ABSTRACT
Many therapists who treat sexual addiction/ compulsivity are often frustrated by difficult patients who do not generally respond well to traditional treatment. These patients are often labeled "rageful," "rebellious," "noncompliant," and even "dangerous." This may be particularly so with female patients being treated for sexual add iction/ compulsivity. Therapists working with other addictions and dually diagnosed populations may be equally as frustrated with female patients who present with dysfunctional sexual behavior that is not understood and is not being addressed. In both populations the presence of borderline personality disorder may not have been adequately recognized or diagnosed. In this chapter we outline our emerging theoretical ideas about the relationship between borderline personality disorder and sexual addiction/ compulsivity in women. We believe that differential diagnostic features delineate three populations: sexually addictive/compulsives, sexually addictive/compulsive borderlines, and borderlines who may act out sexually, but who are not sexually addictive/compulsive. Failure to recognize these differences can lead to ineffective and frustrating treatment strategies for both the therapist and the patient.
