talk to me about C-PTSD and borderline personality disorder
June 20, 2021 7:20 AM   Subscribe

I want to learn more about the link between the two.

A counselor told me that the biggest indication of BPD is a stressful childhood.

My therapist said that C-PTSD results from prolonged exposure to traumatic events.

I have been diagnosed with both, but the symptoms overlap significantly. Both stem from watching my mother slowly die of cancer, watching the horror of her cancer treatment, and my father's neglect of me in caretaking her, including a refusal to put me in therapy to process her illness as it was happening and a refusal to put me in grief counseling when she passed. I never dealt with my fear and my grief and in late 2019, nearly 25 years after she passed, I had a nervous breakdown that has been clearly traced with my childhood experiences. The counselor I spoke with about BPD says that my description of my childhood was one of the most stressful childhoods she had heard in her career.

However, I read somewhere (maybe even on Metafilter) that some mental health professionals feel that BPD and C-PTSD are essentially the same thing, and some feel that BPD is over-diagnosed as a result. Because BPD has such a stigma, even in the mental health community (some practitioners refuse to treat people with BPD, even now), this can result in a patient who doesn't have a chance at recovery.

I have not been able to find much information on the mental health professionals who believe these two diagnoses are basically the same personality disorder. I am curious to learn more about this but don't know where to begin to look. Does anyone have any insight as to where I might find the research on this topic? I have heard that there is one mental health practitioner in particular who wants to remove BPD as a diagnosis because she genuinely believes that C-PTSD is a more accurate diagnosis for those with the symptoms of BPD. Given the overlap in symptoms in my diagnoses, I am intrigued and curious to look into this more.

Thanks in advance for any help you can provide.

One last thing: I would appreciate if those who choose to answer refrain from disparaging those diagnosed with BPD. In particular, the book I Hate You Don't Leave Me is not something I am interested in; that book is basically a litany of disgust and hatred towards those with BPD. I know there are other MeFites with BPD here, and it is hurtful to read comments about how we are essentially psychopathic and harmful to loved ones and unsaveable. In my experience this is untrue; DBT has helped me tremendously and I almost don't meet the diagnostic criteria for the disorder any longer after a year of DBT. Those of us who want to change can. I understand that many people have been hurt and traumatized by the often frightening behavior of friends or family with BPD, and I understand and am empathetic to that pain. However, the last time I asked about BPD and BPD treatment here I was met with a few answers that basically made me feel horrible about myself and that I didn't deserve to be loved or cared for. The stigma is real and painful. But many of us want to heal and get better. I am begging you to please opt out of answering if your answer is simply that BPD can't be cured and people should run far from us with this diagnosis.

Thank you.
posted by nayantara to Health & Fitness (10 answers total) 17 users marked this as a favorite
I'm sure other people will have research, although I'd start with the names in this article here, but I can share a bit of community discussion left over from the early 00s. At that time C-PTSD wasn't a thing but there was more willingness to diagnose DID/MPD (as well as some iatrogenic/mistaken diagnoses. Not interested in debating, people are suuuuuper weird about the idea of multiple personality.)

Because BPD involves a lack of a sense of self, at that time it was kind of a hot debate whether people with MPD/DID were "actually" people with BPD who were somehow "getting attention"* for having multiple personalities. But if you think about it, people with BPD also display sort of...I don't want to say lack of childhood development milestones but kind of, like they haven't been able to develop certain things like object permanence, etc.

And people with MPD/DID have people/personalities/alters who have by definition not passed through those milestones (inner children, etc.) so of course in an adult body they are going to display criteria for BPD at times, especially if your diagnostician's base stance is "adults should do XYZ."

I suspect the same thing is going on with C-PTSD because I suspect that C-PTSD is standing in a little bit for MPD/DID, in that all three kind of fit into a cluster of "shit went down, whether biochemical or external trauma, people's development went off of human standard."

The reason I'm outlining all this for you is in my lifetime alone, all three of those disorders, often diagnosed in women (all forms of PTSD at least also have a chunk of male soldiers/etc. so fortunately they get more cachet than the ones where women are more often diagnosed) have had porous boundaries depending on the person who is diagnosing them.

Because BPD has such a stigma, even in the mental health community (some practitioners refuse to treat people with BPD, even now), this can result in a patient who doesn't have a chance at recovery.

I want to gently push back on the idea that a patient's recovery doesn't have a chance. Whether your therapist/doctor/care team is operating under BPD or PTSD or any other umbrella, the actual treatment will focus on the person's needs and goals. Stigma makes treatment harder to access, and community harder, but it really is about getting the drugs and tools and skills you need. I do know people diagnosed under all three disorders who are having great and healthy lives. it sounds like you are in that category too.

* Other than 3 people on Oprah, I'm never really sure what kind of great attention you are supposed to get for being multiple or having any mental difference or unusual identity.
posted by warriorqueen at 8:08 AM on June 20, 2021 [1 favorite]

Best answer: From trying to determine the difference between the two and to figure out what is affecting me, I've gathered that there are some similarities but if you do a google search of BPD vs CPTSD you'll find that some obvious and distinguishing traits, like fear of abandonment, inappropriate anger, and extremely unstable relationships are unique to BPD.

The way I see it is that they are both trauma reactions, but CPTSD is perhaps 'lighter' and less defining of the person. Like something that happens on top of a fully formed personality, whereas BPD is more insidiously part of who you are. I've asked my therapist "what if it's not BPD but CPTSD that I have!" and she said it literally does not matter, these are just labels, they're not entirely accurate for anyone. They're guidelines. Ultimately what matters is what your unique triggers and cognitive distortions are.

Also, as someone with BPD, I disagree strongly with the 'object permanence' concept. Unless I'm misunderstanding what is meant by it, it sounds absurd to me to say that we 'missed' some kind of developmental milestone. It sounds like a lazy, old-timey pseudo-science idea. I have object permanence! When my partner leaves, I don't think that he ceases to exist, or his departure means he no longer loves me. What does happen though, is that the sad thoughts begin to seep in––the foundational BPD thoughts that I am unlovable, unsatisfiable. I just convince myself daily that he's lost interest and need an impossible amount of reassurance. We have a hard time differentiating real interest and care from abuse... it's more complicated than: he's not there = abandonment.

The reason that people with BPD think so, is because they *have* been abandoned and have not had models of healthy interaction. People with BPD have almost unanimously had very difficult, lonely upbringings, have endured serious cruelty and abandonment. I see BPD as a natural response of a healthy, rational mind to protect itself against further abandonment and cruelty. In adulthood the dysfunctional coping mechanisms no longer serve you and need to be replaced. I don't see BPD as a mental illness so much as a set of dysfunctional coping mechanisms that are very very set in stone and define one's worldview.

Another hot take: one major reason borderline patients are so difficult to treat is because they do everything they can to avoid being helped because they deeply believe no one actually wants to help them, and in many cases just wants to hurt them. Why? Because that's all we've ever known! When you're raised by narcissists, you have parents who are actively and consistently malicious towards you and want you to suffer. Of course it's hard to trust people after that. I am in disbelief that love between people can exist. Thanks to therapy I now see evidence for it, though, and though foreign and new to me, I am starting to see that there is a healthier way to live.

Some psychologists believe that all personality disorders are essentially the same 'thing', which I agree with. CPTSD and DID seem different, though.
posted by saturday sun at 9:14 AM on June 20, 2021 [22 favorites]

Thank you for posting this. I was dx with BPD in my early 20s. Looking back CPTSD fits much better. And I'm also glad I'm not the only one who hated and found that book insulting. The shrink at the hospital was all gung ho that I was BPD after just a few meetings. Psychiatrists and psychologist that I've worked with since just shake their heads. That dx really messed with my head.
posted by kathrynm at 10:52 AM on June 20, 2021 [3 favorites]

Best answer: I have heard that there is one mental health practitioner in particular who wants to remove BPD as a diagnosis because she genuinely believes that C-PTSD is a more accurate diagnosis for those with the symptoms of BPD.

I'm not a scholar or someone who works in the mental health field, which makes me less well equipped than other MeFites to address your question.

But I have come across one practitioner -- a man who is a counseling professor in the US – and a researcher -- a woman who is a psychiatry professor in Australia – who question the accuracy of the BPD diagnosis.

In a 2003 article, Shannon Hodges, a professor of counseling at Niagara University in New York state who also counsels in community agencies, states that BPD is a "nebulous diagnostic category" that fails to account for the impact of social and historical stressors on patients; that discredits women as court witnesses in cases involving sexual assault, and that makes patients more vulnerable to institutionalization, forced medication, and loss of parental rights.

He concludes:
... The saying "If it ain't broke don't fix it" has become a cultural cliche in society. Unfortunately, there is often much denial regarding what is broken and what needs fixing. Certainly, the current ability to manipulate and attach pejorative labels such as borderline personality disorder to women in order to avoid facing deeper societal ills (e.g., sexual assault, domestic violence, and poverty) is clearly in need of fixing. The current system of mental health care undoubtedly requires the use of the DSM-IV regardless of questions regarding its validity. Given such realities, it is my conclusion that the DSM-IV's separate categories of PTSD and BPD should be combined, with BPD reclassified as a subcategory of PTSD. This reclassification would also formally recognize the overlapping nature of the two disorders and potentially destigmatize posttraumatized women diagnosed with BPD. Given that the reliability and validity of the BPD diagnosis is questionable (Becker, 1997; Francis & Widigen, 1987) and that BPD has remained almost exclusively a diagnosis applied to women, a destigmatization and general overhaul of the BPD category is a necessity.
In 2017, Jayashri Kulkarni, a professor of psychiatry at Monash University in Melbourne, focusing on issues in women's mental health, published an article for which only the abstract is available.

Kulkarni asserted that "trauma, in its broadest definition, plays a key role in the development of both c-PTSD and BPD" and that the overlap between the conditions, combined with the stigma of BPD, makes a good case for "using the diagnostic term ‘complex posttraumatic stress disorder’ to decrease stigma and provide a trauma-informed approach for BPD patients."

In 2019, Kulkarni took on this topic again, co-authoring, with Patrick Walker, an adjunct research associate at Monash, an article for The Conversation. (Which I highly recommend, BTW. It's a nonprofit news organization that vets and publishes research by scholars from all over the world in order to make it more accessible to the public.)

Kulkarni and Walker wrote in response to research that showed that Australians with BPD face major barriers when they seek high-quality, affordable care. The headline – "We need to treat borderline personality disorder for what it really is: a response to trauma" – for once accurately reflects the authors' thesis.

The authors point out that "the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) does not mention trauma as a diagnostic factor in BPD, despite the inextricable link between BPD and trauma. This adds to viewing BPD as what its name suggests it is – a personality disorder."

Changing the name of the condition, they say, would "(link) BPD to trauma (and) could alleviate some of the stigma and associated harm that goes with the diagnosis, leading to better treatment engagement, and better outcomes."
posted by virago at 11:57 AM on June 20, 2021 [4 favorites]

Best answer: I would argue that diagnoses are not some kind of Permanent Record, they are at best an educated opinion and at worst prejudiced garbage, and if you want to approach a documented specialist in C-PTSD and say you want to explore that as a potential treatment path - so the goal is the treatment methodology and not simply a diagnosis - that would be a workable path forward.

I am one of those people who feel like BPD diagnoses are mostly institutionalized misogyny and a way of gatekeeping "trauma" to only apply to manly shit like wars and industrial accidents.
posted by Lyn Never at 12:07 PM on June 20, 2021 [5 favorites]

Best answer: I am just in the process of reading Trauma and Recovery by Judith Lewis Herman, which is a classic text on C-PTSD. I think she was the person who came up with the term and the definition? Anyways, she has a lot to say about the relationship between the diagnosis of BPD and C-PTSD, if you want to find her book or some of her other work. Trauma and Recovery in particular is a very readable and eye-opening book, so I would highly recommend looking for a copy. It also goes into the reasons and how certain diagnoses (BPD, hysteria, shell shock, etc) become either fashionable or get dismissed by clinicians over time.
posted by EllaEm at 12:15 PM on June 20, 2021 [4 favorites]

Some people maintain that the two are different conditions because there is some significant number of people diagnosed with BPD who do not report childhood trauma, which is usually translated into a claim that a significant number of people with BPD did not experience childhood trauma. this is, as you can see, a different claim.

but what I think this means is that the distinction between the two is of greatest importance to people who do have symptoms but do not have an identifiable trauma history, and urgently need to be able to access treatment not reserved for those with C-PTSD. It used to be the case that people pushed hard to replace BPD with C-PTSD because personality disorders were not only stigmatized but supposed to be incurable by definition, and so instead of adjusting the definitions when patients surprised them, psychiatrists preferred to invent new categories. but I think most reputable professionals will now admit that people are not required by a law of nature to keep all of their troubles forever just because the big book says they ought to.
posted by queenofbithynia at 12:28 PM on June 20, 2021 [1 favorite]

There's another category of mood disorders? For legal reasons, our family member got a BPD diagnosis early and then later was re-diagnosed with a mood disorder, Axis 2 something-something which was apparently the current version of BPD with more granularity. But also with CPTSD. When I was doing my research, it was that some people without a history of childhood trauma still developed BPD and there seemed to be a strong family history to imply it was a separate condition that worsened with childhood trauma, BUT it was also definitely an institutional misogyny disorder as well as a catch-all.

I don't these days feel so bad about nebulous disorders because I have had the experience of having one for a rare physical condition that is idiopathic, ie: no known cause, and they had to label it *something* for the giant bureaucracy of medicine to be able to cheaply and effectively treat it. Sometimes you really do need to check a damn box to get to help someone. And looking back, that checked box helped the family member access a lot of help otherwise inaccessible because CPTSD was still an academic idea in our area.

And if it helps, that family member after a very difficult period, has stabilised, employed and is in a small but supportive network of relationships. Most people with BPD stabilise after a rough period. That you are already in treatment and self-aware - whether it is BPD, CPTSD and/or mood disorders, you are halfway up the hill and sound like someone who is shaping and understanding themselves with a lot of clarity.
posted by dorothyisunderwood at 3:37 PM on June 20, 2021 [1 favorite]

Best answer: IMO, borderline personality disorder and PTSD are pretty much the same thing (especially when you look at measurable physical brain effects), except women tend to get diagnosed with the former and men tend to get diagnosed with the latter.
posted by Jacqueline at 8:32 PM on June 21, 2021

Best answer: Here is a webinar on the differences (and significant overlap) of C-PTSD and BPD presented by Lois Choi-Kain, who is a specialist in BPD.
posted by gemutlichkeit at 3:34 PM on June 23, 2021 [1 favorite]

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