{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T12:59:13Z","timestamp":1776949153598,"version":"3.51.4"},"reference-count":138,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV-serodiscordant heterosexual couples consist of one partner who is HIV-positive and the other who is HIV-negative. Our previous studies found that the HIV-negative female partner in no-prevention couples (NPC) may be affected by borderline personality disorder (BPD) and might have a history of child abuse, trauma, and neglect. These couples provide valuable insights into public health, particularly regarding health behaviors and psychosocial factors that influence the relationship between psychopathology, illness behaviors related to borderline personality disorder, and the transmission of sexually transmitted diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population and methods<\/jats:title>\n                    <jats:p>This study was conducted in three sequential phases. Phase One involved a cross-sectional, multicenter, anonymous survey of 175 HIV-serodiscordant couples, aimed at assessing preventive sexual behaviors. Participants reported sexual protection use during at-risk sexual encounters on a scale ranging from 0% (\u2018never\u2019) to 100% (\u2018always\u2019). Phase Two, which constitutes the core of the present investigation, employed qualitative, unstructured interviews and narrative analysis with HIV-negative female partners in serodiscordant relationships. The analytic focus was on identifying patterns of psychopathological comorbidity and health-related behaviors. Through iterative narrative synthesis and thematic coding, the presence of Borderline Personality Disorder (BPD) emerged consistently across cases. The confirmation of BPD as a clinical diagnosis was thus an outcome of this phase, derived from converging narrative indicators and psychopathological profiles rather than a pre-established inclusion criterion. Phase Three, drawing on the findings from both preceding phases, involved developing a theoretical model of the observed behavioral patterns. Integrating quantitative trends from Phase One with the qualitative insights from Phase Two, we developed a conceptual framework to explain the interaction between BPD-related psychopathology, relational dynamics, and HIV (or other sexually transmitted diseases) risk behaviors. This model aims to guide future healthcare strategies for HIV-negative women with BPD in serodiscordant relationships, a group identified as particularly vulnerable to sexually transmitted HIV due to compromised primary prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Specific health belief models and behaviors related to health emerged among HIV-negative female partners with BPD who decline prevention during behaviors that put them at risk for HIV sexual transmission in stable relationships with HIV-positive males. Results illustrate that women with BPD who have a history of child abuse and trauma often exhibit comorbid self-defeating personality disorder (SDPD), dependent personality disorder (DPD), and complex post-traumatic stress disorder (CPTSD). We could not replicate similar findings in HIV negative males.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The current study confirms that health behaviors and women\u2019s health may be influenced by underlying personality, behavioral, and psychosocial factors, which public health policymakers must address to improve primary prevention of transmissible diseases. We suggest that child abuse, neglect, and trauma may be connected to overlooked health behaviors across a person\u2019s entire life span.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1775933","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T12:08:41Z","timestamp":1776946121000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychiatric comorbidities and sexual health risks in HIV-serodiscordant heterosexual couples involving women with borderline personality disorder: a mixed-method study and theoretical modeling"],"prefix":"10.3389","volume":"17","author":[{"given":"Carlo","family":"Lazzari","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Intenational Centre for Healthcare and Medical Education (ICHME)","place":["London, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Rees","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Sunderland","place":["Sunderland, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yitka","family":"Graham","sequence":"additional","affiliation":[{"name":"Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland","place":["Sunderland, United Kingdom"]},{"name":"Faculty of Psychology, University of Anahuac","place":["Mexico City, Mexico"]},{"name":"University of Huddersfield","place":["Huddersfield, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Owens","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Sunderland","place":["Sunderland, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"B1","article-title":"Health psychology and philosophy e","volume-title":"Italian: Psicologia e filosofia della salute","author":"Lazzari","year":"2015"},{"key":"B2","article-title":"Can we stop sexual transmission of AIDS","volume-title":"Italian: Si pu\u00f2 arrestare la trasmissione sessuale dell\u2019AIDS?","author":"Lazzari","year":"1993"},{"key":"B3","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.copsyc.2015.05.002","article-title":"Social determinants and health behaviors: conceptual frames and empirical advances","volume":"5","author":"Short","year":"2015","journal-title":"Curr Opin Psychol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-7-104","article-title":"A review of health behaviour theories: How useful are these for developing interventions to promote long-term medication adherence for TB and HIV\/AIDS","volume":"7","author":"Munro","year":"2007","journal-title":"BMC Public Health"},{"key":"B5","first-page":"75","article-title":"Background on the health belief model","volume-title":"Health behavior: Theory, research, and practice","author":"Skinner","year":"2015"},{"key":"B6","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1592\/phco.22.5.282.33191","article-title":"Health literacy: a review","volume":"22","author":"Andrus","year":"2002","journal-title":"Pharmacotherapy"},{"key":"B7","volume-title":"Living with HIV when one partner is positive and the other is negative","year":"2024"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.33545\/26648962.2022.v4.i2a.51","article-title":"Samos syndrome, borderline personality disorder and pathophilia: why we cannot stop pandemics","volume":"4","author":"Lazzari","year":"2022","journal-title":"Int J Psychiatry Res"},{"key":"B9","first-page":"161","article-title":"Deliberate HIV infection as a way of committing suicide","volume":"1","author":"Lazzari","year":"1993","journal-title":"Ital J Suicidology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1089\/apc.1994.8.106","article-title":"AIDS has an increasing diffusion within the heterosexual population","volume":"8","author":"Lazzari","year":"1994","journal-title":"AIDS Patient Care"},{"key":"B11","doi-asserted-by":"publisher","first-page":"12","DOI":"10.9734\/bpi\/cidhr\/v7\/1271G","article-title":"Samos syndrome, women with borderline personality disorder and risk for sexually transmitted infections and HIV: their role during pandemics","volume":"7","author":"Lazzari","year":"2023","journal-title":"Curr Innov Dis Health Res"},{"key":"B12","article-title":"A guide to the psychological assistance of the HIV positive and AIDS patient","volume-title":"Italian: Guida all\u2019assistenza psicologica del paziente HIV positive e con AIDS","author":"Lazzari","year":"1992"},{"key":"B13","article-title":"Sex and AIDS. Can we stop sexual transmission of AIDS","volume-title":"Italian: Sesso e AIDS. Si puo\u2019 arrestare la transmission sessuale dell\u2019AIDS?","author":"Lazzari","year":"1993"},{"key":"B14","volume-title":"Voyage chez les l\u00e9preux","author":"Zambaco Pacha","year":"1880"},{"key":"B15","article-title":"Il silenzio del corpo","volume-title":"Engl: The Silence of the Body","author":"Ceronetti","year":"1979"},{"key":"B16","doi-asserted-by":"crossref","DOI":"10.9734\/bpi\/cidhr\/v7\/1271G","article-title":"Samos syndrome, women with borderline personality disorder and risk for sexually transmitted infections and HIV: their role during pandemics","volume-title":"Current innovations in disease and health research","author":"Lazzari","year":"2023"},{"key":"B17","article-title":"Sindrome di Samo","volume-title":"Wikipedia, L\u2019enciclopedia libera","year":"2023"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: a challenge for biomedicine","volume":"196","author":"Engel","year":"1977","journal-title":"Science"},{"key":"B19","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1177\/0269215517709890","article-title":"The biopsychosocial model of illness: a model whose time has come","volume":"31","author":"Wade","year":"2017","journal-title":"Clin Rehabil"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2017_31_289","article-title":"What comes first? Exploring the relationships between BPD traits, attachment, and childhood trauma","volume":"31","author":"Choi-Kain","year":"2017","journal-title":"J Pers Disord"},{"key":"B21","doi-asserted-by":"publisher","first-page":"18029","DOI":"10.1038\/nrdp.2018.29","article-title":"Borderline personality disorder","volume":"4","author":"Gunderson","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2008.07081360","article-title":"Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder","volume":"165","author":"Choi-Kain","year":"2008","journal-title":"Am J Psychiatry"},{"key":"B23","doi-asserted-by":"crossref","DOI":"10.1093\/med:psych\/9780199680375.001.0001","volume-title":"Mentalization-based treatment for personality disorders: A practical guide","author":"Bateman","year":"2016"},{"key":"B24","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1007\/s10461-013-0554-5","article-title":"Personality as a predictor of unprotected sexual behavior among people living with HIV\/AIDS: a systematic review","volume":"18","author":"Shuper","year":"2014","journal-title":"AIDS Behav"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"Singer","year":"2017","journal-title":"Lancet"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1080\/13691058.2017.1368711","article-title":"Negotiating sexual safety in the era of biomedical HIV prevention: relationship dynamics among male couples using pre-exposure prophylaxis","volume":"20","author":"Malone","year":"2018","journal-title":"Cult Health Sex"},{"key":"B27","volume-title":"Global HIV & AIDS statistics \u2014 2023 fact sheet","year":"2023"},{"key":"B28","volume-title":"HIV\/AIDS: Key facts","year":"2023"},{"key":"B29","volume-title":"HIV basics","year":"2023"},{"key":"B30","unstructured":"How is HIV transmitted?\n          \n          2023"},{"key":"B31","unstructured":"How HIV spreads\n          \n          2024"},{"key":"B32","unstructured":"How HIV is transmitted"},{"key":"B33","volume-title":"Borderline personality disorder","author":"Chapman","year":"2022"},{"key":"B34","volume-title":"Cognitive-behavioral treatment of borderline personality disorder","author":"Linehan","year":"1993"},{"key":"B35","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1186\/s12888-017-1383-2","article-title":"Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms","volume":"17","author":"Cattane","year":"2017","journal-title":"BMC Psychiatry"},{"key":"B36","first-page":"57","article-title":"Childhood maltreatment and borderline personality disorder","volume-title":"Theories of borderline personality disorder","author":"Salavati","year":"2025"},{"key":"B37","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"B38","volume-title":"Diagnostic and statistical manual of mental disorders. 5th ed, text revision (DSM-5-TR)","year":"2022"},{"key":"B39","volume-title":"The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines","year":"1992"},{"key":"B40","unstructured":"International classification of diseases for mortality and morbidity statistics (11th revision)\n          \n          2019"},{"key":"B41","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"B42","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/S0193-953X(18)30439-8","article-title":"The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism","volume":"12","author":"van der Kolk","year":"1989","journal-title":"Psychiatr Clin North Am"},{"key":"B43","volume-title":"Trauma and recovery: the aftermath of violence\u2014from domestic abuse to political terror","author":"Herman","year":"1992"},{"key":"B44","volume-title":"Personality and its disorders: A biosocial learning approach","author":"Millon","year":"1985"},{"key":"B45","volume-title":"Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R)","year":"1987"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.09.032","article-title":"Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD\u201111 Trauma Questionnaire (ICD\u2011TQ)","volume":"9","author":"Karatzias","year":"2016","journal-title":"J Affect Disord"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13099","article-title":"ICD\u201111 PTSD and complex PTSD in the WHO World Mental Health Surveys","volume":"140","author":"Cloitre","year":"2019","journal-title":"Acta Psychiatr Scand"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.112.1.3","article-title":"Dependent personality disorder: A review of etiology and treatment","volume":"18","author":"Bornstein","year":"2012","journal-title":"J Psychiatr Pract"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1037\/a0028257","article-title":"Personality disorder symptoms and marital functioning in a community sample","volume":"121","author":"Disney","year":"2012","journal-title":"J Abnorm Psychol"},{"key":"B50","volume-title":"Designing and conducting mixed methods research","author":"Creswell","year":"2018"},{"key":"B51","volume-title":"NVivo [Software]","year":"2024"},{"key":"B52","volume-title":"MedCalc statistical software [Software]","year":"2024"},{"key":"B53","volume-title":"Designing and conducting mixed methods research","author":"Creswell","year":"2017"},{"key":"B54","doi-asserted-by":"crossref","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs\u2014principles and practices","volume":"48","author":"Fetters","year":"2013","journal-title":"Health Serv Res"},{"key":"B55","article-title":"Three techniques for integrating data in mixed methods studies","volume":"341","author":"O\u2019Cathain","year":"2010","journal-title":"BMJ"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1177\/1744987116674257","article-title":"An overview of mixed methods research","volume":"21","author":"Doyle","year":"2016","journal-title":"J Res Nurs"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1177\/1558689806298224","article-title":"Toward a definition of mixed methods research","volume":"1","author":"Johnson","year":"2007","journal-title":"J Mixed Methods Res"},{"key":"B58","volume-title":"NVivo qualitative data analysis software","year":"2023"},{"key":"B59","volume-title":"MedCalc Statistical Software version 23.0.8","year":"2024"},{"key":"B60","volume-title":"Narrative methods for the human sciences","author":"Riessman","year":"2008"},{"key":"B61","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B62","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4135\/9781526405555.n2","article-title":"Thematic analysis","volume-title":"The SAGE handbook of qualitative research in psychology","author":"Terry","year":"2017"},{"key":"B63","volume-title":"Constructing grounded theory","author":"Charmaz","year":"2014"},{"key":"B64","volume-title":"Ethnography: principles in practice","author":"Hammersley","year":"2007"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1177\/10497323231217392","article-title":"Hybrid qualitative analysis: Integrating thematic, narrative, and ethnographic approaches","volume":"33","author":"Williams","year":"2023","journal-title":"Qual Health Res"},{"key":"B66","volume-title":"Qualitative inquiry and research design: Choosing among five approaches","author":"Creswell","year":"2013"},{"key":"B67","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1177\/135581960501000110","article-title":"Synthesising qualitative and quantitative evidence: a review of possible methods","volume":"10","author":"Dixon-Woods","year":"2005","journal-title":"J Health Serv Res Policy"},{"key":"B68","volume-title":"Qualitative research & evaluation methods","author":"Patton","year":"2015"},{"key":"B69","article-title":"Understanding HIV-risk behavior among adolescents in psychiatric care: links to child abuse and psychiatric disorders","volume":"44","author":"Donenberg","year":"2005","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B70","doi-asserted-by":"publisher","DOI":"10.1002\/cd.57","article-title":"Parent-adolescent communication about sex and birth control: a conceptual framework","volume":"97","author":"Jaccard","year":"2002","journal-title":"New Dir Child Adolesc Dev"},{"key":"B71","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1521\/pedi.2008.22.1.22","article-title":"BPD\u2019s interpersonal hypersensitivity phenotype: a gene-environment-developmental model","volume":"22","author":"Gunderson","year":"2008","journal-title":"J Pers Disord"},{"key":"B72","article-title":"Structured interview. Definition, guide & Examples","volume-title":"Scribbr","author":"George","year":"2022"},{"key":"B73","article-title":"Unstructured and semi-structured interviewing","volume-title":"The oxford handbook of qualitative research","author":"Brinkmann","year":"2014"},{"key":"B74","doi-asserted-by":"crossref","DOI":"10.7208\/chicago\/9780226702797.001.0001","volume-title":"Redesigning social inquiry: fuzzy sets and beyond","author":"Ragin","year":"2008"},{"key":"B75","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9781139004244","volume-title":"Set-theoretic methods for the social sciences: A guide to qualitative comparative analysis","author":"Schneider","year":"2012"},{"key":"B76","doi-asserted-by":"crossref","DOI":"10.1016\/0147-1767(85)90062-8","volume-title":"Naturalistic inquiry","author":"Lincoln","year":"1985"},{"key":"B77","volume-title":"The constructivist credo","author":"Lincoln","year":"2013"},{"key":"B78","volume-title":"The foundations of social research: meaning and perspective in the research process","author":"Crotty","year":"1998"},{"key":"B79","doi-asserted-by":"crossref","DOI":"10.4135\/9781483398969","volume-title":"The sage dictionary of qualitative inquiry","author":"Schwandt","year":"2015"},{"key":"B80","volume-title":"How to design studies and write research proposals: A guide for nursing, allied health and social care students","author":"Parahoo","year":"2024"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.1177\/1745691620969647","article-title":"Theory construction methodology: A practical framework for building theories in psychology","volume":"16","author":"Borsboom","year":"2021","journal-title":"Perspect Psychol Sci"},{"key":"B82","volume-title":"A user\u2019s guide to path analysis","author":"Olobatuyi","year":"2006"},{"key":"B83","volume-title":"Latent Variable Models An introduction to factor, path, and structure","year":"2016"},{"key":"B84","volume-title":"Successful qualitative research: A practical guide for beginners","author":"Braun","year":"2013"},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.1177\/070674370505000207","article-title":"Finding our way: An introduction to path analysis","volume":"50","author":"Streiner","year":"2005","journal-title":"Can J Psychiatry"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1177\/1077800410364740","article-title":"Using numbers in qualitative research","volume":"16","author":"Maxwell","year":"2010","journal-title":"Qual Inq"},{"key":"B87","volume-title":"Narrative analysis: An integrative approach","author":"Bamberg","year":"2020"},{"key":"B88","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780198237907.001.0001","volume-title":"Epistemic injustice: Power and the ethics of knowing","author":"Fricker","year":"2007"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.1111\/japp.12172","article-title":"Epistemic injustice and illness","volume":"34","author":"Kidd","year":"2017","journal-title":"J Appl Philos"},{"key":"B90","volume-title":"Transitions theory: middle-range and situation-specific theories in nursing research and practice","author":"Meleis","year":"2010"},{"key":"B91","volume-title":"Theoretical sociology: 1830 to the present","author":"Turner","year":"2007"},{"key":"B92","volume-title":"The discovery of grounded theory: strategies for qualitative research","author":"Glaser","year":"1967"},{"key":"B93","volume-title":"Symbolic interactionism: Perspective and method","author":"Blumer","year":"1969"},{"key":"B94","doi-asserted-by":"crossref","first-page":"57","DOI":"10.11648\/j.ajpn.20190703.12","article-title":"Psychiatry of radicalization and terrorism in the lone wolf, children, and women: An e-ethnographic approach for analysis","volume":"7","author":"Lazzari","year":"2019","journal-title":"Am J Psychiatry Neurosci"},{"key":"B95","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511815355","volume-title":"Situated learning: Legitimate peripheral participation","author":"Lave","year":"1991"},{"key":"B96","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3102\/0013189X018001032","article-title":"Situated cognition and the culture of learning","volume":"18","author":"Brown","year":"1989","journal-title":"Educ Res"},{"key":"B97","volume-title":"Symbolic interactionism and cultural studies","author":"Denzin","year":"1992"},{"key":"B98","doi-asserted-by":"publisher","DOI":"10.1007\/s40670-024-02074-0","article-title":"Vignettes as an innovative qualitative data collection tool in medical education research","volume":"34","author":"Western","year":"2024","journal-title":"Med Sci Educ"},{"key":"B99","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-057095","article-title":"Developing and using research vignettes to collect qualitative data from healthcare professionals: a scoping review","volume":"12","author":"Tremblay","year":"2022","journal-title":"BMJ Open"},{"key":"B100","doi-asserted-by":"publisher","DOI":"10.1177\/1468794112446107","article-title":"Anonymity and confidentiality in medical research: Ethical challenges of vignette methodology","volume":"13","author":"Wiles","year":"2013","journal-title":"Qual Res"},{"key":"B101","doi-asserted-by":"publisher","DOI":"10.1177\/1049732320944142","article-title":"Understanding healthcare professionals\u2019 decision\u2011making using scenario\u2011based qualitative methods","volume":"30","author":"Tremblay","year":"2020","journal-title":"Qual Health Res"},{"key":"B102","doi-asserted-by":"publisher","DOI":"10.17169\/fqs-20.1.3101","article-title":"Using fiction to reveal truth: Challenges of using vignettes to understand participant experiences within qualitative research","volume":"20","author":"Rizvi","year":"2019","journal-title":"Forum Qual Sozialforschung \/ Forum: Qual Soc Res"},{"key":"B103","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1017\/9781107295094.005","article-title":"Hypothetically speaking: Using vignettes as a stand-alone qualitative method","volume-title":"Collecting qualitative data: A practical guide to textual, media and virtual techniques","author":"Gray","year":"2017"},{"key":"B104","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual Res Sport Exercise Health"},{"key":"B105","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053","article-title":"Declaration of Helsinki: Ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"},{"key":"B106","volume-title":"Confidentiality in HIV\/AIDS counseling: Ethical considerations","year":"2024"},{"key":"B107","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780190649364.001.0001","volume-title":"The ethics of storytelling: Narrative hermeneutics, history, and the possible","author":"Meretoja","year":"2018"},{"key":"B108","doi-asserted-by":"crossref","DOI":"10.1201\/9781003107316","volume-title":"Secure searchable encryption and data management","author":"Gupta","year":"2021"},{"key":"B109","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1186\/s12889-021-11835-0","article-title":"Psychoeducational influences on sexual behavior in serodiscordant couples: A systematic review","volume":"21","author":"Antonini","year":"2021","journal-title":"BMC Public Health"},{"key":"B110","volume-title":"Thematic analysis: A practical guide","author":"Braun","year":"2021"},{"key":"B111","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-021-01182-y","article-title":"A worked example of Braun and Clarke\u2019s approach to reflexive thematic analysis","volume":"56","author":"Byrne","year":"2022","journal-title":"Qual Quant"},{"key":"B112","doi-asserted-by":"publisher","DOI":"10.1177\/1558689809334210","article-title":"On quantitizing","volume":"3","author":"Sandelowski","year":"2009","journal-title":"J Mix Methods Res"},{"key":"B113","article-title":"Trattato moderno di psicopatologia della sessualit\u00e0","volume-title":"Engl: Modern handbook of psychopathology of sexuality","author":"Liggio","year":"2010"},{"key":"B114","volume-title":"Eros, sexual diseases and society","author":"Lazzari","year":"1996"},{"key":"B115","volume-title":"International statistical classification of diseases and related health problems. 10th revision, Fifth edition","year":"2016"},{"key":"B116","first-page":"20","article-title":"Disturbo borderline di personalit\u00e0 e Depressione (It: Borderline Peraonlity Disorder and depression)","author":"Penati","year":"1991"},{"key":"B117","volume-title":"The psychology of love","author":"Freud","year":"1991"},{"key":"B118","article-title":"Il mito dell\u2019amore fatale","volume-title":"Italian: The myth of the fatal love","author":"Buchli","year":"2006"},{"key":"B119","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-319-28099-8_578-1","article-title":"Dependent personality disorder","volume-title":"Encyclopedia of personality and individual differences [Internet]","author":"Simonelli","year":"2017"},{"key":"B120","volume-title":"Women who love too much","author":"Norwood","year":"1985"},{"key":"B121","volume-title":"Daily meditations for women who love too much","author":"Norwood","year":"1997"},{"key":"B122","volume-title":"Diagnostic and statistical manual of mental disorders. 3rd ed. rev","year":"1987"},{"key":"B123","volume-title":"Women who hurt themselves: A book of hope and understanding","author":"Miller","year":"2005"},{"key":"B124","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.20241","article-title":"Mechanisms of change in mentalisation-based treatment of BPD","volume":"62","author":"Fonagy","year":"2006","journal-title":"J Clin Psychol"},{"key":"B125","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2007.07071125","article-title":"Disturbed relationships as a phenotype for borderline personality disorder","volume":"164","author":"Gunderson","year":"2007","journal-title":"Am J Psychiatry"},{"key":"B126","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12510","article-title":"Sexuality and sexual health among female youth with borderline personality disorder pathology","volume":"13","author":"Thompson","year":"2019","journal-title":"Early Interv Psychiatry"},{"key":"B127","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.914109","article-title":"My heart and my brain is what\u2019s bleeding, these are just cuts.\u201d An interpretative phenomenological analysis of young women\u2019s experiences of self-harm","volume":"13","author":"Norman","year":"2022","journal-title":"Front Psychiatry"},{"key":"B128","volume-title":"Psychology and philosophy of health","author":"Lazzari","year":"2015"},{"key":"B129","doi-asserted-by":"publisher","DOI":"10.1037\/0033-3204.41.4.472","article-title":"Trauma, dissociation and disorganised attachment: three strands of a single braid","volume":"41","author":"Liotti","year":"2004","journal-title":"Psychotherapy: Theory Research Practice Training"},{"key":"B130","doi-asserted-by":"publisher","DOI":"10.1002\/j.2051-5545.2010.tb00255.x","article-title":"Mentalisation-based treatment for borderline personality disorder","volume":"9","author":"Bateman","year":"2010","journal-title":"World Psychiatry"},{"key":"B131","article-title":"Chapter 3. Maladaptive behaviors in inpatients with borderline personality disorder: A behavioral game theory explanation","volume-title":"Borderline personality disorder: prevalence, management, options, challenges","author":"Lazzari","year":"2016"},{"key":"B132","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1080\/15299732.2019.1675113","article-title":"The relationship between ICD-11 PTSD, complex PTSD and dissociative experiences","volume":"21","author":"Hyland","year":"2019","journal-title":"J Trauma Dissociation"},{"key":"B133","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2020.43","article-title":"ICD-11 complex post-traumatic stress disorder: simplifying diagnosis in trauma populations","volume":"216","author":"Cloitre","year":"2020","journal-title":"Br J Psychiatry"},{"key":"B134","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2017_31_300","article-title":"Borderline personality disorder traits and sexual risk-taking: The mediating role of impulsivity","volume":"31","author":"Fossati","year":"2017","journal-title":"J Pers Disord"},{"key":"B135","volume-title":"International Statistical Classification of Diseases and Related Health Problems","year":"2019"},{"key":"B136","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.5.827","article-title":"Prediction of the 10-year course of borderline personality disorder","volume":"163","author":"Zanarini","year":"2006","journal-title":"Am J Psychiatry"},{"key":"B137","doi-asserted-by":"publisher","DOI":"10.1007\/s10465-019-09302-w","article-title":"Ghosts in the bedroom: embodiment wishes in couple sexuality","volume":"41","author":"Shuper-Engelhard","year":"2019","journal-title":"Am J Dance Ther"},{"key":"B138","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.045281","article-title":"Borderline personality disorder","volume":"172","author":"Paris","year":"2005","journal-title":"CMAJ"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1775933\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T12:08:59Z","timestamp":1776946139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1775933\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":138,"alternative-id":["10.3389\/fpsyt.2026.1775933"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1775933","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"article-number":"1775933"}}