan, K., White, H. R., & Kroneman, L. (2002). Characteristics of girls with early onset disruptive and antisocial behaviour. Criminal Behaviour and Mental Health, 12(1), 99–118. https://doi.org/10.1002/cbm.489.
Hipwell, A., Stepp, S., Chung, T., Durand, V., & Keenan, K. (2012). Growth in alcohol use as a developmental predictor of adolescent girls' sexual risk-taking. Prevention Science, 13(2), 118–128. https://doi.org/10.1007/s11121-011-0260-3.
Jamieson, L. K., & Wade, T. J. (2011). Early age of first sexual intercourse and depressive symptomatology among adolescents. Journal of Sex Research, 48, 450–460. https://doi.org/10.1080/00224499.2010.509892.
Kramer, U., Temes, C. M., Magni, L. R., Fitzmaurice, G. M., Aguirre, B. A., Goodman, M., & Zanarini, M. C. (2017). Psychosocial functioning in adolescents with and without borderline personality disorder. Personality and Mental Health, 11(3), 164–170. https://doi.org/10.1002/pmh.1377.
Krantz, M., Goldstein, T., Rooks, B., Merranko, J., Liao, F., Gill, M. K., Diler, R., Hafeman, D., Ryan, N., Goldstein, B., Yen, S., Hower, H., Hunt, J., Keller, M., Strober, M., Axelson, D., & Birmaher, B. (2018). Sexual risk behavior among youth with bipolar disorder: Identifying demographic and clinical risk factors. Journal of the American Academy of Child & Adolescent Psychiatry, 57(2), 118–124. https://doi.org/10.1016/j.jaac.2017.11.015.
Lavan, H., & Johnson, J. G. (2002). The association between Axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence. Journal of Personality Disorders, 16(1), 73–94. https://doi.org/10.1521/pedi.16.1.73.22559.
Lazarus, S. A., Beardslee, J., Pedersen, S. L., & Stepp, S. D. (2017). A within-person analysis of the association between borderline personality disorder and alcohol use in adolescents. Journal of Abnormal Child Psychology, 45(6), 1157–1167. https://doi.org/10.1007/s10802-016-0225-x.
Lazarus, S. A., Choukas-Bradley, S., Beeney, J., Byrd, A., Vine, V., & Stepp, S. D. (2019). Too much too soon? Borderline personality disorder symptoms and romantic relationship functioning in adolescence. Journal of Abnormal Child Psychology, 47, 1995–2005. https://doi.org/10.1007/s10802-019-00570-1.
Locke, T. F., & Newcomb, M. D. (2008). Correlates and predictors of HIV risk among inner-city African American female teenagers. Health Psychology, 27(3), 337–348. https://doi.org/10.1037/0278-6133.27.3.337.
Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., et al. (1994). The International Personality Disorder Examination: The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry, 51(3), 215-224. https://doi.org/10.1001/archpsyc.1994.03950030051005.
Mangassarian, S., Sumner, L., & O'Callaghan, E. (2015). Sexual impulsivity in women diagnosed with borderline personality disorder: A review of the literature. Sexual Addiction & Compulsivity, 22(3), 195–206. https://doi.org/10.1080/10720162.2015.1017781.
Mendle, J., Ferrero, J., Moore, S. R., & Harden, K. P. (2013). Depression and adolescent sexual activity in romantic and nonromantic relational contexts: A genetically-informative sibling comparison. Journal of Abnormal Psychology, 122(1), 51–63. https://doi.org/10.1037/a0029816.
Morris, N. M., & Udry, J. R. (1980). Validation of a self-administered instrument to assess stage of adolescent development. Journal of Youth and Adolescence, 9(3), 271–280. https://doi.org/10.1007/BF02088471.
Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus user's guide. Los Angeles: Muthén & Muthén.
Northey, L., Dunkley, C. R., Klonsky, E. D., & Gorzalka, B. B. (2016). Borderline personality disorder traits and sexuality: Bridging a gap in the literature. Canadian Journal of Human Sexuality, 25(2), 158–168. https://doi.org/10.3138/cjhs.252-A8.
Penner, F., Wall, K., Jardin, C., Brown, J. L., Sales, J. M., & Sharp, C. (2019). A study of risky sexual behavior, beliefs about sexual behavior, and sexual self-efficacy in adolescent inpatients with and without borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 10(6), 524–535. https://doi.org/10.1037/per0000348.
Raffaelli, M., & Crockett, L. J. (2003). Sexual risk taking in adolescence: The role of self-regulation and attraction to risk. Developmental Psychology, 39(6), 1036–1046. https://doi.org/10.1037/0012-1649.39.6.1036.
Sansone, R. A., & Sansone, L. A. (2011). Sexual behavior in borderline personality: A review. Innovations in Clinical Neuroscience, 8, 14–18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071095/pdf/icns_8_2_14.pdf.
Smith, D. J., Muir, W. J., & Blackwood, D. H. R. (2005). Borderline personality disorder characteristics in young adults with recurrent mood disorders: A comparison of bipolar and unipolar depression. Journal of Affective Disorders, 87, 17–23. https://doi.org/10.1016/j.jad.2005.02.019.
Steinberg, L. (2007). Risk taking in adolescence. Current Directions in Psychological Science, 16(2), 55–59. https://doi.org/10.1111/j.1467-8721.2007.00475.x.
Stepp, S. D., Scott, L. N., Jones, N. P., Whalen, D. J., & Hipwell, A. E. (2016). Negative emotional reactivity as a marker of vulnerability in the development of borderline personality disorder symptoms. Development and Psychopathology, 28(1), 213–224. https://doi.org/10.1017/S0954579415000395.
Thompson, K. N., Betts, J., Jovev, M., Nyathi, Y., McDougall, E., & Chanen, A. M. (2017). Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Intervention in Psychiatry., 13, 502–508. https://doi.org/10.1111/eip.12510.
Tolman, D. L., & Diamond, L. M. (2001). Desegregating sexuality research: Cultural and biological perspectives on gender and desire. Annual Review of Sex Research, 12, 33–74. Retrieved from https://www.proquest.com/docview/619927609.
Tolman, D. L., Diamond, L. M., Bauermeister, J. A., George, W. H., Pfaus, J. G., & Ward, L. (2014). APA handbook of sexuality and psychology, Vol. 1: Person-based approaches. Washington, D.C.: American Psychological Association.
Torgerson, S. (2009). The nature (and nurture) of personality disorders. Personality and Individual Differences, 50, 624–632. https://doi.org/10.11111/j.1467-9450.2009.00788.x.
Udry, J., & Billy, J. O. (1987). Initiation of coitus in early adolescence. American Sociological Review, 52(6), 841–855. https://doi.org/10.2307/2095838.
Victor, E. C., & Hariri, A. R. (2016). A neuroscience perspective on sexual risk behavior in adolescence and emerging adulthood. Development and Psychopathology, 28(2), 471–487. https://doi.org/10.1017/S0954579415001042.
Wright, A. G., Zalewski, M., Hallquist, M. N., Hipwell, A. E., & Stepp, S. D. (2016). Developmental trajectories of borderline personality disorder symptoms and psychosocial functioning in adolescence. Journal of Personality Disorders, 30(3), 351–372. https://doi.org/10.1521/pedi_2015_29_200.
Ybarra, M. L., Rosario, M., Saewyc, E., & Goodenow, C. (2016). Sexual behaviors and partner characteristics by sexual identity among adolescent girls. Journal of Adolescent Health, 58(3), 310–316. https://doi.org/10.1016/j.jadohealth.2015.11.001.
Young, B. J., & Furman, W. (2008). Interpersonal factors in the risk for sexual victimization and its recurrence during adolescence. Journal of Youth and Adolescence, 37(3), 297–309. https://doi.org/10.1007/s10964-007-9240-0.
Funding
This research was supported by grants from the National Institute of Mental Health (MH056630, MH086713) and the National Institute on Drug Abuse (DA012237).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no conflicts of interest.
Ethics Approval
All study procedures were approved by the University of Pittsburgh Human Research Protection Office (protocol number: PRO16050110; title: Pittsburgh Girls Study: Health Behaviors).
Informed Consent
When participants were under 18, caregivers provided written informed consent and girls provided verbal assent. Participants provided their own written, informed consent at age 18.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Choukas-Bradley, S., Hipwell, A.E., Roberts, S.R. et al. Developmental Trajectories of Adolescent Girls’ Borderline Personality Symptoms and Sexual Risk Behaviors. J Abnorm Child Psychol 48, 1649–1658 (2020). https://doi.org/10.1007/s10802-020-00699-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-020-00699-4