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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and P.T.S.D.  (Read 15665 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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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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vasilisa
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« Reply #10 on: May 08, 2006, 07:26:42 AM »

Just on a personal note: I was diagnosed with PTSD after surviving a brutal attack, and my therapist said it might be complex PTSD since I had all the childhood abuse issues on top of the attack as an adult. 

My main symptoms were bad dreams and having anxiety nearly all the time, I started to avoid some safe situations, like parties, just because I knew I'd get so scared there and I was afraid of looking foolish by being so scared.  I was worried that I had BPD, but my therapist told me that I was still able to percieve reality just fine so that was a big difference.  Like I was anxious all the time and would think "this is silly, I know I'm safe, so why am I so scared?  I guess I'd better get some help!"  While my BPD mother is anxious all the time, but her thinking is "I'm so scared!  Who is causing it?  It must be you making me scared! You're just evil!  I can tell you're plotting against me!" 

So mainly it was the extent that the problem distorted reality and also my reactions to it.

As far as complex PTSD goes--I understand it's more a term to describe trauma after trauma,
but different people can have different severities.

And I'm doing a lot better after just a few months of therapy--it's not just helping with the attack but also with all the other issues.  I don't have as many dreams and I still get scared sometimes but most of the time I can do normal things and be ok.
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NewLifeforHGG
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« Reply #11 on: May 08, 2006, 05:48:18 PM »

V-we have similar stories.
I was diagnosed with PTSD. Possible complex after being assaulted.
I am working with a trauma specialist who is helping tremendously.
I am glad you are doing better.

argh-I am hoping some experts here can shed some light on this.
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tigereyes
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« Reply #12 on: May 08, 2006, 06:32:09 PM »

I've thought about this a lot.

My layman's understanding is that PTSD and complex PTSD have clearly established external causes. Simple PTSD = single incident trauma (assault, accident); Complex PTSD = repetitive trauma (abuse, combat stress). Some people who experience trauma do not have PTSD (e.g., only half of rape victims get it), but everyone who has PTSD has experienced trauma.

We're not really sure what causes BPD. We think that in general, it's a combination of early childhood trauma combined with a genetic predisposition towards high emotionality. However, some people appear to have BPD without any serious traumatic causes (see the section on this board for parents of BPD children).

I had some BPD-like behavior following a stalking incident in college - cried easily, hypervigilant, hypersensitive, overreacting to others - but in retrospect, this was PTSD.

So it's perfectly possible for both to co-exist, but they're also separate. The specifics are fuzzy. How's that for a brilliant non-answer? :smiley
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jreilly
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« Reply #13 on: May 08, 2006, 07:28:28 PM »

BPD is a "Fatal flaw(s) [that are] brain-based dysfunctions of thinking and inpulse that lead to persistent patterns of personality and behavior that betray trust and destroy relationships."  This is the opening line in Stuart C. Yudofsky, M.D. work Fatal Flaws: Navigating Destructive Relationships With People With Disorders Of Personality And Character (APA Press).  PTSD (as defined in DSM-IV-TR) is "the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity..."  These may seen like mouth fulls of words, but they are different in many respects.  BPD affect how the brain thinks or processes the intake of knowledge.  PTSD is an emotional response to trauma.  The difference between emotions, impulses and thoughts are vastly different. 

Persons with emotional disorders can often redirect their feelings with both therapy and medications.  Persons with thought disorders mostly deny ever doing anything wrong, and therefore they see no reason to change anything. BPD is part of the cluster of personality disorders, that also include the following thought disorders:

Hysterical (Histrionic) personality disorder
Narcissistic personality disorder
Antisocial personality disorder
Obsessive-Compulsive personality disorder
Schizotypical personality disorder   

PTSD can be modified and with a lot of patience, therapy and some times medication, can be controlled.  BPD can seldom be modified without intensive 5-10 years of expensive therapy, constant self examination and extreme desire to change.   
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almondjoy
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« Reply #14 on: May 12, 2006, 11:49:42 PM »

I recommend this article written by experts in the field of complex trauma. As I understand it, the term DESNOS (disorders of extreme stress not otherwise specified) is interchangeable with complex ptsd.

The following is from: www.traumacenter.org/DESNOS.pdf

Characteristic of DESNOS is trauma which involves interpersonal victimization, multiple traumatic events, or events of prolonged duration. Disturbances in six areas of functioning are required for the diagnosis: (1) regulation of affect and impulses; (2) attention or consciousness; (3) self-perception; (4) relations with others; (5) somatization; and (6) systems of meaning. The authors offer clinical examples of each of these and go on to describe psychometric tests that can be used as valuable diagnostic aides.

DESNOS vs BPD
Empirical research has established that the BPD and DESNOS diagnoses in general represent overlapping but distinct symptom profiles. On the surface, these disorders may appear to be quite similar, as both relate to aspects of four of the six domains of self-regulatory deficit captured by the DESNOS construct (i.e., affect, attention/consciousness, self-perception, and relationships). Several important distinctions exist, however, between DESNOS and the classic BPD construct, including notable differences in the relative importance and nature of disruptions in these four domains of self-regulation. For instance, whereas chronic affect dysregulation is the hallmark feature of DESNOS, this symptom is secondary to disturbances in identity and relationships with others in BPD. In essence, BPD represents a disorder of attachment, while DESNOS is considered by most leading clinicians and researchers in the field to be better understood as a disorder of self-regulation.

Affect Regulation
Affect in DESNOS patients is more chronically and persistently emphasized in the direction of a downward dysregulation than is the case in BPD patients, who in contrast exhibit greater range in their capacity for transient upward emotional spikes. The continuum of mood in patients with DESNOS typically ranges from a dysthymic/anxious baseline to profound states of rage, terror, or hopelessness. The brief periods of excitement, positive anticipation, and euphoria observed in BPD patient—often associated with transient idealizations of new intimate others or treatment providers—are less commonly observed to be components of a true DESNOS symptom presentation. In fact, a cardinal but under-recognized feature of DESNOS patients is their profound deficit in the capacity to sustain positive emotional states, experience pleasure, and become absorbed in positive and present-focused states of awareness.

Relationships
The nature of interpersonal dysfunction characterized by the DESNOS construct varies from that of the BPD diagnosis as articulated in the DSM-IV. The BPD patients fundamental interpersonal orientation is an active one: an approach-based stance characterized by the duality of desire and disillusionment. BPD is often characterized by the oscillation between intense longing and search for idealized (and therefore unrealistic and ultimately untenable) relationships, and the equally intense devaluation and ultimate sabotage of these relationships. Conversely, when an intimate other threatens to pull out of what had been perceived by the patient to be an unsatisfying relationship, the BDP patient can become overcome with a resurgence of desire to maintain this relationship occasioned by desperate fear of abandonment and rejection by the other. In other instances, the BPD patient will concoct, and become temporarily consumed by vaguely articulated fantasies of a “perfect” future with a new caregiver or potential lover, only later to feel the sting of disappointment at the others inability to fill the profound emptiness at the core of his or her own being. As has been well established and the subject of much of the clinical literature on BPD, these patterns typically manifest themselves early in these patients transference responses to new treatment providers.

In contrast, the basic interpersonal orientation of the DESNOS patient is passive in nature, characterized by a duality of avoidance and revictimization. For example, these patients often engage in prolonged periods of self-inflicted social isolation and avoidance of intimate contact. At other times, however, they report abruptly discovering themselves to be in the midst of an intense emotional relationship that feels unsafe or out of control. In fact, when DESNOS patients do enter intimate relationships, it is often as a result of being the target of victimizing others who have been drawn to these patients emotional vulnerability, underdeveloped capacity to identify danger cues, and tolerance for violence and boundary violations as an inherent component of intimate relationships. DESNOS patients are often observed, to the chagrin of their therapists, to reenact their interpersonal traumas, repeatedly finding themselves helplessly playing out the role of victim, or, alternately, compelled to victimize others in ways similar to those experienced in their own history of childhood traumatization.

DESNOS patients not only tend to fear and believe themselves to be unworthy of meaningful relationships with others; they are generally incapable of imagining a future for themselves in which they can love and be loved in a relationship that is free of abuse. Given this pessimism about the potential for positive interpersonal connection and general distrust of others, DESNOS patients are not surprisingly somewhat less likely than patients with BPD to engage in boundary violations and intrusiveness with their therapists at the outset of treatment. In contrast, they often present as apprehensive, guarded, and at times hostile toward new treatment providers. The establishment of safety and trust is perhaps the most important component of the initial phase of treatment with these patients.

Dissociation
Dissociative symptom presentations differ notably in patients with these two disorders. Dissociative symptoms associated with BPD are characterized by transient responses to stress, the occurrence of which is not required to meet diagnostic criteria. Clinical research on dissociative symptomatology as measured by the DES has consistently found that patients with BPD report lower levels of dissociative symptoms than patients with PTSD. 88 In contrast, the presence of significant dissociative symptomatology is an essential and required component of the DESNOS diagnosis. These symptoms may take a variety of forms ranging from episodic experiences of derealization to lasting psychogenic amnesia for portions of ones traumatic experiences, to the presence of Dissociative Identity Disorder.

Self-Perception
The following distinctions can be made regarding the type and extent of disturbances in self-perception observed in these two disorders. Whereas the primary feature of disturbance in self-perception for patients with BPD involves a fundamental confusion about self, the DESNOS patient experiences a self that has been permanently damaged and alienated from others. At the core of identity disturbance for patients with classic BPD lays the absence of a sense of self or ego identity, and the persistent affective experience of emptiness associated with the void left by the unformed self. Perhaps the key component of the severe psychopathology of these patients is the intolerable black hole of this void that always beckons, making the risk for suicide a constant consideration in treatment. DESNOS patients, in contrast, although plagued by negative affect states of guilt, shame, and ineffectiveness associated with their experience of a damaged self, nevertheless possess, on some fundamental level, a basic core sense of identity, albeit often the problematic dual identity of victim and patient. In fact, their desperate clinging to trauma-based identities as victim/patient is often quite pronounced, as it becomes a source of personal meaning-making and provides a compelling explanatory model for and source of “proof” of their chronic experience of interpersonal suffering and emotional pain. For such patients, this identity formation is perhaps the greatest obstacle to genuine treatment progress.
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cockeyedoptimist
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« Reply #15 on: May 13, 2006, 08:47:32 PM »

AlmondJoy, thanks for the link to the full article and for posting the excerpts.  Reading them has helped me to get a better perspective on the disorders and on my own "diagnosis".  I have been diagnosed with PTSD before and my last T and I talked about DESNOS, but I did not really understand it... I do now though, so thank you.

What struck me the most was where the author of the article stated that one of the differences between BPD and PTSD and DESNOS is a sense of self.  BPDs have none where as those with DESNOS have one, but it is permanently damaged given the early onset of prolonged abuse.  While the optimist in me bristles a bit at the author's use of the word "permanent", the statement does ring true.

As for the co-morbidity issue asked about in this thread and as discussed in the articles, I am reminded of something an old T of mine once said:  "I never diagnose someone as having BPD until any trauma issues have been addressed.  If the characteristics are still there after that, then I will consider BPD."  That makes a lot of sense to me especially when I consider that the motivation behind certain behaviors and the thoughts and core beliefs involved are not immediately apparent to the patient or to the therapist. 

Thanks again,

Carol
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almondjoy
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« Reply #16 on: May 15, 2006, 07:54:29 AM »

Hi CEO - You're welcome. I'm glad to hear it was helpful.

Quote
What struck me the most was where the author of the article stated that one of the differences between BPD and PTSD and DESNOS is a sense of self.  BPDs have none where as those with DESNOS have one, but it is permanently damaged given the early onset of prolonged abuse.  While the optimist in me bristles a bit at the author's use of the word "permanent", the statement does ring true.
I'm hoping the authors meant that the patient experiences a sense of permanent damage, as opposed to the self actually being permanently damaged. Unfortunately, it rings all too true for me as well. It seems I knew I had a sense of self. It's just that I believed there was something somehow permanently flawed, weird and damaged about it. This lead to the belief that I couldn't trust my own instincts, and during the worst times, couldn't trust my own perceptions or version of reality either. I think this was due, at least in part, to the early onset of prolonged abuse because I had no other frame of reference by which to assess myself except through the distorted views my caretakers. And I think your optimism is right on target. It doesn't have to be a permanent, irreversible state of being, it's entirely possible to heal and overcome these kinds of beliefs.

Quote
As for the co-morbidity issue asked about in this thread and as discussed in the articles, I am reminded of something an old T of mine once said:  "I never diagnose someone as having BPD until any trauma issues have been addressed.  If the characteristics are still there after that, then I will consider BPD."  That makes a lot of sense to me especially when I consider that the motivation behind certain behaviors and the thoughts and core beliefs involved are not immediately apparent to the patient or to the therapist.
Exactly. It makes a lot of sense to me too. From what I understand the symptoms of trauma can mimic several different disorders and conditions. It may look the same on the outside though this doesn't necessarily mean that a person's underlying motivations and core beliefs will follow true to the disorder. Hopefully now, with the inclusion of desnos in the new dsm, complex trauma will become more widely understood and accepted, and most importantly, the patient will have a better chance of receiving the proper care and treatment.

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« Reply #17 on: May 16, 2006, 01:29:38 PM »

BPD is a "Fatal flaw(s) [that are] brain-based dysfunctions of thinking and inpulse that lead to persistent patterns of personality and behavior that betray trust and destroy relationships."  This is the opening line in Stuart C. Yudofsky, M.D. work Fatal Flaws: Navigating Destructive Relationships With People With Disorders Of Personality And Character (APA Press). 

I have PTSD from an abusive childhood from an adoptive uBPDm, auto accident and recently from being married to a dBPDh - happy to say working on ending the relationship as soon as my ducks are lined up in a row. PTS comes from being in a traumatic event that is frightening, overwhelming and life threatening, regardless if it's man-made or it comes in the form of a natural disaster. What makes the trauma worse is the context of thoughts, feelings and experiences that happen during the trauma. War, Rape, Witness to a crime, Deadly tornado... PTSD is when you have symptoms such as flash backs, hyper-vigilance, not trusting...that prevent life from enhancing because a traumatized person responds in non-threatening situations and becomes "confused" because of having replys or flashbacks of the trauma(s).

With good T(s), you can move from PTSD, to Resilience, and finally to PTG (Post Traumatic Growth). Someone with BPD...suffers from brain dysfunction - as quoted above with pathfinder - is another story.  wink

Ann
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mommadee
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« Reply #18 on: May 16, 2006, 04:46:30 PM »

I have a question.  I could not bring the article up on DESNOS.
I am not asking for a diagnosis just a better understanding.  Whether it's me today or the descp. is complicated, I cannot seem to grasp it.
Female in long term marriage to a violent BPD, then female violently raped, sliced up with intent to kill, by the grace of God gets away.  Would the trauma from this cause DESNOS or PTS?  Or could it cause either?
Thanks for helping, dee
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Kongs Ann
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« Reply #19 on: May 18, 2006, 12:45:57 PM »

I have a question. I could not bring the article up on DESNOS.
I am not asking for a diagnosis just a better understanding...Female in long term marriage to a violent BPD, then female violently raped, sliced up with intent to kill, by the grace of God gets away.  Would the trauma from this cause DESNOS or PTS?  Or could it cause either? Thanks for helping, dee

Dee,

PTSD is due to normal responses to a traumatic event, the problem is the symptoms, second wounding (the pain when people discount, over simplify, over generalization...to the trauma according to their standard beliefs and judge someone who uses drama to gain attention) 

I can't say that I understand DESNOS (complex PTSD), but I do have insight on someone who suffers from PTS and suffers from BPD. His T says that a borderlines flip flop from The Land of Hate to The Land of Love. Unconsciously looping due to a Trauma. This is how borderlines PTSD looks like. Interesting.

I suffer from PTSD but I can connect from the unconscious to the conscious, which is why I can go towards resilience (healing).

Borderlines stay in their unconscious to cope with their traumas, and Flip Flop in and out to cope with life, and if the trauma happened to them in their childhood...this is why they act like children. They stay stuck in this unconscious (child) PTSD and in some documented cases for over 20 years until they find the right T...at this level is when it's DESNOS..

The 12 Step program is for PTSD, and not AA... An example is An Overview of Psychic Trauma and Post Traumatic Stress Disorder (PSTD) 12 Steps at http://www.luvzbluez.com/post.html.

Ann
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