BPDFamily.com

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

Clinicians often use PTSD (which has a reimbursement code) to describe C-PTSD, a disorder first proposed by Judith Herman, MD, a professor of clinical psychology at Harvard University, but one that has yet to be recognized as an official diagnosis. Patients with C-PTSD are often classified as  PTSD, as I mentioned above or  ":)isorder of Extreme Stress, not otherwise specified”, or “personality change due to classifications found elsewhere”. Further complications in diagnosis arise when one considers the high levels of co-morbidity which are seen in patients who have complicated trauma histories.  Diagnosis which often accompany C-PTSD are depression, OCD, Borderline Personality Disorder, Dissociative Disorders such as DID, agoraphobia and social phobia. 

In the context of BPD, some believe that BPD could be divided between suffers that experienced trauma - C-PTSD - and those that did not - BPD. An alternative is to see C-PTSD as a comorbidity with BPD when trauma is a factor.

In her book “Trauma and Recovery”, Herman proposed the diagnosis of Complex Post Traumatic Stress Disorder (C-PTSD) which differs from the definition of PTSD which is a diagnosis best captured by the presence of a single acute trauma (such as a car accident, single rape, or exposure to natural disaster). Although these cases of PTSD are horrific and distressful a different psychological picture emerges when dealing with clients who have been exposed to multiple trauma’s.

The following is a description of the diagnosis as first described by Herman in 1997:

1. A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including those subjected to domestic battering,childhood physical or sexual abuse, and organized sexual exploitation.

2. Alterations in affect regulation, including

    persistent dysphoria
    chronic suicidal preoccupation
    self-injury
    explosive or extremely inhibited anger (may alternate)
    compulsive or extremely inhibited sexuality (may alternate)

3. Alterations in consciousness, including

    amnesia or hypermnesia for traumatic events
    transient dissociative episodes
    depersonalization/derealization
    reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

4. Alterations in self-perception, including

    sense of helplessness or paralysis of initiative
    shame, guilt, and self-blame
    sense of defilement or stigma
    sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

5. Alterations in perception of perpetrator, including

    preoccupation with relationship with perpetrator (includes preoccupation with revenge)
    unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s)
    idealization or paradoxical gratitude
    sense of special or supernatural relationship
    acceptance of belief system or rationalizations of perpetrator

6. Alterations in relations with others, including

    isolation and withdrawal
    disruption in intimate relationships
    repeated search for rescuer (may alternate with isolation and withdrawal)
    persistent distrust
    repeated failures of self-protection

7. Alterations in systems of meaning

    loss of sustaining faith
    sense of hopelessness and despair

Whether or not C-Ptsd ever appears in the DSM (diagnostic statistical manual of mental disorders) it’s conception has been very important in the field of Trauma.  Obviously, a large number of patients with mental disorders have had complicated histories which often involve catastrophic events which put a strain on the persons coping mechanisms and lead to significant distress.  One could argue that psychological trauma is indicated in too many disorders and therefore is not specified enough to merit it’s own categorization. 

The presence of C-PTSD can be quite validating for patients who have suffered silently from such atrocities throughout their lifetime. In her book “Trauma and Recovery” Herman writes:

    Many abused children cling to the hope that growing up will bring escape and freedom.

    But the personality formed in the environment of coercive control is not well adapted to adult life. The survivor is left with fundamental problems in basic trust, autonomy, and initiative. She approaches the task of early adulthood――establishing independence and intimacy――burdened by major impairments in self-care, in cognition and in memory, in identity, and in the capacity to form stable relationships.”

    She is still a prisoner of her childhood; attempting to create a new life, she reencounters the trauma.

I've added this to several of the discussions on comorbidity... .

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 (https://bpdfamily.com/message_board/index.php?topic=58157.msg541921#msg541921)

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 (https://bpdfamily.com/message_board/index.php?topic=58157.msg541921#msg541921)

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 (http://www.psyweb.com/DSM_IV/jsp/dsm_iv.jsp), 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 (https://bpdfamily.com/message_board/index.php?topic=58157.0)
Additional discussions... .
Personality Disorders
Borderline and Paranoid Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=162162.0)
Borderline and Schzoid/Schizotypal Personality Disorder
Borderline and Antisocial Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=156878.0)
Borderline and Histrionic Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=61196.0)
Borderline and Narcissistic Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=90388.0)
Borderline and Avoidant Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=153546.0)
Borderline and Dependent Personality Disorder
Borderline and Obsessive Compulsive Personality Disorder (https://bpdfamily.com/message_board/index.php?topic=82476.0)
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 (https://bpdfamily.com/message_board/index.php?topic=96965.0)
Borderline PD and Aspergers (https://bpdfamily.com/message_board/index.php?topic=21363.0)
Borderline PD and Attention Deficit Hyperactivity Disorder (https://bpdfamily.com/message_board/index.php?topic=147635.0)
Borderline PD and BiPolar Disorder (https://bpdfamily.com/message_board/index.php?topic=162165)
Borderline PD and Dissociative Identity Disorder (https://bpdfamily.com/message_board/index.php?topic=71454.0)
Borderline PD and P.T.S.D. (https://bpdfamily.com/message_board/index.php?topic=42598.0)
Borderline PD and Reactive Attachment Disorder (RAD) (https://bpdfamily.com/message_board/index.php?topic=150400.0)

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: www.ncptsd.va.gov/facts/specific/fs_complex_ptsd.html


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.

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.

Complex PTSD is not yet officially recognized and is being proposed for addition to the DSM-V by Judith Herman.

---

Mod Note: It was not added to the 2013 DSM 5

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? ::)

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/products/pdf_files/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.

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

Although people with BPD often suffer from PTSD, people with PTSD do not necessarily suffer from BPD.

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

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.

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.

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.

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.

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.

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.

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 staNPDoint, 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

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.

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.

The effects of ptsd article:

www.aaets.org/article158.htm

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.

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 "

I think there may, in many cases, be a relationship between Complex-PTSD and BPD, but not necessarily PTSD .

Based on my readings, I think that BPD relational dynamics are a form of trauma reenactment.

Their serial reenactments, with successive partners, may be failed attempts at mastering the original trauma.

BPD disappearing acts, and NC episodes, may be escape scenarios.

"Many researchers believe that BPD is a dissociative disorder lying somewhere on a spectrum between PTSD and Dissociative Identity Disorder. For a clear overview of this perspective on dissociation and BPD, see: What is the difference between BPD and the spectrum of dissociative disorders?" - Dr. Richard Moskovitz, author of Lost in the Mirror, an introduction to the disorder.

"BPD is a subtype of trauma associated disorders. The criteria of BPD, of complex post-traumatic stress disorders (C-PTSD), and of disorders of extreme stress not otherwise specified (DESNOS) substantially overlap. Neuropsychological deficits in BPD and PTSD as well as psychoendocrinological and neuroimaging studies in BPD und PTSD also revealed common features." - AAPEL -- www.aapel.org/BPD/BLptsdUS.html

"Regarding the high prevalence of traumatic experiences in patients with borderline personality disorders (BPD), we review the available literature focusing on the hypothesis that BPD is a subtype of trauma associated disorders. The criteria of BPD, of complex post-traumatic stress disorders (PTSD), and of disorders of extreme stress not otherwise specified (DESNOS) substantially overlap. Neuropsychological deficits in BPD and PTSD as well as psychoendocrinological and neuroimaging studies in BPD and PTSD also revealed common features.  Further research will have to prove BPD as a complex and early-onset post-traumatic stress disorder after multiple and/or chronic (type II) traumatic experiences during childhood and/or youth. Definitive conclusions require further research efforts." --  :)riessen M, Beblo T, Reddemann L,... .- Medizinische Universitat zu Lubeck, Germany

"We postulate that posttraumatic stress disorder is maintained by learnt cortical and subcortical plastic changes. Specifically, we assume that classical conditioning leads to an intense emotional memory of the trauma that is mainly implicit and related to plastic changes in subcortical structures such as the amygdala. At the same time an insufficient explicit trauma memory is formed that manifests itself in insufficient cortical processing of trauma content. This dissociation of implicit and explicit memory prevents the extinction of the emotional response to the trauma and perpetuates the disorder. First empirical results based on this model confirm the main hypotheses." -- Posttraumatic Stress Disorder and trauma memory - a psychobiological perspective by Wessa M, Flor H., 2002        

      

":)uring a dissociative episode, the brain is thought to switch into a biochemically-induced "high defense mode", during which the storage of new memories is effectively blocked. Yet not all memory is erased, which is quite confusing to those interacting with the individual during these times. Researchers propose that "these early encoding deficits [... .] have a deleterious effect on the short-term memory system; they manifest as deficits in the ability to take in new information but not in the ability to conceptualize and manipulate previously encoded information".  -- Memory, Trauma & BPD --  www.bpdresources.net/memory.html

I've done some reading about Complex-PTSD and BPD, and it seems like there is an ENORMOUS amount of overlap between the two. I've even read that some BPD theorists, researchers and clinicians think BPD would be better served by being renamed "Complex-PTSD".

Does anyone know anything about this subject and/or it those are, in fact, two different labels describing the same set of diagnostic symptoms?

My pwBPD, who was diagnosed and studied psychotherapy as well, said something similar to what you are saying, Wanna Move On: that Complex PTSD has been discussed as an alternative name for Borderline Personality Disorder.  Apparently because of the stigma of the "borderline" diagnosis, and the similarity in symptoms/patterns.  Judith Herman, a well known psychiatrist specializing traumatic stress, may have advocated this as well, if memory serves.

The problem is that studies indicate that a history of childhood trauma, as seen in C-PTSD, is not always present in people diagnosed with BPD.  Nevertheless, the comparisons continue.

I have done a lot of reading on BPD, as a diagnostic entity, and about COMPLEX-PTSD. Not standard, classic PTSD, but specifically "Complex-PTSD." The overlap between the two seems stunning.

I have recently spent some time in AA. (Yes, I had a little bit of a drinking problem post a BPD breakup.) And the one thing that SHOCKED me as I listen[ed] to qualification after qualification, floor share after floor share, is that it seems 90-plus% of the people in AA suffer from either some version of BPD or some version of C-PTSD.

I've also read where Marsha Linehan said, in reference to her realization (prior to her development of DBT) that it seemed the population of suicidal females she initially worked with AND those who were classified as "BPD" in inpatient hospitals where she worked, seemed to be one and the same overlapping crowd.

Similarly, it seems that virtually all the people in AA present with diagnostic symptoms that match with what is labeled as "BPD" and/or "Complex-PTSD."  

Is it possible that BPDer's, C-PTSDer's and alcohol/drug abusers are all one big overlapping crowd, conceptually made to seem distinctive and separate merely by virtue of the fact they are assigned different diagnostic labels?

I'd appreciate any conceptual feedback on this intriguing subject.

Comorbidity of personality disorders was seen as the flaw in the DSM-IV that inspired a new nomenclature system proposal for the DSM 5.0  Just prior to publication, it was determined that the new nomenclature needed more clinical study so it was moved to the appendix to provide a framework for future studies.

C-PTSD is subcategory of PTSD which not recognized by the American Psychiatric Association as a mental disorder. It was not included in DSM-IV or in DSM-5, published in 2013. To our knowledge, except for a few bloggers, there is no movement to change the name BPD to PTSD.  The direction of the new nomenclature is to have a general personality disorder category for people with overlapping PDs.  This would actually lower the number of people in the category of BPD.  

While there is co-morbidity, BPD and alcohol abuse are not the same thing. And half of the people with BPD do not have PTSD - even fewer have C-PTSD.

There are a lot of comorbidities with BPD.

(https://goo.gl/qzHtQf)

Skip, I appreciate your response and I do understand that BPD and alcohol/drug abuse are not the same thing. Maybe the failure was in my communication; maybe it was inexact.

What I was referring to is the statistical reality that the vast majority of people who diagnostically present with BPD and/or C-PTSD are alcohol and drug abusers, to varying extents. And that I recognized from a degree of time involved with AA, that it seems virtually everyone in those rooms present with some degree of BPD and/or C-PTSD symptomology.

I was just wondering, out loud, if the BPD, C-PTSD and alcohol/drug abusing crowd are, in fact, the SAME overlapping crowd, but seen as conceptually distinct due to semantics and/or inexact constructs such as diagnostic labeling.

And now that you have seen the data, what do you think?

What do I think? I guess there is an enormous degree of overlap between those three diagnostic categories. I guess there is a tremendous degree of comorbidity, as you suggest.

This will help pt the combined number in perspective

https://bpdfamily.blogspot.com/2012/03/28-of-us-population-have-either-mental.html

Wow! (I read the link you posted about raw numbers and perspectives.) Again, wow!

Skip, thanks for such prompt responses. I really appreciate it.

BPD is also referred to as "Complex PTSD" by many people who work in the health or medical fields. Regardless of the descriptive names given to these behaviors, there are various similar traits shared by BPD and PTSD traits. BPD may be related to childhood traumas and / or external or dietary toxins while Complex PTSD, in turn, may be related to one or more traumatic life events. Either way, one may have a smaller or "zapped" Amygdala, which then may be the catalyst for these behavioral traits.

www.BPD.about.com/od/relatedconditions/a/Complex-PTSD.htm

Quotes: "Complex post-traumatic stress disorder (PTSD) is also sometimes called "disorder of extreme stress not otherwise specified" (DESNOS). This is a condition characterized by three categories of symptoms: emotion dysregulation, dissociation and problems in physical health.

Complex PTSD or DESNOS is thought to result from severe and chronic childhood maltreatment. Complex PTSD is not listed as a separate diagnosis in the DSM-IV; the features of complex PTSD are instead listed as "associated features" of PTSD.

One of the reasons that complex PTSD was left out of the fourth edition of the DSM was that experts in the field felt that this syndrome was so similar to borderline personality (BP) that it did not warrant a separate diagnostic category. Indeed, many of the features of complex PTSD are also core symptoms of BP. A critical difference, however, is that the cause of BP is not always known, whereas complex PTSD can always be traced back to traumatic events.

Emotion Dysregulation

Severe emotion dysregulation is a symptom typical of both complex PTSD and BP. In both conditions, people experience very intense emotions that shift unpredictably and are difficult to soothe.

Dissociation

Both complex PTSD and BP are also associated with dissociation. Dissociation is a state of altered perception that leaves people feeling "unreal," "zoned out," or "numb." In complex PTSD and BP, dissociation is frequent and chronic – it tends to happen often and can continue for long period of time.

Physical Health

Complex PTSD is also associated with problems in physical health, such as chronic pain, a proneness to frequent illnesses and frequent and complex medical problems that do not respond to medical treatment. While physical health problems are not in the diagnostic criteria for BPD, research suggests that many of these same medical problems are associated with BPD."  

C-PTSD has been finally included in the ICD-11 classification(Euro), but not the DSM-V(USA)...yet.    I found one interesting article comparing the three diagnoses from a symptoms and behaviours point of view.  

https://www.tandfonline.com/doi/full/10.3402/ejpt.v5.25097?src=recsys# (https://www.tandfonline.com/doi/full/10.3402/ejpt.v5.25097?src=recsys#)

Table one has a good side by side description of PTSD, C-PTSD and BPD symptoms and behaviours.  You need to click on the "show table" button in the article.

I downloaded and formatted Table 1 directly from the research paper if you can't see it.
(https://i.imgur.com/QCSw67T.png)

My BPDw psychiatric team has named all three at some point in her treatment history.  I'd say seems to have one or more of the three depending on the day.  And oddly, I'm sort of okay with that.  It helps understand why some treatment approaches are working and others aren't.  

I'm not saying I want to stay in the relationship, but it's provides a bit more clarity on what I'm up against.

Logic...is a cold comfort.  Sigh.