1. Women with mental illness are disproportionately burdened with sexually transmitted disease - STD (Meade & Sikkema, 2005: Rosenberg et al., 2001; Vanable et al., 2007). Borderline personality disorder (BPD) 1-6% of Americans (Grant et al., 2008; Lieb et al., 2004). 59% comorbid substance use disorder (Zanarini et al., 1998), one pathway to risky behavior and STDs (Meade & Sikkema, 2005). engage in risky sexual behavior (Chen et al., 2007; De Genna et al., in press; Neeleman, 2007; Sansone & Wiederman, 2009). It is not clear if BPD symptoms predict more risky sex, independent of the effects of mental illness, substance use and other common risk factors. Borderline Personality Disorder At least 5 of the following symptoms (DSM-IV) frantic efforts to avoid abandonment unstable and intense relationships identity disturbance marked impulsivity recurrent suicidal or self-injurious behavior affective instability chronic feelings of emptiness intense anger and lack of anger control stress-related paranoid ideation or dissociative symptoms Risky sexual behavior in women with and without borderline personality disorder (BPD) Natacha M. De Genna, Ulrike Feske, Teresa Angiolieri, and Melanie A. Gold University of Pittsburgh Medical School Introduction Sample 281 women with male sex partners in past 5 yrs n = 147 with Borderline Personality Disorder n = 134 with another non-psychotic Axis-I disorder (comparison group) Age: 18 – 40 years old (M = 27.04, SD = 6.60 yrs) Race: 34% African-American, 66% White/Asian SES = Hollingshead scores (M = 33.86, SD = 14.21) 46% were currently receiving mental health treatment Assessments Structured Clinical Interview for DSM-IV (SCID-I; First et al., 1995) -BPD and other psychiatric diagnoses Structured Interview for DSM-IV Personality (SIDP-IV; Pfohl et al., 1997) -BPD severity = BPD dimensional scores Child Trauma Questionnaire (CTQ: Bernstein & Fink, 1997) -child sexual abuse scale 6 month Timeline Follow-back Procedure (TLFB) Substance Use in last 6 months Heavy Alcohol Use (2+ drinks every day) = 15% Cannabis Use (any) = 60% Cocaine Use (any) = 25% Opioid Use (any) = 19% Other Drug Use (any) = 50% Risky Sexual Behavior in last 6 months -Unsafe sexual partner = non-monogamous, intravenous drug user, MSM, and/or bought or sold sex (25%) -2 or more casual sex partners (50%) -Sex under influence alcohol/drugs (55%) Methods Significant Predictors of Any Unsafe Sex Partner in Last 6 Mos (Model chi square = 47.3, p <.001; Cox & Snell R 2 =.16) Wald Odds Ratio Conf. Interval BPD score 13.1*** 1.08 (1.04-1.21) Child Sexual Abuse 4.2* 1.31 (1.01-1.71) Significant Predictors of 2+ Casual Sex Partners in Last 6 Mos (Model chi square = 39.1, p <.001; Cox & Snell R2 =.13) Wald Odds Ratio Conf. Interval Cocaine Use 9.3** 4.19 (1.67-10.5) Opioid Use 8.1** 0.26 (0.10-0.66) BPD * Race 8.0** 0.14 (0.03-0.54) Significant Predictors of Sex Under the Influence in Last 6 Mos (Model chi square = 170.7, p <.001; Cox & Snell R2 =.46) Wald Odds Ratio Conf. Interval BPD score 3.2 t 1.04 (1.00-1.09) Child Sexual Abuse 6.8** 1.55 (1.12-2.15) Cannabis Use 44.7*** 15.28 (6.87-33.9) All logistic regression analyses controlled for age, race, SES, child sexual abuse, and each substance use variable. Results BPD severity was associated with having at least one unsafe sexual partner and having sex under the influence of alcohol or drugs in the last 6 months, even after controlling for history of child sexual abuse (CSA) and recent substance use. A significant BPD x Race interaction suggested that BPD severity may be a more powerful predictor of 2 or more casual sex partners among White/Asian women with mental illness. Risky sexual behavior may help explain why women with greater BPD symptoms are at greater risk of STDs. Future Directions Do sexual partnerships mediate the association between BPD severity and STDs? How can we protect women with BPD? Acknowledgements We wish to acknowledge the contribution of the women from the Women’s Personality Study. This research was supported by grants from the National Institutes of Health (NIH) awarded to Drs De Genna (DA020130) and Feske (DA 020130). Discussion