Disclosure about sexual behaviour in therapy in EUPD/BPD individuals
Research type
Research Study
Full title
Disclosure about sexual behaviour in therapy with BPD/EUPD individuals
IRAS ID
346209
Contact name
Bardana Singh
Contact email
Sponsor organisation
University of Surrey
Duration of Study in the UK
1 years, 8 months, 1 days
Research summary
Research Summary:
The aim of the first study is to assess what factors people with EUPD/BPD (emotionally unstable/ borderline personality disorder) find influential in their decisions to disclose or not disclose information relating to their sexual behaviour in therapy. 30-40 participants will aim to be recruited from mainstream community PD services in Surrey and London. The study will adopt a Q-methodology where participants will be given a set of statements highlighting different factors that may influence decisions to disclose about sexual behaviour in therapy that relate to their BPD/EUPD diagnosis. Participants will have to rate these statements in a table from most likely to least likely salient in their decisions to disclose. A factor analysis will be conducted to generate factors that identifies groups of participants who sorted the statements in comparable ways (i.e., who share a similar viewpoint on the topic). This will provide an insight into what factors are influential to disclosure about sexual behaviour in therapy for people with EUPD/BPD.
The second study will go further to explore reasons behind these influential factors for individuals with EUPD/BPD, based on personal experiences. Participants will be recruited from mainstream community PD services in Surrey and London as with MRP 1. Approximately 10 participants will be recruited from this sample for a semi-structured interview with the researcher. An Interpretive Phenomenological Analysis (IPA) will be adopted for this study that will take a closer look into how people with EUPD/BPD individually make sense of disclosure about their sexual behaviour in therapy through reflections of their lived experience. Both studies together will allow for a wider and collective view on the variability of factors chosen, to a closer and individual view on how people make sense of their influences to disclose about sexual behaviour to their therapist, in relation to their EUPD/BPD identity.
Lay summary of study results:
Study 1: Sexual experiences can be closely linked to relationships, identity, trauma and emotional coping, particularly for people labelled as having Emotionally Unstable Personality Disorder (EUPD) or Borderline Personality Disorder (BPD). However, sex is not always talked about in therapy. This study explored how people decide whether to discuss sexual experiences with their therapist.
Adults who had experience of therapy and labelled as having EUPD or BPD were invited to take part in an online sorting task. They were asked to rank different statements about what might influence their decision to talk about sex in therapy. We then analysed patterns in how people arranged these statements to understand common viewpoints.
Two main perspectives were identified. Both highlighted the importance of trust, feeling safe, and believing that the therapist is skilled and non-judgemental. For some participants, once this sense of safety was established, talking about sexual experiences was seen as helpful and part of making progress in therapy. For others, even when trust was present, feelings of shame or fear of being misunderstood made disclosure feel riskier. In this latter group, safety needed to feel consistent and clearly demonstrated before sexual topics could be discussed.
The findings suggest that not talking about sex in therapy does not mean it is unimportant. Instead, people may carefully weigh up the risks and benefits before deciding whether to share. Making therapists’ competence, confidentiality, and openness clear may help create safer conditions for these conversations.
Study 2: Lay summary
Many people find it hard to talk about sex in therapy, including when it relates to wellbeing, relationships, trauma, shame, or safety. For people labelled as having Borderline/Emotionally Unstable Personality Disorder (BPD/EUPD), this may feel riskier because they anticipate being judged through stereotypes (for example, being seen as “too much”, “manipulative”, or “sexually excessive”). This study explored what helps or blocks sexual discussion in therapy.
Seven adults with experience of therapy took part in interviews via videocall. All opted in knowing the interview would focus on sexual experiences. The interviews were analysed to identify patterns while keeping each person’s account in view.
Participants said sex was rarely discussed in therapy or was covered only in narrow ways. When discussion came up, they were usually framed around trauma, risk, or safety rather than pleasure or intimacy. Decisions about whether to speak depended on how safe the session felt. Participants described scanning for cues such as warmth, steadiness, and whether the therapist seemed comfortable.
Uncertainty about confidentiality, note-writing, or whether information might be shared across services often led people to hold back, use vague language, or change the subject. Clear, respectful explanations about boundaries and how notes are used helped some participants speak more openly.
Who the therapist was mattered too. Participants described how therapist gender, age, cultural background, and faith could shape worries about shame, judgement, or gossip, and therefore what felt possible to share. After discussing sex, some people felt relief and reduced shame, while others replayed the session and worried about how they had been seen.
Overall, these findings suggest that silence about sex in therapy often reflects safety concerns rather than avoidance. Clinicians may help by signalling that sexual topics are welcome, countering stigma, and responding with clarity and care when sexual material arises.
REC name
London - Surrey Research Ethics Committee
REC reference
24/LO/0740
Date of REC Opinion
14 Nov 2024
REC opinion
Further Information Favourable Opinion