BPD/CPTSD differential diagnosis

December 2, 2019 4:44 AM

An important person in my life is struggling with persuading mental health services that they have CPTSD (and a form of DID) instead of BPD. While I don't feel that specific diagnoses are always useful, it's important in this case because extensive previous treatment for BPD has not helped, in contrast with some (very limited) treatment they had for CPTSD and DID, which really did help. We want them to get more of the treatment that helps.

I'm looking for differential diagnosis info between CPTSD and BPD that we can offer to mental health professionals. So far, I have found this journal article which has a useful table and symptom profile. Can anyone offer anything else that might be useful, particularly if it's more recent? How do psychologists actually differentially diagnose in this area? Do they have any particular framework/s that they use?

posted by rrose selavy to Health & Fitness (6 answers total)

Honestly in this case find someone who works with cptsd and dissociative disorders as their specialty and then work on the diagnosis issues from there. Most people who work with this stuff know that the diagnosis history is convoluted and all over the place.

You are looking for someone who likely does EMDR in house (though WARNING, EMDR and dissociative disorders is a very difficult thing and you want the person doing it to seriously know what's up and what they are doing because things can go very sideways)

Avoid people who use DBT as a primary modality in general.

Again, The history you are describing is incredibly common for someone with this presentation. Finding appropriate therapy is an absolute minefield but it very possible. The Sidran Institutemay come up with names and they've got some good resources too. It is hard even in metro areas to find people who do this work, but they are out there.
posted by AlexiaSky at 5:48 AM on December 2, 2019 [4 favorites]

Please note that some ideas in DBT are useful, but overall DBT is not what you want.
posted by AlexiaSky at 5:57 AM on December 2, 2019 [1 favorite]

Response by poster: Thank you for the suggestion but this is not possible as we're talking about a public healthcare system not private - we're stuck with the Psychotherapist who has been assigned for the next appointment (at least for the time being).
posted by rrose selavy at 6:15 AM on December 2, 2019

What AlexiaSky said. Don't go for a general diagnosis from someone; look for an expert in this area and see that person. Actually look for at least three and make appointments with all three.

If the person seeking help identifies as female, quite often women's centres/shelters in the area will have lists of therapists. I found my best therapist by calling a women's centre in tears with their general referral sheet and asked the intake person to please point me at the best people on the list...she couldn't do that directly but got her opinion across.

Then in the first interview, ask about their experience with CPTSD/DID. Ask them about their understanding of prevalence, how long they think it takes on average for people struggling with those issues to access appropriate treatment (spoiler! Almost 10 years!), ask them about how they establish safety, what techniques they use. Go with the person that is most knowledgeable and thoughtful.

The terrible thing about looking for help with DID is that many therapists still are following completely outdated views around prevalence and treatment. So there's a weight in the system that prevents accurate diagnosis up front; it helps to stack the deck a little by seeing people who acknowledge that it exists and that in fact in its presentation it can resemble BPD.

... I just read your update and I think in that case, the best thing to do is present what's helped and what hasn't helped. But if you can ask for a referral if that therapist doesn't seem to believe the client/patient, that might be a way to go. In the article I linked, it does talk about differentiating between BPD and DID, so you might take that to the therapist for discussion.
posted by warriorqueen at 6:19 AM on December 2, 2019 [1 favorite]

I've read your comment history and it looks like you're in the UK. Be aware that the answers you get from Americans are going to be wildly unhelpful if they assume that the context you're operating in is similar to theirs. It is not. Psychologists here are unlikely to make a diagnosis at all, that's something a psychiatrist would do, although a psychologist may suspect a diagnosis and refer to a psychiatrist based on that. What I'd suggest is that your person tries to get a referral to the trauma and dissociation service at the Maudsley hospital in London. They take referrals on a national basis from "Clinical Commissioning Groups, Consultant Psychiatrists, IAPT, Community Mental Health Teams, GP or GP Consortia", so the psychologist you've been assigned may be able to make the referral. They do assessments and differential diagnosis there. In the mean time, I'd focus less on getting the psychologist to make a diagnosis (which they are unlikely to do) and more on trying to get them to use modalities that have worked, and avoid ones that haven't.
posted by Acheman at 11:23 AM on December 2, 2019 [4 favorites]

Here is another article that talks about differentiation. You might find the NICE guidelines useful (they subsume c-PTSD under PTSD).

That said... there's a whole debate over BPD/cPTSD/DESNOS/DTD and another one over the nature of dissociative disorders, but I think the trauma therapy approach is generally: treat dissociation + past trauma before emotion dysregulation. (& yep, EMDR without stabilizing dissociation/ BPD is very risky.)
posted by ahundredjarsofsky at 12:15 AM on December 8, 2019