When abandonment terror is combined with habituation to extreme distress and alternating idealization and devaluation of self and others are prominent, as well as a history of neglect or otherwise compromised childhood relationships with primary caregivers, the careful safety planning and affect identification skills that are hallmarks of efficacious BPD treatment are indicated [202]. Ford JD, Smith S: Complex posttraumatic stress disorder in trauma-exposed adults receiving public sector outpatient substance abuse disorder treatment. Epub 2022 Mar 23. While most often comorbid with BPD (33%), cPTSD was not present in two of three BPD cases, and occurred most often when BPD and somatoform disorders were comorbid (38%). Am J Psychiatr 2003,160(2):369371. [Comparative Study Research Support, Non-U.S. Govt], Bryant RA. In both conditions, there are issues with emotional distress and emotional triggers. People with PTSD may have difficulties managing their emotions, and therefore experience intense feelings or have constant mood swings. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. and transmitted securely. [Review]. CAS eCollection 2022. PMID: 28347146. Wedig MM, Silverman MH, Frankenburg FR, Reich DB, Fitzmaurice G, Zanarini MC. Strawn JR, Adler CM, Fleck DE, Hanseman D, Maue DK, Bitter S, DelBello MP. California Privacy Statement, Thus, while PTSD may complicate BPD, a more precise formulation of the specific types of trauma-related dysregulation hypothesized to be involved in cPTSD may be necessary in order to account for the role of trauma in BPD. NCI CPTC Antibody Characterization Program. HHS Vulnerability Disclosure, Help Therefore, we next consider the clinical and research evidence linking primary caregiver relationships, and specifically maltreatment in those relationships, with BPD. Zlotnick C, Mattia JI, Zimmerman M: Clinical correlates of self-mutilation in a sample of general psychiatric patients. Accessibility Weinberg I, Ronningstam E, Goldblatt MJ, Schechter M, Maltsberger JT. Rabinak CA, Angstadt M, Welsh RC, Kenndy AE, Lyubkin M, Martis B, Phan KL. Yan X, Brown AD, Lazar M, Cressman VL, Henn-Haase C, Neylan TC, Marmar CR. Compr Psychiatry 2013,54(6):639648. doi:10.1002/jts.20050. Wingenfeld K, Lange W, Wulff H, Berea C, Beblo T, Saavedra AS, Driessen M. Stability of the dexamethasone suppression test in borderline personality disorder with and without comorbid PTSD: a one-year follow-up study. The most common profile for BPD patients (40%), with or without comorbid Axis I somatoform or other psychiatric disorders, was a combination of under- and over-regulation of affect. This is consistent with the laboratory research finding that physiological reactivity by individuals with childhood sexual or physical abuse histories who met criteria for BPD was strongest when exposed to scripts highlighting themes of abandonment, while those meeting criteria for PTSD but not BPD had peak physiological reactivity when exposed to scripts of traumatic (e.g., violent, abusive, life-threatening) events [64]. Am J Psychiatry 2006,163(7):11731178. Extreme BPD-plus-comorbidity cases thus may constitute a cPTSD sub-type of BPD, although whether childhood victimization contributes uniquely to these cases remains to be investigated systematically. J Clin Psychiatry 2013,74(8):841849. Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH. Am J Orthopsychiatry 2012,82(2):187200. An update on the controversy. adults meeting criteria for either PTSD or BPD also met criteria for the other disorder, and 3070% of adults di-agnosed with BPD had an episode of PTSD at some point in their lifetime [50]. Psychother Psychosom 2013,82(4):221233. Independent of BPD, childhood trauma exposure places children and adults at risk for mood (e.g., bipolar or major depressive disorder), anxiety (e.g., panic, social phobia), obsessive-compulsive, eating, dissociative, addictive, psychotic, somatoform, and personality disorders, as well as significant safety problems including suicidality, self-harm, impulsivity, aggression, reckless behavior, self-medication, and re-victimization [1, 72]. Half of the participants met criteria for comorbid BPD. Moreover, dissociative disorders are common comorbidities of PTSD among individuals with histories of childhood traumatic victimization [177, 178]. In: Courtois CA, Ford JD, editors. A person with BPD may go to extreme lengths to avoid real or perceived abandonment, with many of the relationship issues stemming from this behavior. cPTSD prevalence estimates have not been reported in community or primary healthcare samples. CC provided input to the reviews organization and literature review, and co-wrote or edited sections of the manuscript. Thus, the neurobiology of pain in PTSD is complicated and appears to range from acute analgesia (associated with dissociation) to chronic hyperalgesia (associated with affective distress and hyperarousal). Individuals with BPD and intermittent explosive disorder also showed dorsolateral PfC hypo-activation and elevated orbital PfC and amygdala activation and connectivity in response laboratory tasks eliciting interpersonal frustration [120] and fear [121], similar to the failure of PfC inhibition of amygdala activation found in PTSD and with adults who have child maltreatment histories [122133]. Powers A, Petri JM, Sleep C, Mekawi Y, Lathan EC, Shebuski K, Bradley B, Fani N. J Anxiety Disord. The new PMC design is here! Before Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Extreme BPD-plus-comorbidity cases thus may constitute a cPTSD sub-type of BPD, although whether childhood victimization contributes uniquely to these cases remains to be investigated systematically. The These findings provide an independent and well-controlled replication demonstrating the efficacy of combining trauma narrative processing with DBT for women with CSA-related PTSD and BPD. doi:10.1176/appi.ajp.2010.09081213. volume1, Articlenumber:9 (2014) There is psychobiological evidence supporting the existence of a dissociative sub-type of PTSD [30, 119, 175], particularly among individuals with histories of childhood traumatic victimization [176]. When abandonment terror is combined with habituation to extreme distress and alternating idealization and devaluation of self and others are prominent, as well as a history of neglect or otherwise compromised childhood relationships with primary caregivers, the careful safety planning and affect identification skills that are hallmarks of efficacious BPD treatment are indicated [202]. Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S. Front Psychiatry. These can be suicidal thoughts, dissociation, flashbacks, anxiety and depression. Obesity and obesity-related illnesses in borderline patients. A 10-year follow-up of adults diagnosed with BPD found that most (85%) who initially were diagnosed with PTSD continued to meet criteria for BPD but experienced a remission of PTSD [26, 27]. [Research Support, U.S. Govt, Non-P.H.S. Biol Psychiatry 2010,67(5):399405. Self-disturbances are characterized by negative self-concept marked by persistent beliefs about oneself as diminished, defeated or worthless [possibly] accompanied by deep and pervasive feelings of shame or guilt Interpersonal disturbances are defined by persistent difficulties in sustaining relationships [due to a tendency to either] avoid, deride or have little interest in relationships [or] occasionally experience[ing] close or intense relationships but [having] difficulty maintaining emotional engagement. Google Scholar. J Abnorm Psychol 2008,117(3):502519. Psychol Med 2010,40(5):847859. cPTSD adds to the core PTSD fear symptoms three forms of dysregulation which may involve either or both hyperarousal and hypoarousal: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational engagement [33, 59, 156, 157]). DOI: 10.1177/1039856217700284. However, the high drop-out rate reported even by potentially efficacious combined BPD+PTSD interventions [210] may signal the need for alternative therapeutic frameworks such as those offered by cPTSD therapies that do not modify exposure-based interventions but instead directly address dissociation [213] or severe affect dysregulation [215]. Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA. (2017). Consistent with a cPTSD perspective, across all psychiatric disorders, cases with the heaviest childhood trauma burden also have the most severe psychosocial impairment [106]. Ford, J.D., Courtois, C.A. Zlotnick C, Mattia JI, Zimmerman M. Clinical correlates of self-mutilation in a sample of general psychiatric patients. 8600 Rockville Pike Descriptive statistics. Compr Psychiatry 2008,49(6):603615. The impulsive behaviors and unstable relationships common in people with BPD can place them at a greater risk for experiencing a traumatic event such as a motor vehicle accident, physical assault, or sexual assault. The symptoms of each condition are amplified by the co-diagnosis, so it is important for people with both to get the right support. CPTSD isnt currently recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) as a separate disorder from PTSD. BPD and CPTSD are treatable, even if they occur together. CAS BPD often involves pain analgesia consistent with dissociation [7] and self-medication with analgesic medications [94], potentially mediated by a neurobiological substrate (i.e., 2-AG endocannabinoids) specific to BPD (versus PTSD) has been identified [145]. doi:10.1080/00048670701392833, Hobson RP, Patrick MP, Hobson JA, Crandell L, Bronfman E, Lyons-Ruth K: How mothers with borderline personality disorder relate to their year-old infants. Individuals with childhood histories of sexual abuse were least likely to remit on PTSD. Runnals JJ, Van Voorhees E, Robbins AT, Brancu M, Straits-Troster K, Beckham JC, Calhoun PS. [Research Support, Non-U.S. Govt], Hoerst M, Weber-Fahr W, Tunc-Skarka N, Ruf M, Bohus M, Schmahl C, Ende G. Correlation of glutamate levels in the anterior cingulate cortex with self-reported impulsivity in patients with borderline personality disorder and healthy controls. 2021 May 6;8(1):16. doi: 10.1186/s40479-021-00155-9. doi:10.1111/j.16000447.2011.01805.x. Nervenarzt 2002,73(9):820829. Eur J Psychotraumatol 2013., 4: doi:10.3402/ejpt.v4i0.20706. cPTSD includes features that reflect both under- and over-regulation of affect, positive and negative dissociation, difficulties in both experiencing and recognizing emotions, and both a surfeit and deficit in self-referential beliefs. PubMed Central Method: Ford JD, Courtois CA (Eds): Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. Understanding the heterogeneity of BPD symptoms through latent class analysis: initial results and clinical correlates among inner-city substance users. Borderline personality disorder and childhood trauma: evidence for a causal relationship. J Personal Disord 2010,24(3):296311. These are critically important outcomes, but DBT did not show greater effectiveness than expert treatment as usual (TAU) with regard to guilt, shame, anger suppression, anxiety, core schemas, and impulse controlsymptoms that are central to cPTSD. In: Van der Kolk B, editor. When these disorders and severe impairments occur as comorbidities or features of BPD [19, 24, 60, 9193], these complex cases tend to be particularly chronic, dangerous, and treatment-refractory [8, 9, 94100]. Complex PTSD and borderline personality disorder. Zlotnick C, Franklin CL, Zimmerman M: Is comorbidity of posttraumatic stress disorder and borderline personality disorder related to greater pathology and impairment? Epub 2020 Oct 1. Rusch N, Holzer A, Hermann C, Schramm E, Jacob GA, Bohus M, Corrigan PW. If avoidance of perceived or actual threat of suffering or causing harm in current relationships (along with dysphoria, dissociation, and/or hyperarousal) was debilitating, PTSD would be focal. BPD versus Complex PTSD BPD Fear of abandonment Unstable relationships that alternate between idealizing and devaluing the other person Complex PTSD Chronic avoidance of Although comorbidity frequently occurs in BPD cases, BPD is a relatively uncommon comorbidity of other psychiatric disorders. Curr Psychiatr Rep 2014,16(3):438. doi:10.1007/s119200140438-z, Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH: Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. 2015;2:11. doi:10.1186/s40479-015-0032-y. Gratz KL, Latzman RD, Tull MT, Reynolds EK, Lejuez CW. Am J Psychiatr 2010,167(7):748751. PLoS ONE 2013,8(6):e65824. Background: There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when Zanarini MC, Horz S, Frankenburg FR, Weingeroff J, Reich DB, Fitzmaurice G. The 10-year course of PTSD in borderline patients and axis II comparison subjects. Experts refer to this higher level of diagnosis as Complex PTSD (CPTSD). In a combined concurrent and retrospective study, young women meeting BPD criteria were particularly likely compared to age-matched women with no psychiatric diagnosis to report feeling unprotected in their relationship with their mother and to have elevated cortisol levels at the outset of a laboratory interaction with their mother [193]. Since then, hundreds of clinical or scientific studies of cPTSD and cognates (e.g., Disorders of Extreme Stress [11, 12]; Developmental Trauma Disorder [13, 14] have been published. Functionally, affect dysregulation can be divided into under-regulationdifficulties in modulating and recovering from uncontrolled experiencing and expression of extremely intense forms of negative affect (e.g., rage, despair, impulsivity), and over-regulation (i.e., numbing, suppression, or dissociation) of positive and negative affect [158, 159]. In adult psychiatric samples, childhood trauma history was more strongly related to paranoid personality disorder than BPD [2] and both PTSD and dissociative disorders have been found to be equally or more often comorbid with avoidant, self-defeating, and passive-aggressive personality disorders as with BPD [113]. Gratz KL, Rosenthal MZ, Tull MT, Lejuez CW, Gunderson JG. http://scholar.google.com.au/citations?view_op=view_citation%hl=en%user=z6lcOR0AAAAJ%26cstart=20%citation_for_view=z6lcOR0AAAAJ:M3ejUd6NZC8C, Bardeen JR, Dixon-Gordon KL, Tull MT, Lyons JA, Gratz KL: An investigation of the relationship between borderline personality disorder and cocaine-related attentional bias following trauma cue exposure: the moderating role of gender. [Research Support, U.S. Govt, Non-P.H.S. Neuroimaging studies have shown that military veterans with PTSD exhibit increased activation in the hippocampus, insula, and putamen, and decreased PfC and amygdala activation in reaction to externally-induced acute pain [153], while women with PTSD secondary to interpersonal violence showed increased activity in both the insula and PfC during acute pain but reduced insula activation with repeated pain induction [154]. In Treating Complex Traumatic Stress Disorders : an Evidence-Based Guide. J Affect Disord 2013,144(12):7278. With CPTSD, emotional dysregulation revolves around a persons inability to calm themself down. The mediating role of complex posttraumatic stress and borderline pattern symptoms on the association between sexual abuse and suicide risk. In BPD this failure of biological and psychological emotion habituation was associated with greater affective instability and reduced insula-ventral ACC functional connectivity. The paranoid and obsessional styles share a common preoccupation with hypervigilance to perceived threat which is consistent with the PTSDs anxiety and guilt-proneness. The signs and symptoms of CPTSD include the three categories of PTSD symptoms: The symptoms are often strong and frequent and are primarily related to the initial traumatic event. Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans. Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) III: associations with functional impairment related to DSM-IV disorders. [Comparative Study Research Support, U.S. Govt, P.H.S.]. An official website of the United States government. A study with college students found that having valued relationships outside the family in the larger community statistically mediatedand mitigated againstthe risk of developing BPD traits associated with a history of exposure to childhood betrayal trauma [203]. Complex PTSD refers to specific symptoms derived from exposure to prolonged, repeated trauma. Bethesda, MD 20894, Web Policies doi:10.1097/NMD.0b013e318064e7fc. Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. What Is Histrionic Personality Disorder (HPD)? Most cases of Axis I and II disorders do not have comorbid BPD: the highest BPD comorbidity rates are 50% for eating disorders [24], 30-35% for SUD or bipolar disorder, and 25-50% for paranoid, avoidant, dependent, and schizotypal personality disorders. Symptom endorsement of Complex PTSD and BPD items by class. Compr Psychiatry 1989,30(1):1825. Review. They may also: CPTSD and BPD may increase your chance of self-harm. Psychiatry 2013,76(4):365380. doi:10.1016/j.jpsychires.2010.04.016. However, it is unlikely that cPTSD occurs only as a BPD sub-type. The dev When these disorders and severe impairments occur as comorbidities or features of BPD [19, 24, 60, 9193], these complex cases tend to be particularly chronic, dangerous, and treatment-refractory [8, 9, 94100]. ), Persistent and extreme efforts to avoid real or imagined abandonment by others, Problems with identity, self-image, or a sense of who one really is, The intense experience of anger and/or difficulties controlling anger. Can J Psychiatry 1994,39(5):259264. Adults diagnosed with BPD have been shown to be more likely than adults with other psychiatric or personality disorders or no psychopathology to report a history of psychological trauma [5, 6570]. BPD comorbidity is typically found in less than 10% and at most 15-20% of Axis I or II disorders [19]. Unable to load your collection due to an error, Unable to load your delegates due to an error. PTSD uniformly also involves persistent fear manifested as physiological hyperarousal due to an explicit or implicit attentional bias toward (i.e., hypervigilance), or avoidance of, actual or perceived threats [59, 156]. J Pers Disord 2009,23(4):357369. A person with CPTSD may have issues with trust and staying connected with people, but they dont have the fear of abandonment; thats a telltale sign of BPD. Those two disorders would be Borderline Personality Disorder (BDP) and Post Traumatic Syndrome Disorder (PTSD). We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD. BPD and cPTSD overlap substantially, but it does not seem warranted to conceptualize cPTSD either as a replacement for BPD nor simply as a sub-type of BPD. Unable to load your collection due to an error, Unable to load your delegates due to an error. J Personal Disord 2012,26(2):192202. Experts refer to this higher level of diagnosis as, An intense fear of abandonment, including separation from and rejection by others, Occurrence of paranoia that could last hours, Inconsistencies between self-identity and self-image, bad views of oneself, Inpulsive and dangerous behaviors, including addictions, unsafe sex, thrill-seeking, and risks with employment and relationships, Suicidal ideology with threats of suicide to manipulate others, Wide mood swings over hours and days in duration, Any discussion about what is CPTSD should start with the definition of PTSD. Soc Psychiatry Psychiatr Epidemiol 2011,46(11):10791086. de Jong J, Komproe IH, Spinazzola J, van der Kolk BA, Van Ommeren MH: DESNOS in three postconflict settings: assessing cross-cultural construct equivalence. DBT-PTSD was associated with substantial reductions in PTSD severity for women with or without BPD, while those in a wait-list treatment-as-usual condition showed almost no change (i.e., reductions on average of 33 vs. 2 points on the Clinician Administered PTSD Scale). PLoS ONE 2012,7(3):e33293. A better differentiated empirically-grounded view of cPTSD, BPD, and PTSD is a high priority for the advancement of clinical practice and research with traumatized adults. Spinazzola J, Blaustein M, van der Kolk BA. The .gov means its official. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Loneliness and needing to self-isolate are common in people with BPD but there are steps you can take to move toward connection and healing. BPD and avoidant personality disorder patients showed dorsal ACC hypo-activation after viewing repeated emotionally distressing pictures, as well as smaller increases in insula-amygdala functional connectivity and a lack of habituation in their ratings of the emotional intensity of the images [118]. Behav Res Ther 2014, 53: 4754. Bluhm RL, Williamson PC, Osuch EA, Frewen PA, Stevens TK, Boksman K, Lanius RA. Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self Bozzatello P, Garbarini C, Rocca P, Bellino S. Diagnostics (Basel). 2013;76(4):365380. In the world where psychological and physiological symptoms define psychological ailments, complex post-traumatic stress disorder (C-PTSD) and borderline personality disorder (BPD) are often neck-and-neck in similarities. We've updated our Privacy Policy, which will go in to effect on September 1, 2022. CPTSD presents additional symptoms such as: Borderline personality disorder (BPD) affects a persons ability to regulate their emotions. Lis S, Bohus M: Social interaction in borderline personality disorder. Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for posttraumatic stress disorder. Edited by: Courtois CA, Ford JD. Google Scholar. doi:10.1111/j.17517893.2010.00173.x, Berenbaum H, Thompson RJ, Milanek ME, Boden MT, Bredemeier K: Psychological trauma and schizotypal personality disorder. doi:10.1017/S0033291712000517, Yen S, Gagnon K, Spirito A: Borderline personality disorder in suicidal adolescents. Ford JD, et al. J Consult Clin Psychol 2002,70(5):10671074. Journal of Groups in Addiction and Recovery 2008, 3: 285303. Int J Methods Psychiatr Res 2012,21(3):169184. In addition, both BPD diagnosis and childhood sexual abuse history were found to be related to a structural marker for impaired neural network integration (i.e., reduced corpus callosum volume) in a study of women with comorbid BPD and ADHD [43, 44], specifically in pathways connecting the right and left hemisphere loci for emotion regulation and self-monitoring, i.e., the ACC [117]. Dissociative disorders in DSM-5. If only PTSD is assessed, for example with a severely and chronically poly-victimized client, the evaluation may fail to identify crucial components of affect dysregulation and altered relational- and self-schemas that may shape, amplify or perpetuate intrusive re-experiencing, avoidance, pervasive negative affect states and beliefs, hypervigilance, and dissociation. As a proxy for cPTSD, several studies have shown that the combination of a history of childhood victimization and DSM- IV PTSD are associated with distinct BPD presentations, including: (1) deficits in cognitive empathy [37] and cognitive affect management [38], (2) suicide attempts [22, 39] and lethality [40], (3) non-suicidal self-injury [40, 41], (4) crises leading to hospitalization [25], (5) psychotic symptoms [42], (6) anxious and guilt-prone (rather than disgust- or shame-based) self- concept [4345], and (7) in approximately 30% of a sample of patients diagnosed with BPD, obesity [46]. Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is an alternative DBT-informed cPTSD therapy, which engages clients in trauma processing with a present-centered cognitive therapy rather than exposure or other trauma memory-focused techniques. Mission Harbor not overly concerned about which diagnosis you might have. You can learn more about it and try a few exercises at dialecticbehavioraltherapy.com. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals.