Distinguishing between Complex Post Traumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD) is often a source of confusion, at both a professional and a consumer level. The two diagnoses have a substantial amount of overlap, and it is possible to be diagnosed with both simultaneously. It’s also possible to be diagnosed with one, but really be experiencing the other! Here, I’ll give a brief overview of each of the two conditions, along with what they have in common, and where you’ll find their differences.
While PTSD is generally a response to an isolated event, CPTSD is associated with an experience of a pattern of ongoing, repeated trauma. Examples of ongoing trauma that lead to CPTSD include, but are not limited to, long term physical, emotional, or sexual abuse, ongoing domestic violence, or being a refugee. Many of the symptoms of CPTSD overlap with PTSD. Individuals may re-experience their trauma through flashbacks or nightmares, they may have difficulties regulating their emotion, they may dissociate or ‘lose touch’ with reality, and they may experience significant depression and anxiety. More unique to CPTSD, however, is the fact that the individual is often left with many distorted perceptions of themselves, of others, or of their environment. Despite knowing the logical dangers, an individual with CPTSD may seek comfort from their abuser or from events that mirror their trauma, they may seek out people who will treat them in a similarly abusive manner, or they may, unintentionally, centre their entire identity around their trauma or the person/people/institutions responsible for it.
Borderline Personality Disorder is an illness which has, at its core, difficulties in regulating emotion. There are both biological and environmental risk factors for BPD. Some research has shown differences in the frontal lobe of individuals with BPD, which is involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly. Also common in individuals with BPD is a significantly disrupted childhood. This may involve being separated from a parent or caregiver, being exposed to conflict and an unstable family environment, or witnessing or experiencing sexual, physical, or emotional abuse.
Symptoms common to both CPTSD and BPD include periods of stress-related paranoia, dissociation, impulsive behaviours, constant feelings of emptiness, and engaging in self harm and other suicidal behaviours. Cloitre et al., (2014) conducted a study distinguishing between PTSD, CPTSD, and BPD, and found a number of symptoms that are distinct to individuals with BPD. These include:
Frantic efforts to avoid real or potential abandonment
A pattern of unstable and intense relationships
Alternating between extremes of idealisation and devaluation of other people
A persistently unstable sense of self worth, purpose, or identity,
Marked impulsiveness, often involving risky sex, binge eating, drug use, and excessive spending
Higher presence of suicidal and self injurious behaviours
Unfortunately, BPD often evokes negative connotations, which is likely in part because many of its symptoms occur in the context of relationships. The judgment surrounding the diagnosis is, however, cruel and unnecessary. Many of the symptoms that individuals with BPD experience make sense in the context of their personal history – if an individual was abandoned as a child, it makes perfect sense that they would catastrophise the prospect of abandonment as an adult. If a child experienced ongoing emotional abuse, they may not learn how to take care of themselves emotionally, which may result in an unstable sense of identity or an increased likelihood of using self harm as an emotion regulation strategy. The stigma that is attached to BPD is entirely uncalled for – I have once heard a professional refer to the disorder as ‘Post Traumatic Personality Organisation’ and I can definitely see how and why that may fit.
Both CPTSD and BPD can be debilitating, but there are medications and therapeutic interventions that can do wonders for symptoms. Please don’t use this overview as a diagnostic tool – if you have any concerns, reach out to a mental health professional or your gp.
