A look at “Bridging the blind spot in psychotherapy research on personality disorders: a proposal for sexuality-related outcomes as indicators of therapeutic change” by Agnieszka Izdebska, Marta Elżbieta Szymańska-Pytlińska, Jerzy Bandel, Michał Marcin Sieński, Joanna Agata Franczyk and Monika Olga Jańczak (2026)
When researchers test whether a therapy works, they measure all sorts of things: mood, self-harm, relationships, how well someone is getting on at work. One thing almost never makes the list is sex. This Polish paper asks, rather pointedly, why not?
What they argue
This isn’t a study with participants. It’s a proposal, aimed at researchers working on therapy for people with a personality disorder diagnosis. These are long-standing patterns in how people feel about themselves, manage emotions and relate to others.
The authors make a simple case. Sexuality is tangled up with exactly the things therapy for personality difficulties tries to help with: identity, emotional regulation and intimacy. The diagnostic criteria themselves mention sexual behaviour and relationships. Yet when the authors looked at major reviews of therapy trials, they found that none measured sexual wellbeing directly. At most, it appeared as a single questionnaire item (“I have problems in my sex life”) buried in a broader score.
They review how four established therapies (mentalisation-based treatment, DBT, schema therapy and transference-focused psychotherapy) already touch on sexuality, often indirectly. Then they propose a framework of things future research could measure, built on a model of sexual development. It covers areas such as desire, pleasure, comfort with one’s own arousal, the ability to regulate sexual impulses, and the capacity for close, trusting relationships.
Crucially for an LGBTQIA+ audience, the authors are clear on one point. Gender identity is not a sign of a personality disorder, whether someone is cis, trans or nonbinary. Trying to change it in therapy would be unethical and amount to conversion practice. Therapy can support someone’s sense of self becoming more stable and coherent, but not change who they are.
A grain of glitter ✨
It’s a thoughtful, well-argued paper that names a genuine gap, and the authors call it “an early-stage conceptual exploration” themselves. There’s no new data, so none of the proposed measures has been tested yet.
Some of the indicators also need careful handling. Listing “level of sexual activity” or “sexual desire” as signs of therapeutic progress could, if used carelessly, imply that more sex equals better health, which doesn’t fit asexual people or anyone simply content with less. Sexual orientation is mentioned in passing but barely features in the framework. And some of the measures the authors critique (such as “feeling shy with the opposite sex”) show how heteronormative existing tools can be. Any new measures would need to be built with queer, trans and asexual people in mind from the start.
It’s also worth saying that “personality disorder” is itself a contested label. Many argue it can obscure the role of trauma and carry heavy stigma.
Why this matters
For many people, sex and intimacy are where the hardest feelings live: shame, fear, longing and confusion. If therapy research never asks about them, therapists may be less likely to as well. This paper is a nudge towards making it normal to talk about sexuality in therapy, safely and without judgement, as part of everyday wellbeing.
Here at the stable, every part of you is welcome in the room, including the sparkly bits people usually tiptoe around.