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This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question.

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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and P.T.S.D.  (Read 19020 times)
Christopher
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« on: April 17, 2006, 10:35:14 AM »

Im told that today in physco circles the dx's of PTSD and BPD are virtually interchangeable...can I get some feedback please...thanks
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snaillady2
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« Reply #1 on: April 18, 2006, 07:23:42 AM »

Although PTSD and BPD can have very similar symptom profiles, PTSD and BPD differ in diagnostic criteria in that PTSD requires a traumatic event to be present in the patient's history, whereas BPD does not.  Even though a LOT of BPD sufferers have history of abuse, the disorder is prevalent enough in those without abuse backgrounds that abuse is not considered a criterion for diagnosis (one of the 9 traits as specified in the DSM-IV).

When dealing with a patient with both a traumatic personal history AND symptoms of BPD, some psychiatrists/psychologists are more likely to diagnose PTSD because it is more likely to be covered by insurance, whereas BPD is not.  Even in the absence of a true traumatic moment that one could identify for PTSD, drs may go to the PTSD diagnosis because it is more likely to be covered by health insurance for the longer term.

It's very hard taking into account diagnosis trends because the managed care network prevalent in the US has skewed doctors to diagnoses which will get the patient the most support from health insurance rather than being absolutely diagnostically correct.

Hope this clarifies some.

Snails
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mystique85
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« Reply #2 on: April 19, 2006, 11:45:06 PM »

BPD is a personality disorder and PTSD isn't. I think people define a personality disorder as something that causes problems in every aspect of your life and is nearly impossible to change.

PTSD is an anxiety disorder. I have PTSD. My symptoms are flashbacks, panic attacks, and ocassional explosive anger. The only time it causes problems is either if I am not doing anything and I zone out and have a flashback or if something triggers me, like a TV show with a violent rape scene or when people are extremely insensitive and blaming towards abuse survivors. My symptoms have been on different levels depending on the medications I was on (some antidepressants can worsen anxiety, which I found out the hard way.) I was in the hospital around the middle of February and got my medication stabilized, and I have not had an extremely bad freak-out since then. My PTSD does not affect me every day- it's just when certain situations are brought up that it hits me like an anvil. BPD affects people every day of their lives and their mood swings can happen within seconds. I think BPD is more than just fear, anger and sadness which is my experience with PTSD. I think people with BPD have the full range of mood swings, even going all the way into mania or euphoria, and it is much harder to identify what will trigger them. I think their mood swings are also a lot more intense and longer lasting. I mean if I have a panic attack I can go take an anxiety pill and within a half hour I will be considerably calmer. I don't think that BPD is that easy to control.
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GENERAL ANNOUNCEMENT

This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question.

Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board.

You will find indepth information provided by our senior members in our workshop board discussions (click here).

LavenderMoon
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« Reply #3 on: April 20, 2006, 01:37:48 PM »

Im told that today in physco circles the dx's of PTSD and BPD are virtually interchangeable...

typical of the psycho system to be clueless. they have a plaque hanging on their wall & charge money, not impressed.


post traumatic stress *disorder* is not a *disorder*.  it is so named to be covered by insurance.  but, most believe it truely is a disorder.


post traumatic stress *reaction*, post traumatic stess *syndrome*, or just post traumatic stress is the reality.  it is a reaction or order of changes that can occur after an event.

the psycho system needs to relearn it & rename it after every war.

judith herman, md, brings a lot of this out in her book, tauma & recovery.  she states that post traumatic is often misdiagnosed as bpd.
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jreilly
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« Reply #4 on: April 20, 2006, 04:22:45 PM »

t-shirt,

I'm going to add a little to what others have said about both PTSD and BPD.  BPD belongs to a group of thought disorders called "disorders of personality and character".  BPD by itself is not a mood disorder.  A thought disorder (in laymen' terms) is a flaw in how information is either received,  processed or worked on by the brain.  It's kind of like being in a fog: sometimes the fog is very heavy and nothing is correctly processed and at other times the fog lifts a little and things seem better.  But as Stuart C. Yudosfsy M.D. says in the title to his book Fatal Flaws: Navigating Destructive Relationships With People With Disorders Of Personality And Character, it is a fatal flaw.

PTSD belongs to a group of disorders that are called "anxiety disorders".  DSM-IV-TR (again in layman's terms) says PTSD" is characterized by the re experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma"  That's a mouth full.  A little history might help.  In WWI when soldiers could no longer function during combat and became withdrawn or irrational they called it "shell shock" thinking it was the result of concussions from exploding shells.  In WWII when like things occurred it was called "combat fatigue".  In Vietnam it got a new name: PTSD, because it was showing itself when soldiers returned to civilian life - after (post) combat. 

This is not to say that someone with BPD can't also have PTSD, yes they can.  But generally PTSD is what happens to ordinary people when their "brain circuits" (how's that for a layman's term) get overloaded and the mind says "enough - I give up".  Like others have said here it's very unfortunate that the current psychiatric world is driven to make incorrect diagnosis in order to be paid.  So many BPDs are being misdiagnosed as bipolar, and substance misuse/abuse is called pain management or adjustment disorders.  Sitting down in front of a therapist who knows your situation and having series of good questions about BPD and PTSD could help a lot.  Don't be afraid to demand that therapist take the time to answer your questions. 

Hope this has added more light than smoke to your questions.
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Skippy
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« Reply #5 on: April 21, 2006, 06:23:12 AM »

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong illness was diagnosed or whether there are comorbid (multiple) personality disorders at play. Bipolar and Major Depressive Disorder, for example, are far more responsive to pharmaceutical therapy than Borderline Personality.

~ If you are trying to get along better with your wife, it's not as important to precisely pinpoint the specific disorder or analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's important to know that the distinctions are not all that neat and tidy. In an NIH study, comorbidity with another personality disorder was very high at 74% (77% for men, 72% for women).  This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.
More info

In the study, comorbidity with mood disorders was also very high at 75% as was anxiety disorders 74%.

Mood/Anxiety Comorbidities ----
Anxiety Disorder
-Post traumatic stress
-Panic with agoraphobia
-Panic w/o agoraphobia
-Social phobia
-Specific phobia
-General anxiety
Mood Disorder
-Major depressive
-Dysthymia
-Bipolar I
-Bipolar II
More info
Men---------
-
30%
8%
16%
25%
27%
27%
-
27%
7%
31%
7%
Women------
-
47%
15%
21%
33%
47%
42%
-
37%
12%
33%
9%

Some helpful hints for sorting through this.

  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control

  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.

  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.

  • Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.   smiley  A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.

  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 

I hope this helps keep it in perspective.   smiley

Skippy



DIFFERENCES|COMORBIDITY: Overview of Comorbidity

Additional discussions...

Personality Disorders
Borderline and Paranoid Personality Disorder
Borderline and Schzoid/Schizotypal Personality Disorder
Borderline and Antisocial Personality Disorder
Borderline and Histrionic Personality Disorder
Borderline and Narcissistic Personality Disorder
Borderline and Avoidant Personality Disorder
Borderline and Dependent Personality Disorder
Borderline and Obsessive Compulsive Personality Disorder
Borderline and Depressive Personality Disorder
Borderline and Passive Aggressive Personality Disorder
Borderline and Sadistic Personality Disorder
Borderline and Self Defeating Personality Disorder

Other
Borderline PD and Alcohol Dependence
Borderline PD and Aspergers
Borderline PD and Attention Deficit Hyperactivity Disorder
Borderline PD and BiPolar Disorder
Borderline PD and Dissociative Identity Disorder
Borderline PD and P.T.S.D.
Borderline PD and Reactive Attachment Disorder (RAD)
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almondjoy
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« Reply #6 on: April 21, 2006, 03:52:46 PM »

Sometimes 'Complex PTSD' or DESNOS (disorder of extreme stress not otherwise specified) is considered to be the same as bpd. The term complex ptsd was originally coined by Dr. Judith Herman to describe the effects of long term abuse and exploitation. It's different from regular ptsd which occurs as the result of a single, isolated event. The following is from: http://www.ncptsd.va.gov/facts/specific/fs_complex_ptsd.html

Quote
What are the symptoms of Complex PTSD?

The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization. Those symptoms include:

* Alterations in emotional regulation, which may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger

* Alterations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body

* Alterations in self-perception, which may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings

* Alterations in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge

* Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer

* Alterations in one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair

My personal opinion is that a person can experience ptsd symptoms (emotional numbing, hyper arousal, dissociation, etc.) from prolonged exposure to an abusive environment, and not necessarily meet the criteria for bpd. It would be pretty amazing for someone to live through years of chronic abuse and emerge completely unscathed. However, this doesn't mean they will resort to using primitive defense mechanisms (splitting, etc.), or the interpersonal push/pull as seen in bpd.

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jr
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« Reply #7 on: April 21, 2006, 06:24:25 PM »


Just an aside... I think there are some doctors/researchers who subscribe to the notion that BPD might possibly be considered PTSD of a most severe and chronic degree. This would be based upon the supposition that the BPD-sufferer experienced some form of early childhood trauma or ongoing neglect or abuse. (Joseph Santoro, author of The Angry Heart?)

I can see how this correlates, especially in someone with a predisposition, but I do not believe it to be universal for *all* BPD-sufferers.

And certainly all who suffer from PTSD (or Syndrome) would not be considered to have BPD.


~ jr
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LavenderMoon
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« Reply #8 on: April 24, 2006, 04:38:53 PM »

i picked up 2 books yesterday.  one of them has a sub-heading stating:  "PTSD is a personality defect".
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argh

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« Reply #9 on: May 08, 2006, 06:13:59 AM »

I am also very interested in this topic.  I am not an expert, but from what I understand, Complex PTSD is PTSD accompanied with some BPD characteristics and is the result of long term trauma.
I believe that Complex PTSD is not yet officially recognized and is being proposed for addition to the DSM-V by Judith Herman.
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