Our sexual behavior expresses not only our psychosexual makeup but also the entirety of our personality. Sex is the one realm of conduct which involves the full gamut of emotions, cognitions, socialization, traits, heredity, and learned and acquired behaviors. By observing one’s sexual predilections and acts, the trained psychotherapist and diagnostician can learn a lot about the patient.

Inevitably, the sexuality of patients with personality disorders is thwarted and stunted. In the Paranoid Personality Disorder, sex is depersonalized and the sexual partner is dehumanized. The paranoid is besieged by persecutory delusions and equates intimacy with life-threatening vulnerability, a “breach in the defenses” as it were. The paranoid uses sex to reassure him that he is still in control and to quell is anxiety.

The schizotypal individual develops a fear of, strong objection to, or incapacity for social interaction, due to the sum of their past social experiences being negative in nature. As infants they do not learn how to interact with others, and as children and adults this inability quickly makes them a target for other people.

The patient with Schizoid Personality Disorder is asexual. The schizoid is not interested in maintaining any kind of relationship and avoids interactions with others - including sexual encounters. He prefers solitude and solitary activities to any excitement sex can offer. The Schizotypal Personality Disorder and the Avoidant Personality Disorder have a similar effect on the patient but for different reasons: the schizotypal is acutely discomfited by intimacy and avoids close relationships in which his oddness and eccentricity will be revealed and, inevitably, derided or decried.

The Avoidant remains aloof and a recluse in order to conceal her self-perceived shortcomings and flaws. The avoidant mortally fears rejection and criticism. The schizoid’s asexuality is a result of indifference - the schizotypal’s and avoidant’s, the outcome of social anxiety.

Patients with the Histrionic Personality Disorder (mostly women) leverage their body, appearance, sex appeal, and sexuality to gain narcissistic supply (attention) and to secure attachment, however fleeting. Sex is used by histrionics to prop up their self-esteem and to regulate their labile sense of self-worth. Histrionics are, therefore, “inappropriately seductive” and have multiple sexual liaisons and partners.

The sexual behavior of histrionics is virtually indistinguishable from that of the somatic narcissist (patient with Narcissistic Personality Disorder) and the psychopath (patient with Antisocial Personality Disorder). But while the histrionic is overly-emotional, invested in intimacy, and self-dramatizing (”drama queen”), the somatic narcissist and the psychopath are cold and calculating.

The Somatic narcissist and the psychopath use their partners’ bodies to masturbate with and their sexual conquests serve merely to prop up their wavering self-confidence (somatic narcissist) or to satisfy a physiological need (psychopath). The somatic narcissist and psychopath have no sexual playmates - only sexual playthings. Having conquered the target, they discard it, withdraw and move on heartlessly.

The cerebral narcissist is indistinguishable from the schizoid: he is asexual and prefers activities and interactions which emphasize his intelligence or intellectual achievements. Many cerebral narcissists are celibate even when married.

Patients with the Borderline Personality Disorder and the Dependent Personality Disorder both suffer from abandonment and separation anxieties and are clinging, demanding, and emotionally labile - but their sexual behavior is distinguishable. The borderline uses her sexuality to reward or punish her mate. The dependent uses it to “enslave” and condition her lover or spouse. The borderline withholds sex or offers it in accordance with the ups and downs of her tumultuous relationships. The codependent tries to make her mate addicted to her particular brand of sexuality: submissive, faintly masochistic, and experimental.

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