DIFFERENCES|COMORBIDITY: Borderline PD and P.T.S.D.

[GENERAL ANNOUNCEMENT]

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).

[Christopher]

Im told that today in physco circles the dx's of PTSD and BPD are virtually interchangeable...can I get some feedback please...thanks

[snaillady2]

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

[mystique85]

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.

[GENERAL ANNOUNCEMENT]

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]

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.

[jreilly]

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.

[Skippy]

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.     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.  

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)

[almondjoy]

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

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.

[JR]

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

[LavenderMoon]

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

[argh]

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.

[vasilisa]

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.

[NewLifeforHGG]

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.

[tigereyes]

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? :

[jreilly]

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.   

[almondjoy]

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.

[cockeyedoptimist]

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

[almondjoy]

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

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.

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.

[Kongs Ann]

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. 

Ann

[mommadee]

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

[Kongs Ann]

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

[NewLifeforHGG]

Although people with BPD often suffer from PTSD, people with PTSD do not necessarily suffer from BPD.
PTSD is not an Axis 2 dx nor is it pervasive and ongoing for everyone.

Post-traumatic stress disorder symptoms may include:
     Flashbacks, or reliving the traumatic event for minutes or even days at a time
   Shame or guilt
   Upsetting dreams about the traumatic event
   Trying to avoid thinking or talking about the traumatic event
   Feeling emotionally numb
   Irritability or anger
   Poor relationships
   Self-destructive behavior, such as drinking too much
   Hopelessness about the future
   Trouble sleeping
   Memory problems
   Trouble concentrating
   Being easily startled or frightened
   Not enjoying activities you once enjoyed
     Hearing or seeing things that aren't there


BPD:

   Frantic efforts to avoid real or imagined abandonment
   A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
   Identity disturbance: markedly and persistently unstable self-image or sense of self
   Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
   Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
   Chronic feelings of emptiness
   Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
   Transient, stress-related paranoid ideation or severe dissociative symptoms


Types of PTSD:

Normal Stress Response
The normal stress response occurs when healthy adults who have been exposed to a single discrete traumatic event in adulthood experience intense bad memories, emotional numbing, feelings of unreality, being cut off from relationships or bodily tension and distress. Such individuals usually achieve complete recovery within a few weeks. Often a group debriefing experience is helpful. Debriefings begin by describing the traumatic event. They then progress to exploration of survivors’ emotional responses to the event. Next, there is an open discussion of symptoms that have been precipitated by the trauma. Finally, there is education in which survivors’ responses are explained and positive ways of coping are identified.

Acute Stress disorder
Acute stress disorder is characterized by panic reactions, mental confusion, dissociation, severe insomnia, suspiciousness, and being unable to manage even basic self care, work, and relationship activities. Relatively few survivors of single traumas have this more severe reaction, except when the trauma is a lasting catastrophe that exposes them to death, destruction, or loss of home and community. Treatment includes immediate support, removal from the scene of the trauma, use of medication for immediate relief of grief, anxiety, and insomnia, and brief supportive psychotherapy provided in the context of crisis intervention.

Uncomplicated PTSD
Uncomplicated PTSD involves persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, emotional numbing, and symptoms of increased arousal. It may respond to group, psychodynamic, cognitive-behavioral, pharmacological, or combination approaches.

Comorbid PTSD
PTSD comorbid with other psychiatric disorders is actually much more common than uncomplicated PTSD. PTSD is usually associated with at least one other major psychiatric disorder such as depression, alcohol or substance abuse, panic disorder, and other anxiety disorders. The best results are achieved when both PTSD and the other disorder(s) are treated together rather than one after the other. This is especially true for PTSD and alcohol or substance abuse. The same treatments used for uncomplicated PTSD should be used for these patients, with the addition of carefully managed treatment for the other psychiatric or addiction problems.

Complex PTSD
Complex PTSD Difficulties regulating emotions, including symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger
Variations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes of dissociation (during which one feels detached from one's mental processes or body)
Changes in self-perception, such as a sense of helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings
Varied changes 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
Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair

[ian]

I have thought alot about this, BPD and complex PTSD are VERY similar, and even if you read the criteria for DID (dissociative identity disorder) it is also much alike but more extreme with the identity problems.  A large percentage with DID (used to be called Multiple Personality Disorder) are supposed to be comorbid BPD. And then Bulimia; what I have read about Bulimic personalities sounds just like BPD, and the root causes are supposed to be the same. Not suprisingly a large chunk of Bulimics are supposed to be BPD.

The best way I can figure is that all of these disorders have some kind of PTSD experience at the heart of them, usually childhood abuse. BPD, CPTSD and DID all seem to grow out of this kind of early experience. Some have speculated that what tends to determine each is the developmental stage when abuse happened. In BPD it is in the first 1-3 years, with DID and other dissociative disorders it's 5-8 and I think CPTSD is more of an adult disorder.

This doesn't really explain the bulimia connection, but BPD and Bulimia are both thought to be the product of overly enmeshed families. I suspect that my exgf is bulimic.

[NewLifeforHGG]

I think the area of trauma is relatively new.
I went to dbt for PTSD for a short time. I can see how it could be effective for many many people not just BPD. The group I was going to was geared to trauma recovery. Some of the people in there were BPs who had been through horrendous trauma. Some were people with eating disorders. Some were people who had lost someone through violence. It is effective for those that are stuck.
There does seem to be a trauma connection. Ongoing trauma changes the brain.

[flex60]

I once worked in a mental institution for about two years, I had difficulty discerning Borderline Personality  Traits and Bi-Polar Traits.  I come to learn after much reading, the difference lies in the borderline, who demonstrates abandonment issues, and feeling empty. I recall a lot of the medications were the same.
Post Traumatic Stress and Borderline Disorder, I had a SO 3/4 years ago, who I thought was suffering from PTSD. After going through a national EMDR association, I was put in contact with a PDock about a hundred ten miles away.  In the meantime, two local therapist dxed her borderline.  Oddly enough a third therapist, was astounded to learn others had dxed her BPD.  I attended the first three therapy sessions with this person, it was a sort of dog and pony show, she reported an hour early, was given a full and total body massage, then into therapy with the PDock.  The PDock was adjusting her meds, when we decided to go different paths.

I had lunch with this lady, it has been three years since I have seen her, and most of the afternoon walking and talking, she seemed entirely different than I recall, much more grounded and real.  She had been in therapy some twenty years prior to being treated for PTSD. She told me, she was over the past two years given EMDR Therpay once, and three couch sessions a month.  I am a little confused by all this.

I have done some minor research on the two different problems, and both seem similiar, (PTS/BPD) would anyone like to comment on the difference?
regards david

[geroldmodel]

Well I am not an expert but I think borderline personality disorder is pervasive and is caused by a disturbed emotional development in childhood.
This can be caused by a traumatic experience, emotional abuse by parents or a biological reason.
Adults cannot develop BPD.

PTSD is caused by a traumatic experience:
If I was to go to a warzone, as a healthy adult, for example, I could develop PTSD.
This would not change my emotional development at all, but it could affect my emotional state for the rest of my life.

So, there can be a huge overlap of PTSD and BPD if the BPD had a traumatic experience in childhood.

[LavaMeetsSea]

Also, as someone who's been dxed with PTSD, I have quite a few long-term relationships.  I may tend to isolate when I'm depressed because I feel embarassed, or don't want to bring people down, but I've never been described as cruel (except by my BPD mother, of course).

Also... label or not, PTSD DOES result in structural changes to the amygdala and hippocampus that ARE observable through very expensive testing.  I can relate to an aversion to labeling, but before railing against the entire concept of the DSM, it may be more useful to actually read say, Bessel van der Kolk or Judith Herman. 

[shay]

Hey- can you say all that in English?  I too had PTSD from the war, but I can tell you without a doubt...I knew I was acting out. Got help, and forced myself to get sunlight etc- face the evil I saw over there. ... I also shut in when depressed... as I did with my BPD x GF.  It was so draining, so consuming, so challenging, so walking on eggshells... draining.

[LavaMeetsSea]

Lol, sorry Shay.  The amygdala is the part of the brain that regulates fight, flight, and freeze responses.  The hippocampus affects things like memory; it's why traumatic memories are often so darn different than regular ones, so intense and emotional, sometimes fragmented so you get the smells, sounds, body sensations, as a war veteran you probably already know.  Anyway, there's a bunch of research being done by Drs like van der Kolk and Herman, and they can actually see major differences in the way those parts of the brain function after trauma like combat, rape, torture, that sorta thing.

[Cyndi]

I have suffered from PTS for many years.  I was witness to a horrible murder many years ago which was indirectly my fault.

I have suffered many years with this without seeking help, but I really couldn't tell you why.  Maybe in my family we were never coddled, always put on a brave face, never let them see you sweat. was our family motto.

Anyways, I can tell you what the difference is.  I would NEVER outright hurt someone, in fact, I would bend over backwards to prevent it.  I was married for 13yrs, and have had a 3yr relationship after that.  I am capable of experiencing intimicy, that does not scare me.  I do not reject people for no reason, and am able to comprimise and work out solutions to problems.  They only problem that I seem to have is worrying that something will happen to someone, so at times, I may be a bit clingy.  No one has ever complained about this, so, it must be more internal than I let on.  Perhaps rejection hurts me more than others, I do tend to take it rather badly, but I do manage to get over it.  I have never cheated on anyone, nor did I go out of my way to openly hurt someone.  This is completely foriegn to me.  I also tend to be truthful to a fault, and very very loyal to those I care about.

Being in a relationship with a BPD truly brought out the worst of my PTS, and I think he knew it.  He used it whenever he could.  He ENJOYED hurting me.  Right there is the difference.  He needed to do this to make himself feel important.

[LavaMeetsSea]

Hugs if ok, Shay.  I recommend reading "Trauma and Recovery" by Judith Herman; it's got research on Holocaust survivors, political prisoners, rape and incest survivors, war veterans, and a chapter on the history of shell-shock.  I need a medical dictionary to get through any of Bessel van der Kolk's stuff, but he's the one doing most of the physical/biological tests, so if you've got that kind of patience, he's a pretty good read too.

[NewLifeforHGG]

I notice that a lot of people with BPD will discuss the PTSD all day long but as a sufferer of PTSD I can say that I am nothing like my ex, his mother, my father or others I have known with BPD. I can have friendships, respect boundaries, have a minimal fear of abandonment and don't cause chaos wherever I go. I don't lash out, I don't feel empty and I am not abusive. I empathize with others.
I do get a numb feeling going at times, or can be fearful about safety sometimes but I have overcome most of it.
Having PTSD is very different than having BPD.

[flamingo13]

Those of you who suffer(ed) from PTS, would you please share what feelings, behaviors, etc. you experience(d) that indicates Post Traumatic Stress Syndrome/Disorder?

Constant nightmares (for years... anytime there is sleep), extreme startle response (I used to be really 'laid back'), hypervigilant, panic attacks (rare and I do not remember any, but Dr. says they are charted), anxiety, depression, extreme agoraphobia, anterograde & retrograde memory problems, abnormal weight changes (I forget to eat!), and avoidance of triggers/reminders of the events.

I am sure there are more things, but those are the main ones that came to mind.


Until this past year or so, I rarely slept more that 2.5~4 hours a day. With all the benzodiazepines (a whole lot more than I like taking), I can get between 4~7 hours of sleep a day. The Dr. figured the first Rx would keep me asleep for well over 12 hours or much more & the dose would need to be reduced. Dr. wanted to 'knock me out' and then reduce from there. Unfortunately, this was not the case so another strength benzodiazepine was added that I 'technically' take BID (twice a day) but Dr. has me take them PRN (as needed). So, there is a rather large regular supply of benzodiazepine throughout each day. This is augmented as needed/if needed with another, lower dose of benzodiazepine. When the lower dose is taken to the maximum allowed by the Dr. (rarely) it puts me about 5 mg over maximum recommended dosage by my calculations. The meds also cut down on the agoraphobia and anxiety. Prior to PTSD, you could rarely get me to take even an OTC acetaminophen... I did not like taking meds and still don't. LOL

BTW: PTSD cost me a career as a physician.

[LavaMeetsSea]

PTSD... it can manifest in many ways, but usually there's the flight, the fight, and the freeze.  When an experience triggering that much adrenaline prolongs, repeats, or is extreme enough, those reactions don't end with the experience itself.  Traumatic memory is different, more intrusive, more sensory, more state-dependent, which means you tend to feel it as intensely (or close) in memory as you did the first time around - maybe even more, if you were in shock or denial.  One of my triggers, for example, is hearing a police or ambulance siren.  I completely loose focus, my heart starts pounding, I have to remind myself to breathe, and I can count on not remembering a thing that was said to me if it was at work, in class, therapy, whatever, until that siren is gone.  I'm not reacting to what's really happening in the moment - I'm reacting to something that happened years ago.  Only it doesn't feel that way when I hear a siren.

Often my reaction is OVERLY empathetic... though if I dig deeper, I find it's really about identifying with the victim in a situation and I'm just vicariously trying to re-enact and somehow master the situation.  I've burst into tears just seeing someone with a nosebleed. 

On the other extreme, I do this thing where I step back and instead of feeling my life, it's like I'm watching a movie of it.  Short-term, it's calming and I too am really together in a crisis.  Long-term, it's made it difficult to inhabit my body, know what I'm feeling, and take comfort from the people around me.  Sometimes I can't shake that feeling, and the world seems garishly absurd, like I'm living in ToonTown at Disneyland, flat, disproportionate, unsubstantial.  When my depression was at it's heights, there were days when simply lifting a toothbrush felt like a Herculean task beyond my abilities.  I'd long for sleep, and not be able to.

PTSD is NOT pleasant, and I too went from refusing OTC meds to taking anti-depressants.  For me it's a quality-of-life issue, and a recognition of the lasting biological ramifications of trauma.  Still, I think talk-therapy is where most of the real lasting work is done.  The meds are like a crutch that helps you be mobile while the wound is healing.  Eventually though, you want to be able to get around without them.  You can't really do that unless it's cleaned out and set properly.  I guess what I'm trying to say is that there is no pill that'll get you out of bawling about it in front of someone else; it seems to be the only way to lessen the intensity, frequency, and duration of those %^&* flashbacks.

I think the easiest differences to spot between PTSD and BPD are relational, though.  I went to a support group for sex abuse survivors for a year.  We all had PTSD symptoms, and most of us eventually outgrew the group.  We maintain the friendships though, and most of us use the techniques we learned and have all gotten (at least a little) better.  My BPD Mom and sister were not at my wedding.  Four of my old support group friends were, even though I'd moved.  One of them did my hair and make-up, something I trusted her to do because she knew intuitively to be slow when touching my face.  There is NO WAY I'd ever trust someone with BPD with a curling iron near my skull.  Been there, done that.  Someone with PTSD (no personality disorder)?  They understand the value of gentleness.

[eastmeetswest]

One very big difference between PTSD and BPD is that PTSD can have onset at anytime in one's life.  There is often adult onset.  War, trauma, living with someone who has BPD can all lead to PTSD.  It occurs when the body is placed in a physical place where the mind is not ready to go.  It can occur in an instant, meaning a one-time event or over a period of events or exposures to traumatic events.

BPD occurs during childhood/growing up.

[Mollyd]

I agree with the first part of what eastmeetswest wrote, but not the second.

There are some people with bpd who have no history of trauma and abuse in their childhood; pointing to a biological component to the disorder. 

I'd add PTSD is in the Anxiety cluster of mental health conditions.  It's like hyper-drive after a life threatening (or perceived life threatening) event.

There is an overlap of symptoms in PTSD and bpd, but there is also an overlap between bpd and bi-polar.  Bpd, as it's currently defined, is a class of personality disorders, meaning it's the symptom set that is inflexible (not just happening as a reaction to a perceived cue of danger), and pervasive (meaning it crosses into many aspects of life- work, relationships, sense of self, etc.).  It's a way one views and interacts with the world.

[eastmeetswest]

Sorry Mollyd - I misstated it.  I should have said it could start from ...how should it be stated when it is biological?  Mollyd, does it show itself from early on (like autism or only as early adult...?)  I don't know much about this aspect.

[flamingo13]

<quote>
I'd add PTSD is in the Anxiety cluster of mental health conditions.  It's like hyper-drive after a life threatening (or perceived life threatening) event.
<quote>

As a first hand sufferer of Dxed PTSD, I woud most undoubtedly agree that it is anxiety related (in this cluster). Almost all my symptoms are in the anxiety area whereas the other people in my life w/Dxed or uDxed problems were remarkably different. The uBPD was and is still Dxed bipolar (but I seriously doubt that Dx anymore) and the symptoms were way off from PTSD. I developed PTSD (possibly uDxed C-PTSD) after more than a decade married to the uBPD. I was my entire childhood and early adulthood with uDxed sociopaths (one perhaps some uNPD) and a possible uDxed histronic.

The differences between all of them were very noticable close up and day to day. Perhaps I was too close to see objectively but I did get intimate glimpses daily into the 'worlds' of each that therapists and the like would never have.

My PTSD is really in the anxiety realm whereas I could not see past the lack of identiy in the uBPD to detect exactly from where the behaviors were coming. It appeared to be all based in lack of self identity. In this case, there was early trauma. However, the uBPD's mother, aunts, and sister all exhibit almost identical behavior (save one aunt who appears asymptomatic). They are so similar that their handwriting even appears the same. My uBPD's handwriting and usage of language changed to match that of the mother, sister, and aunts after splitting (I believe that is the correct term). Prior, uBPD could not stand their behavior, handwriting, usage of language were completely different. It was almost as if some sort of switch was suddenly turned on and uBPD became a clone of the relative. It was straight from the twighlight zone -- right down to the same style of stationary. 

Of course, my sample size is very small, objectivity/distance is out the window, and I am no clinician so YMMV. 

[Mollyd]

emw -

no need to apologize!  Just sharing thoughts here.


I think there is a popular thought that both bpd and ptsd have their roots in abuse and trauma, but that is not necessarily so.

PTSD - is a patterned anxiety response to an event or series of events.  BPD, as it's currently conceptualized, is a disorder of the personality - an inflexible and pervasive way of interacting and perceiving the world - that involves cognition, affect, and interpersonal relationships. There is a high incidence of reported abuse in people who've been dx'ed with bpd, but, again, not all people with bpd have an abuse history.  Both bpd and ptsd have a biological component - not meaning they are inherited, but meaning there is brain activity involved, so the brain matters.

BPD is traditionally viewed as not being a diagnosis in children, although there are some teens/older children who might show the symptoms (some or all of them).  The reasoning for the hesitation in diagnosing children/teens is that their personality isn't fully formed.  To say one has an inflexible personality with pervasive traits - when the personality isn't fully formed is problematic. 

BPD doesn't show itself in a similar way to autism, which can be seen clearly in early childhood.  BPD is more comfortably approached as a diagnosis when people are in earlier adult life, where coping strategies, patterns of thinking, behavior and emotional reactivity can be viewed.

However, all that said - my personal belief is that with some people you can see some traits in the teen years, and with most people you really can't safely consider a pd until adulthood.

I think it's important to figure out (as I wrote in another thread) the reason one is making the distinction. Therapists have different needs to make the distinction of PTSD and BPD than perhaps a family member.   From a clinical standpoint, bpd and ptsd are different - thus how one would be treated is different.  That's not to say there isn't significant overlaps, but the tx for someone who had a tragic accident would look different than the treatment for someone whose been repeatedly hospitalized for self harming.  And, someone with bpd might very well have issues of trauma and abuse that would need to be addressed in the context of pstd ...

Molly

[StreetSmart]

DEar NLHGG:

My understandin' of PTSD in its strictest definition is that it must be a life- threatening trauma (or the belief that your life is on the line) and not just an anxiety producing condition.


Street

[Silas Pseudonym]

As Molly said there is a "brain" component involved in who "gets" PTSD.  Somewhere I read, that a big difference is those who get off, without long term consequences, come from loving families. (It needs to go on more than a month to be PTSD.)

In my history, there were traumas many soldiers at war never experience, & I was resilient.  Always able to stand up, dust myself off, & walk on.  This was such a part of who I am, that adults marveled, looked to me as older than I was, & gave support elsewhere ...knowing...I was ok.

It was not until I was beaten by that person so expected to love & care for me, my husband, that I exhibited any signs.  Even so they are subtle compared to some.  Startle reflex, a biggie, feeling stuck, & sometimes I react to his sh*t, as though I am going to be killed.  Not such a bad thing that.

Just wanted to pipe up with the loving family bit, & how there must be a connection with how it works within a relationship...like Puddin.  My FOO was not like that.  I was never hit, slapped, ridiculed, insulted or demeaned.  With my sibs, we could not say dummy, or duh, even about ourselves.  No my FOO was not perfect, Dad was distant, & Mom was a lush...she did not allow us to abuse, or be abused...

In a marriage, there is a contract.  It might include, not letting yourself go, getting fat, many assumptions not verbally expressed.  There are some spoken too.  After the beating death of my Mom, the estranged promised never to hit.  Makes it a whole different deal...

Silas

[eastmeetswest]

Well, I read some lit at the site for vets - I think they are cutting edge and there are some/quite a few variables that may allow for PTSD to become more likely but likewise as many studies show that there is no cause/effect in the general pop.  It can emerge in anyone under the unfortunate confluence of conditions.  However, there are some characs that make it more likely to emerge in an individual - some were leaving the household at an early age (didn't have to be for a bad reason), folks with other anxiety disorders, depr, or PDs are more likely to get it.

Hence for many, it isn't a sleeping tiger.  It is a result of severe trauma, or ongoing incredible inconsistent stress for long period of time.  Take one normal adult - shaken, not stirred, repeatedly and you can create quite a concoction.

[discohornet]

Post Traumatic Stress Disorder.

It is basically a heightened state of chronic stress you experience after something bad happened to you.

For some people it can be getting shot at in war. For some people it can be abuse from someone they love.

There are good treatments out there for it. Try going to google and type in PTSD treatment if you think you may have it. I'm guessing almost ALL of us here do to one extent or another.

[LAPDR]

As a note of history it was called many different things in the past for soldiers.

Civil War - lethargic
WW I - shell shock
WW II - battle fatigue

When soldiers first started to come back from Vietnam they used the term Vietnam Veteran Syndrome but that was quickly changed to Post Traumatic Stress Syndrome.

[johnkane]

PTSD, as I understand it, is essentially a disconnect between emotions and thoughts.

Certain stresses can cause this.

So, you free-floating emotions that are disconnected from thoughts and perceptions.

I believe reconnecting the emotions to thoughts is the healing part.

I just posted about ptsd, if you read through the posts you'll get to it:

http://bpdfamily.com/message_board/index.php?topic=85580.0

[yamada]

I got it three years ago through work..i worked in the acute end of mental health.  there is so much info on the net, but in short my specialist said that its similiar to a closed head injry as it not only messes around with thought and emotions, it messes with the process of thinking, thus I have spend a long time trying to string my sentences together.
when you search add to the search cognitive changes.

[LtL]

I have pts too, thank you guys for the comments. 
will read more of your comments later.

[LtL]

yamanda,
Yes, I think I have some cognitive changes too! will look that up

[johnkane]

The effects of ptsd article:

http://www.aaets.org/article158.htm

[LtL]

Thanks johnk for your post. It seems easy to look at somebody elses problem such as BPD.
It can be much more difficult to look at our own issues such as PTSD. However I don't like to add
the word disorder on the end of post traumatic stress.

As a young adult when I developed it, it was hard for me to explain it to my friends. Nowbody around me could understand the type of stress I went through and continued experience. I tried to find and explain that it was a normal reaction to abnormal events. The opportunities that I have missed, jobs lost, career put on hold, relationship struggles, retirement age is now higher. A relationship with a beautiful, kind and non bp woman. The chance at a truely unique career, that took a lifetime to develop. The uphill battle that I already won, I lost. I can truely say that I have seen the absolute best and the absolute worst that this world can offer.

Come here you terrorist turds!

[sandpiper]

I have complex ptsd which is kind of a notch up on the ptsd severity spectrum, lots of my old friends here also had it when I was here years ago.
I was diagnosed with ptsd when I was 21, I had amnesia at around the age of six and there were big chunks of my childhood that I simply couldn't remember.
Over 20 years later I had another nasty flare up where I got triggered by running into someone from my past (a relative, I didn't recognize him at the time, just freaked out) and big chunks of my memory started to return. It was pretty overwhelming.  Like a bad dream, really.  I went back to therapy and my diagnosis was upgraded to c-ptsd, which they didn't know about in the 80's when I started treatment.

PTSD is classed as an anxiety disorder and it is often characterized by control or avoidance - the sufferer either tries to control situations to alleviate feelings of anxiety, or else you avoid situations and people that remind you of the trauma so that you can continue to block it out.

Generally its caused by severe trauma - usually by being in a life threatening situation or by witnessing someone else in that situation.

Soldiers have suffered from it for as long as we have records - they write about it in the Greek classics.
During WW2 they tried to screen for susceptibility to it and it failed.  Trauma is trauma.  You can't predict who will go on to develop ptsd after trauma, although there are a lot of factors that affect resilience during recovery (i.e. a sane healthy supportive family, but I'm here to tell you that you manage and recover without that!)
Rape victims, people who've been imprisoned and tortured, or exposed to extreme violence and danger also get it.

Complex ptsd is something that therapists see in children who've been raised in violent or abusive situations, concentration camps or by abusive/mentally ill/addict/PD parents, for example.
It can be a lot more extreme.
Having said that, everyone brings their own unique personality and circumstances to a situation and in no way do I wish to diminish anyone's experience here.  My father was a war veteran so I've done a lot of group stuff with vets and their families and I've seen how profoundly it affects not only the veteran but the family. I think sometimes men and women deal with things differently, too, I suspect that women are more inclined to seek help and we are better at building support networks.  Isolating yourself isn't good if you have ptsd, although it's often what you instinctively want to do.

Ask your therapist for more info, or if she can suggest some good reading material.
I found a great book by Aphrodite Matsakis called 'Post Traumatic Stress Disorder'.  It was in the Uni library (I'm studying health science so I found it in the Psych section).  I believe it was a textbook, went out of print and I heard a rumour at the med school bookstore that its being revised for a new edition.
I found a lot in there that made sense for me.
Someone here also put me onto a site, I think it was petewalker.com - that I found very useful.
It talks about the effect of 'The Inner Critic'.  That voice in your head that tells you you're no good, you can't do that, you're bad...all the yucky stuff - and it offers suggestions how to deal with it.  People with ptsd can become very negative, about themselves and about others, and it takes work to get past that.
There's probably a lot of crossover between BPD and ptsd, because borderlines have generally suffered so much trauma.
They are different, though.
In the case of the BPD its affected their brain chemistry so that they have a mood regulation disorder.  Last time I checked the psychiatrists were all debating about what to say about BPD and c-ptsd in the next edition of the DSM.  Psychiatry, I've been told, is a developing field of medicine and they really don't know everything they can, yet.  There's a lot to discover.

A big thing about ptsd is that it can make you edgy, jumpy, irritable, paranoid (I don't really like that term so I say 'Unrealistic threat assessment) and it tends to really screw with your sleep and your libido.  (fun times, hey?)
the good thing is that its treatable and it settles down.  I found that working with the trauma counselor and doing Group did a lot to restore my sense that the world was a safe place to walk around in.
I hope I haven't overloaded you with information.
I count myself very blessed that I was diagnosed and got help so young.
Its made a huge difference in that I've been able to build a good life for myself. 
I hope you put yourself in good hands and have a therapist who can guide you through this.  It isn't easy, in fact some parts of it are just downright hellish, but lots of us here have made that journey and we're here to help.

[LtL]

sandpiper,

Thanks for the detailed post. You have not overloaded me with information. This is good and valuable. Thanks.

[sandpiper]

Glad I could help.
Just a ps...one of the things my therapist told me was that a lot of the symptoms of ptsd are due to heightened levels of adrenalin in the body, which affect all the fight and flight responses.
I had terrible mood swings with this latest relapse - am fine now but dear God, it gave me sympathy for the BPDs in my life (easy to feel when when they're out of firing range). 

Just an interesting aside, I was listening to the radio one day and I heard a university researcher saying that he'd studied a lot of vietnam vets with ptsd and discovered that they all had particular strong senses of smell, although they couldn't always accurately identify what they were sniffing.
For as long as I can recall I've had 'supersmell' (DH says that if the sniffer dogs at the airport ever get kidnapped, I could replace them) but I'm really good at IDing whatever the hell is out there.
The researchers said that they believed that the emotional regulation centre in the brain is probably adjacent to the smell centre, so the heightened levels of adrenalin affecting the emotions could be overstimulating the smell centre too.
I wonder if I am good at identifying smells because I was diagnosed so young (21) and a lot of my therapy focused on being in my body (learning not to dissociate and to 'stay with the feeling) and to recognize and identify what I was feeling and allow myself to stay calm and move through that.
Might be a girl thing, too, women often being more comfortable with their emotions than men.
I did notice that during the acute flare ups, smell was one of the most powerful triggers for me.
All the best with your treatment.

[Randi Kreger]

Lol, sorry Shay.  The amygdala is the part of the brain that regulates fight, flight, and freeze responses.  The hippocampus affects things like memory; it's why traumatic memories are often so darn different than regular ones, so intense and emotional, sometimes fragmented so you get the smells, sounds, body sensations, as a war veteran you probably already know.  Anyway, there's a bunch of research being done by Drs like van der Kolk and Herman, and they can actually see major differences in the way those parts of the brain function after trauma like combat, rape, torture, that sorta thing.

Great explanation. I think that people with a borderline parent are subject to PTSD-like symptoms and end up being emotionally traumatised in ways that can lead to various physical illnesses as adults.

Randi Kreger
 
Author, "The Essential Family Guide to Borderline Personality Disorder "
 

[blackandwhite]

Hello Sinorixxx,

BPD is commonly diagnosed along with other conditions ("comorbidity"). Here are some statistics, from the National Alliance for Mental Illness (NAMI)

Borderline Personality Disorder rarely stands alone.  BPD occurs with, and complicates, other disorders.

Co-morbidity with other disorders:

----------------------------------------------------- Major Depressive Disorder                                         Dysthymia  (chronic, moderate to mild depression) Eating Disorders Substance Abuse Bipolar Disorder Antisocial Personality Disorder Narcissistic Personality Disorder

-------- 60% 70% 25% 35% 15% 25% 25%

Here are some links on PTSD and BPD as well:

http://bpdfamily.com/message_board/index.php?topic=62126.0
http://bpdfamily.com/message_board/index.php?topic=71710.0
http://bpdfamily.com/message_board/index.php?topic=43163.0

B&W