Sexual abuse victims often diagnosed with BPD instead of CPTSD

[Cat Familiar]

This is an interesting article in the Guardian about how frequently sexual abuse victims have been misdiagnosed with BPD instead of Complex PTSD. https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abuse-victims-being-diagnosed-with-a-mental-disorder-they-dont-have

"The disorder is called complex PTSD. It was identified in 1990 by American psychiatrists studying the experiences, behavior and symptoms of sexual abuse victims and other patients who have experienced extreme trauma and neglect, usually at a young age. A decade later, new science – in the form of brain scans – revealed this was a distinct condition affecting certain areas of the brain."

The DSM has yet to recognize CPTSD, but as of last year, it was formally recognized in the UK.

The article goes on to explain how an inaccurate diagnosis of BPD can have unfortunate life-altering consequences.

[I Am Redeemed]

That's really interesting, Cat, and I have also read that BPD is often misdiagnosed as PTSD. Or, PTSD is present but the BPD is overlooked.

Either way it would have a negative impact on someone seeking treatment.

Redeemed

[empath]

The Body Keeps the Score is a fascinating book about trauma and its treatment. Van der Kolk talks about the similarities between C - PTSD and BPD and kids who have experienced abuse. He proposes that there should be a broader category in the DSM for people who are experiencing the effects of trauma. The more interesting part is that he has found some methods that help.

[Red5]

This really hits home for me.

My first wife was a csa victim... we are talking 1975-1980...

I married her in 1984, she was barely seventeen and I was eighteen...

She told me a few years later, after our first son was born, I think it was 1988... of course at that time I had not a clue in the world what it all meant.

She told me things...
*did not remember hardly any of her childhood.
*her mother put her tranquilizers when she was a child.
*the perp was her older brother... later she said it was an uncle too, at one point a step dad.
*her younger sister was also abused too.
*she had never even met her real father... there were four siblings... each had a different father... only the last one was a “command law marriage”.

She saw a few counselors over the years... mostly as we sought answers - treatment for our autistic son...

Never anything substantial... until about 1992... then we had our third child... a daughter...

In 1994... things exploded... still no clue as to why she was acting out so...

She left us several times, cheating... drugs... and several suicide attempts... still no diagnoses for the few times she saw a doctor...

This went on into the ninties...’remember’... this was before the internet... as we know it today...

In 1995, after she came back after an attempt at leaving... we got her to see a trauma therapist... finally... but, she pretty much lost it, after only two sessions... she actually disappeared for three days...   she couldn’t handle the demons...

We were married for twenty one years... it was very hard... I... we tried so hard, so many times... but she finally just walked away from me and the kids in 2006...

I don’t think she ever did try to heal... she’s always lived as a victim... she is still living with the man she left me for... I heard he threw her from a moving car one time... they now have a son together...

It’s almost as though she is repeating her mother’s life...

I see her every once in a while when she wants to see my autistic son... she looks like hell, like a meth adict... she used to be a very beautiful girl... she is fifty-one now, she looks like she is seventy something ; (

It was years after the divorce before either of my two younger children... teenagers at that time even wanted to see her  ...

My middle son... he is twenty nine now, and has pretty much no relationship with his mother... at all,

She lives with her partner still, they aren’t married...in the next state now.

What is creepy to me, this man she lives with... is the spitting image of her now deceased brother... whom abused her.

Her sister is also now deceased... as is her mother and of course the grandmother...

This phenomena is a generational thing... and as the perps die off, and their is no closure or responsibility taken... the victim never is able to heal... they seem to just spiral further and further...

I could go on for quite a while... but I’ll stop here for now... I heard and learned things that would turn your hair white...

It’s so sad, so much hurt... lives destroyed... terrible...

Abuse victims... hard to help, hard to understand... very complicated... deeply deeply hurt... diagnoses may be impossible for some... like my ex wife... she told many times that she just wanted to die... that’s all I got for now,

Red5  

[Cat Familiar]

Perhaps it really doesn’t matter for family and spouses to have a correct diagnosis, but merely to realize that their loved one has been through a tremendously painful ordeal that no one should ever have to endure.

The tools we learn here work well for emotionally healthy people as well as people with personality disorders.

[AskingWhy]

Does the current DSM recognise C-PTSD?

I know abuse of any kind will predispose some to BPD, though.  My FIL is a uNPD terror:  self-absorbed, egotistical, favored his younger son over the older one, my H.

Now FIL is elderly.  Like many NPDs, he has a huge opinion of himself, but nothing to show for it.  BIL is a shiftless, drug addicted loser, while H had a successful military career and now a successful retirement career.

Guess who literally comes begging and crying for money when he needs it?  FIL.  He spent his adult life in deadend careers as long as he could hunt, fish and play golf.  He gave nothing of value to his wife in their many decades of marriage, and spent all money on himself.  The W and children had little except the bare necessities.
 
My uBPD H has a lot of responsibility in his field of professionals, and it very practical with his life and finances. He is stingy, though, like his F and love to spend lavishly on himself and his adult children.

I can see how his BPD was caused by his childhood of emotional abuse and spare childhood.  

[an0ught]

The article may provide a perspective on CPTSD. What concerns me quite a bit is that BPD is portrait as very bad, with stigma and hopeless.

But first let's look at this:

“The borderline diagnosis for sexual abuse survivors is nonsense and misleading because it suggests that the problem is within the personality of the survivor rather than a result of what has happened to them,”

There is discussion about seeing BPD as "emotional regulation disorder". BPD is also understood as having a diverse set of causes - some external and some internal. The association here of BPD primarily with "personality" from a professional is not helpful.

Her BPD diagnosis also led to dismissive treatment away from medical situations. While giving witness testimony in a case alleging police brutality at the 2010 G20 Toronto summit, the defense lawyer used the BPD diagnosis to humiliate her, holding open a book of mental health disorders and suggesting that because she had it, she had behaved irrationally angrily and aggressively at the protest. (She later sued the police and they settled.)

This is a real problem for pwBPD, there is a lot of stigma attached to it. And yes, pwBPD can turn their environment into a form of hell - no doubt about it.

(they are told their personality is “disordered”; they are called “difficult”; and as the condition can’t be cured, some psychologists avoid treating them.)

But then it is also the one mental condition that has a very good chance of being treated successfully. The "can't be cured" is simply absolutely wrong and does not represent the result of current studies.

Being associated with negatively labeled BPD can cause real problems but the root issue here is the negative labeling. The "pwBPD" we use here is to remind us every time that these are people first and foremost and they are with BPD condition.

Nurses seemed less compassionate when she self-harmed. An ER doctor appeared irritated by the [BPD] diagnosis and attempted to stitch up a self-inflicted leg wound without an anesthetic.

This is wrong, very, very wrong. But blaming lack of anesthetics on a BPD vs CPSTD diagnosis?

After diagnosis, she researched the condition, and found some of the symptoms did not fit. Her psychiatrist downplayed her concerns, and told her not to protest, because the BPD diagnosis was the only way of accessing a free, six-month course combining several therapies.

This is the real problem. Insurance concerns force premature labeling. Labeling is the gateway to treatment and it does do damage. In case of this article the damage is  through stigma of BPD and a less effective treatment. While there is considerable overlap of BPD and PTSD therapy approaches there are also differences and in any case her commitment to treatment will be weakened and that is never good.

For pwBPD the very real risk however are the diagnosis of bi-polar (often used to avoid the BPD stigma) or schizophrenic  as these have vastly different treatment regimes. Earlier and longer access to therapy without conditioning it on labeling would be a good thing.


CPTSD is a condition that deserves compassion. So is BPD. The article sadly paints BPD black in order to shed light on the real suffering of CPTSD victims. This is a disturbing tactic.

Last but not least - a lot of us non's here are subject to long ongoing trauma and some of us may well qualify for a CPTSD diagnosis at times.

[Cat Familiar]

The article may provide a perspective on CPTSD. What concerns me quite a bit is that BPD is portrait as very bad, with stigma and hopeless.

The negative portrayal of BPD in this article bothered me too. However, it is true that people diagnosed with BPD are often stigmatized and may not receive the treatment they need or are marginalized and some are even abused.

But first let's look at this:There is discussion about seeing BPD as "emotional regulation disorder". BPD is also understood as having a diverse set of causes - some external and some internal. The association here of BPD primarily with "personality" from a professional is not helpful.

Recently what I've read suggests that there is a strong genetic component to BPD and certainly that seems likely to me, based upon my own observations.

[Red5]

Recently what I've read suggests that there is a strong genetic component to BPD and certainly that seems likely to me, based upon my own observations.

I’ve also spent quite some time reading in this area.

*nature - *nuture

Predisposed genetic programming perhaps... and when the precipitating conditions are present in early childhood or else later in life do to tramua... Pandora’s box is opened.

Certainly not the fault of the individual person.

That said... once a degree of adulthood is reached and the ability to reason somewhat effectively between what is right and wrong... “free will”, the ability to ‘choose’, to make a choice, as to how to act, what to do... which fork in the road to take, understanding what the resultant consequences will be, and be willing to accept the responsibility of our actions and words towards others... professed  loved ones, companions, family etc’.

This is where I get confused... we often read here, persons with borderline personality disorder must take responsibility for those words and actions... must be held accountable... must understand and respect boundaries... etc’ etc’ etc’.

We hear the person ‘is’ BPD, they don’t ‘have’ BPD, can they ‘help it’... are they actually aware, I struggle with this...

CPTSD/PTSD... and BPD, in this context resultant from sexual abuse in childhood or else later in adulthood... thusly misdiagnosed as BPD vice CPTSD, again BPD to me is more than likely genetically predisposed... not a ‘condition’ brought about by trauma... but triggered into active behavior ‘by’ trauma...

The combat Veteran who drinks and beats, abuses his wife and children can no more say the reason he did this was because of what he may have seen, experienced, or participated in during the action in Fallujah Iraq, (CPTSD)... than the person diagnosed with BPD can justify the pain and emotional agony that they may inflict on a wife, or husband due to serial adultery... that was a conscious choice...

Yes... trauma will directly effect how we deal with everyday life, but I believe it’s the choice of the individual person as to their own choices that they know may hurt others...

Red5

[Cat Familiar]

*nature - *nuture

Predisposed genetic programming perhaps ... and when the precipitating conditions are present in early childhood or else later in life do to tramua ... Pandora’s box is opened.

Certainly not the fault of the individual person.

Someone, who has a genetic predisposition to heart disease or diabetes, may not get the disease if they take good care of their health. But children are not capable of protecting themselves from trauma inflicted upon them when they are very young.

That said ... once a degree of adulthood is reached and the ability to reason somewhat effectively between what is right and wrong ... “free will”, the ability to ‘choose’, to make a choice, as to how to act, what to do ... which fork in the road to take, understanding what the resultant consequences will be, and be willing to accept the responsibility of our actions and words towards others ... professed  loved ones, companions, family etc’.

A very good distinction. As adults we are expected to own the consequences of our behavior, something many pwBPD are unlikely to do. This is a part of the maturation process that they have missed, but they are capable of learning this lesson later in life.

The combat Veteran who drinks and beats, abuses his wife and children can no more say the reason he did this was because of what he may have seen, experienced, or participated in during the action in Fallujah Iraq, (CPTSD) ... than the person diagnosed with BPD can justify the pain and emotional agony that they may inflict on a wife, or husband due to serial adultery... that was a conscious choice ...

The operative word here is “justify”. Rather than using “wise mind”, both individuals in this example are operating out of a more primitive part of the brain, seeking emotional release, without consideration of the consequences of their behavior.

Certainly they can be taught to behave mindfully, however offering any justification for their behavior merely inhibits taking personal responsibility.

[empath]

That said ... once a degree of adulthood is reached and the ability to reason somewhat effectively between what is right and wrong ... “free will”, the ability to ‘choose’, to make a choice, as to how to act, what to do ... which fork in the road to take, understanding what the resultant consequences will be, and be willing to accept the responsibility of our actions and words towards others ... professed  loved ones, companions, family etc’.

Ah, one would hope that the decision making process would be based on rational and logical thoughts instead of the attachment/trauma reactions.

I was talking with my h this past week and he described himself as "highly sensitive" and "empathetic" (I just listened at that point). Basically, he had a lot of emotions growing up, and he said that his dad would tell him that he shouldn't have those emotions. Invalidation. Dad also has a huge entitlement leaning, so he transmits that to the kids, too. The result is that h has emotions that were invalidated and feels entitled to act on those emotions.

As a child, I had a traumatic experience that was limited and had PTSD symptoms growing up. I still have residual symptoms in certain situations. The effects were not something that I could control or do anything about until I had better tools to manage my own reactions - and a good bit of physical distance from the triggers. The difference with people who have had relational trauma is that they can't exactly find a place where there are no relationships, so they don't know what life is like without the constant triggering environment.

Taking responsibility includes being able to consider what one has done and keep it in mind. When a person is intensely sensitive to the shame of their actions, it can be difficult to stay in that place. The easier path is to escape and avoid it.

[Red5]

This is a part of the maturation process that they have missed, but they are capable of learning this lesson later in life.

That “maturation process”... in both the marriage relationships I’ve been in during my life, the first failed one, and the current one that is in “failure mode”... after things “went off the rails”... I’ve spent a lot of time looking, investigating, both these individuals pasts, as in the first, if I could have understood what she had gone through, and what she endured, that made her so unstable in adult hood (we married as teenagers)... then I thought for many years... in fact right up till the end (twenty one years); that I could have provided her with these “maturation tools”... and a supportive, and nurturing relationship that she would have been able to live the rest of her life with me, in a healing and validation manner, well I failed, I was wrong, dead wrong, that survival healing initiative has to come form that individual... you can’t offer it, provide it, or else “make it so”... no matter how much you learned, studied, or else sought that for them...

Marriage relationship number two, I’m doing the exact same thing with her... I’ve fallen right back on the same old play book, “if I can only crack the secret family code”... then I can deprogrammed, reprogram her... with that correct software upgrade of “maturation process”...

Well I’m fifty-three years old now, and I’m running out of “railroad track” here...

I remember... in this current marriage debacle, when I felt the steel wheels leave the tracks... I immediately fell onto, “OMG, was she sexually abused too, she’s crazy too... oh’ NO!... what did I miss, I thought I was wise to this, where was the red flags here... why is she acting like she has “multiple personality disorder”...

See how flawed my thinking was back then... I used Tom actually think that my first wife had “MPD”... I had a head shrinker tell me that back in 1994, he said, “she does this, reverts back and forth, left and right, in these “personas” in order to,escape,her memories of the abuse”...

He continued...”I bet one of them is a scared little girl, and one is a rogue teenager”... I said, “I married the second one back in 1984 Doc”... I was twenty-nine back then, the “Doc” said, go to the library... and see if they got this book... “The Courage to Heal” by Ellen Bass...

Anyways, what is I learned was, (thought) basically that / that marriage was doomed, she was too damaged emotionally...mentally... and the older she got, the worse sh was going to get... “Doc” says to me, “Sergeant Red”... take a good long look at mum, sis, aunts... and grandmama... there you will see your future...

He was dead on...

So back to the future here, do I think my current wife was sexually abused... I really don’t know, there are some “markers” there... I’ve observed and experienced of her, with her.

She’s told me things after we got to the bottom of that box of wine, and ran out of cigarettes... back in the day...

... she told me a lot as a matter of fact... like weigh points on a map...

(Fear of engulfment)’... some sexual dysfunction at times, “changed personas on me”... a clue ?

I do believe she was in a dysfunctional “Foo”... I’ve been told too much by the other too BIL’s to think otherwise (generational)... she did leave home at sixteen to marry a twenty two year old soldier... (escape, as wife no.1 did with me)...

Now when I think about it all... “multiple personality disorder”... hmmm,I believe that’s been overhauled, repainted, new software has replaced the eight track tape player, and it is now known as “Dissociative Identity Disorder, or “DID”...

But back in 1994, it was “MPD”... the “Doc” I was talking too also dropped “schizophrenia” due to trauma as well... “1994”... Navy Doctor...

PTSD was practically unheard of back then, still not “mainstream”, PTSD made it into the DSM in 1980 something?, via the military’s use of the term to understand “combat related disorders” in Veterans, mainly from the Vietnam era,

Now PTSD/CPTSD is quite “mainstream”... and it firmly and fastly hitched to the pharmaceutical industry, which in turn is firmly and fastly attached to the insurance industry...

I remember my Grandfather talking about one of the Men in th community, whom I now understand to be CPTSD Veteran, he’s long deceased now, he was in World War II, Korea, and also Vietnam... he was pretty crazy, drank, spent a lot of time in the county jail, for growing marijuana... and other nefarious “enterprises” around Suwannee county, just you’re average Combat Veteran of three wars, missing parts of himself, both physically and mentally... well, he used to talk to Grampa late in the afternoons out in the sawmill, after had “knocked off”, and before supper...as they all went to Church together, for decades... Grampa said at the supper table one night, I remember it vividly, “that Bobby _____ says he is trying to find himself”... “I don’t reckon I know what he means by that Granny”... he said...

Old man “Bobby”...wow, and whoa... he was certainly “operating off the reservation”... he died resultant from a gun shot... in a fight, at some bar over in Gilcrist county one night, I think Jimmy Carter’s was in office when that happened (time frame), I think he may have been about forty’ish something at that time... it was late nineteen seventy something back when that happened... long before I was old enough to,have a drivers license  ... (time stamp)

I’ve gone on too long...

Red5

 

[Cat Familiar]

What's difficult for those of us who are caretakers/codependent is when we see that someone is missing a "life lesson" and we think we can "help" them get up to speed.

There's a lot to unpack in this. First, there's a difference in status. We are assuming a "teacher/mentor" role that likely they are not really comfortable having us in this position, since we are supposedly equals, being in a romantic relationship.

Second, we are assuming that we know what is best for them. Perhaps we do. Perhaps we don't.

Third, we are violating an implicit agreement in that we are conducting a "training" that they didn't sign up for.

[I Am Redeemed]

Cat, you are dead on with that. I got so caught up in that kind of thinking. I just wanted to "help", to "fix", to get him to learn the skills he never learned growing up. It would make life better. It would solve a lot of problems.

Where I really got off track was thinking that I had the power to do this. Moreover, I didn't understand that his perception of "needing me to help him" was "needing me to enable him", and my perception of helping was to "enlighten" him to his need for maturation and healthy coping skills. We both had unrealistic expectations and goals that were completely opposite from each other.

[Red5]

We are assuming a "teacher/mentor" role that likely they are not really comfortable having us in this position

I’ve read many times now, in a marriage / romantic relationship... maybe parental as well,  not quite sure about that last configuration... but something along the lines of... “the significant other, husband, wife, companion or lover can never, should never try to assume the role of the other; significant other’s therapist”, these two rolls, partner and therapist (reconfigure this term as required)... should never ever be conjoined... ever.

This may be right up there with telling pw/BPD that they are BPD, may as well put kryptonite in Super Mans lunch box...

This paradigm however..., to me; is extremely confounding and perplexing... very frustrating to “take onboard”...

In an intimate healthy relationship, marraige... your partner is supposed to be your best friend... trusted confidant... etc etc etc... “we share everything... trust each other completely”...

I may have had this sporadically, off and on over the years... maybe... otherwise I’d have to say I’ve never really fully experienced this in any of my romantic relationships...

I can tell you this, persons who have been sexually abused, are very fragile within... it is very difficult to win over and keep their complete trust for very long... as there are many of those early bits of “software” missing or else damaged, these souls are very deeply hurt, and depending on the severity, length of time, and the age of occurrence, will transfer over into the severity of the persons ability to cope with day to day life as an adult... I can certainly see how even a highly trained clinician could misdiagnose between BPD and cptsd...

My ex wife, was never diagnosed as far as I know... save “anxiety” and also depression a few times over the years...’due to’ our trying to accept our sons condition, and to try to understand how to best care for him along side his younger brother and sister whom were developing normally... it seemed that she began to slowly deteriorate emotionaly over the years starting at year eight of marriage... she went from being totally engrossed in our sons autism diagnoses, and his daily schooling and care...which was another journey all together due to the “changing times”, 1986 forward... to her completely abandoning all of us, permanently... in the end, that was thirteen years ago now,

I think she didn’t want to know... I remember when her younger sister and her were together... also several of her female cousins...’it would get quite explosive’... my ex wife chose to be invisible as far as any diagnoses I think, like we read about quiet and invisible borderlines... perhaps...

She used to tell me that she felt “empty” inside... many times she also said to me “I wish I’d never been born”... that is a glimmer at the depth of what sexual abuse victims feel, and I feel that incest is the worst... the worst... it still amazes me now looking back that she functioned at all for so many years... after her brother died (abuser), 2004, she seemed to really accelerate towards the final summation of the marriage...  we divorced in 2006, so two years... she completely lost it,

Sorry for another long post.

Red5

[an0ught]

We are assuming a "teacher/mentor" role that likely they are not really comfortable having us in this position

This role is highly problematic and not just for ethical reasons. We tend to be co-dependent. We tend to have weak boundaries.  We are in some way uniquely disqualified and trying to straddle these roles is damaging to us. Besides it tends not to work. We are worn down. We are hurting. We are weak. Any sustainable strategy needs to start with our own needs.We need to learn to put our needs first.

What has worked for me at least was not teacher/mentor but role model. Focusing sharply on how I should be. Boundaries are really powerful in shaping relationships (true for any organization). By  being clearer (and while not adding much distress beyond extinction bursts) what I accept it became easier for her to adjust. This was not explaining but simply me doing.

On the validation side I would not so strictly distinguish between me and us. Communication is a matter of two people engaging and Fruzetti's "High conflict couple" is a book that at least in theory can be worked through together. Validating her is a necessity and helped her to quieten her invalidating self-talk. At times I did share my self validating self-talk - one can see it as coaching but it was also about helping her better understand my emotions - helping her to better understand herself. And yes, it is a balancing act as it meant making myself vulnerable and that is only wise to an extent. Boundaries should not be forgotten.

This is where I get confused ... we often read here, persons with borderline personality disorder must take responsibility for those words and actions ... must be held accountable ... must understand and respect boundaries ... etc’ etc’ etc’.

Holding accountable is something from the outside. It is about boundaries and consequences and our job. Taking responsibility is holding yourself accountable.

There are some pwBPD who are constantly so distressed that they are not able to think clear much at all. Boundary enforcement and validation from the outside may provide occasional breaks where clearer thinking is possible. Expecting much taking responsibility here is futile as distress reduction comes first.

Being open about taking responsibility imho. is always a milestone when people post here. Even before that time there may be some awareness of wrongdoing. We know guilt and shame is one of the overwhelming drivers of pwBPD. Getting to the point where they can openly validate themselves feeling responsibility and regret is a big step forward dampening these overwhelming and thus toxic emotions.

[PeteWitsend]

Wow... I had never heard of c-ptsd before.

That does explain a lot; I did suspect my UBPD-xw suffered some childhood trauma.  she mentioned being largely abandoned by her parents for stretches of time when she was a toddler, when other relatives were supposed to care for her, but really just put her outside in the yard of her apartment complex and then let her in to sleep after dark..  I also gathered from some of her disjointed memories that she may have been sexually abused.

Years ago, when I reached out to others for advice on the troubles in our marriage, and was first informed of BPD, I was surprised by how closely her behavior mirrored that of BPD - EXCEPT for, notably, she didn't exhibit wanton behaviors (no drugs, or casual sex), and AFAIK never self harmed or threatened suicide.  That seems to align with what the article says is more typical of C-PTSD.

When I look back, she did seem to have an unhealthy fixation on sexual misconduct in general (frequently accusing me of affairs, looking at other women, thinking about other women (!), etc), and sometimes even more bizarre fixations .. I can see how that would all be related.  

I felt sometimes like she resented me for having a normal childhood, and seemed to go out of her way to attack anything associated with my past (from keepsakes, to family relationships, even to any memories of mine that predated our relationship).  All of this really confused me until I realized I wasn't dealing with someone who was being honest and straightforward with me.

[Cat Familiar]

Wow, many people give their dog or cat more love and attention than that.

[Turkish]

I asked my then not ex if she were molested.  She said no.  She lied. I don't blame her.  I knew my mother was in 1989 when she told me.  I had a spidey-sense since we hung out with so many victims. My boss at the cafe I worked at from '87-92 was a victim.

My ex admitted it in front of me over two years later when I convinced her to return after our daughter was likely molested.

My mother, a few years ago,  told me she was in therapy when I was a child for PTSD.

BPD... CPTSD, does it matter how our loved (or past loved) ones were hurt?

They were hurt,  brutally, and they hurt us. Hurt people hurt people.

I'm thankful I was never hurt as my mom and my ex were.  I was still hurt by them.  I still try to process this.