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

[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.

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[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