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Integrate Treatment for Complex PTSD, Borderline Personality Disorder

Integrate Treatment for Complex PTSD, Borderline Personality DisorderResearchers from the University of Connecticut and Elements Behavioral Health find that complex PTSD is not simply a subtype of BPD and suggest the disorders be addressed together.

People affected by borderline personality disorder often have diagnosable symptoms of a form of post-traumatic stress disorder called complex PTSD, according to recent findings from the University of Connecticut Health Center and Elements Behavioral Health.

Complex PTSD is an unofficial but scientifically verified form of post-traumatic stress disorder that increases the mental health burden of damaging stress reactions in important ways. In a study review published in 2014 in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers from two U.S. institutions gauged the degree of overlap between borderline personality disorder (BPD) and complex PTSD in the general population. These researchers found a high amount of overlap between the two conditions, but also identified clear differences between the effects of BPD and the effects of complex PTSD.

Borderline Personality Disorder

Borderline personality disorder is a relatively common and severe personality-based mental illness. All individuals with BPD have emotion control difficulties that substantially impair their ability to avoid acting in reckless ways, keep their moods on an even keel and/or avoid maintaining highly polarized relationships with friends and loved ones. Among its many damaging effects, borderline personality disorder is associated with a sharply increased risk of seriously contemplating suicide and making suicide attempts. For this and other reasons, mental health professionals view the disorder as a highly dangerous condition and seek to treat it as rapidly and effectively as possible. The acknowledged BPD rate among American adults is roughly 1.6 percent; however, many affected people may never receive a proper diagnosis of their condition.

Complex PTSD

All people with diagnosable post-traumatic stress disorder have at least one symptom that falls into each of four main categories. These categories are an unwanted waking or sleeping recollection of a highly traumatic situation, event or series of events; avoidance of conversations or circumstances that serve as a reminder of prior trauma exposure; the adoption of a largely negative set of emotions and beliefs; and an inability to control the physically and emotionally keyed-up reactions that characterize the body’s “fight-or-flight” response. People with complex PTSD have seriously damaging stress reactions above and beyond the core symptoms of PTSD. In any given individual, these additional symptoms may include a collapse of religious or moral belief, a strong sense of mental or physical detachment from reality, a preoccupation with the person or persons responsible for trauma exposure and loss of identification with other human beings.

Typically, people with complex PTSD have a history of prolonged and/or repeated exposure to highly traumatizing events or situations, the U.S. Department of Veterans Affairs’ National Center for PTSD reports. Since the vast majority of affected individuals qualify for a traditional PTSD diagnosis, the American Psychiatric Association does not officially recognize complex PTSD as a separate mental illness. However, unofficially, the condition is well-recognized among mental health professionals who treat post-traumatic stress disorder and other trauma- or stress-related mental health ailments.

Overlap of BPD and Complex PTSD

In the study review published in Borderline Personality Disorder and Emotional Dysregulation, researchers from the University of Connecticut Health Center and Elements Behavioral Health used a large-scale analysis of previous studies to explore the degree of overlap between borderline personality disorder, PTSD and complex PTSD. The researchers undertook this project, in part, because many people now considered to be affected by complex PTSD at one point had received a diagnosis of borderline personality disorder. They also undertook the project in recognition of the relatively high rate of trauma exposure in people affected by BPD.

After completing their literature review and analysis, the researchers concluded that borderline personality disorder and complex PTSD share many features, including loss of the ability to exercise control over shifting moods, a tendency to experience mental or physical detachment from reality and exposure to highly traumatic circumstances (including traumatizing treatment at the hands of family members and other designated caregivers). The researchers also concluded that there is a significant potential treatment benefit associated with emphasizing the connections between PTSD, complex PTSD and borderline personality disorder.

Despite the extensive overlap between borderline personality disorder and complex PTSD, the study review’s authors believe that it is inappropriate to view complex PTSD as a specific manifestation of BPD, or alternately to view a complex PTSD diagnosis as a reasonable substitute for a BPD diagnosis. However, they note that substantial numbers of people with borderline personality disorder may require treatment that focuses on the co-existing symptoms of complex PTSD.

Posted on August 27, 2015 and modified on April 24, 2019

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