Borderline Personality DIsosrder vs Post-Traumatic Stress Syndrome?

[Mary S]

There is an interesting article in the current (January, 2022) issue of Scientific American: “The Long Shadow of Trauma,” by Diana Kwon.( I haven’t found the article online without a paywall, but I think the issue is available for a reasonable fee at bookstores, etc., and it might also be available at public libraries )

The cover of the issue says, “Rethinking Borderline Personality Disorder, and the blurb about the article in the table of contents says, “Borderline personality disorder is one of the most stigmatized psychiatric diagnoses. Is it time to recast it as a trauma-related condition?”

A quote from the first page of the article (pp. 50-51):

“ BPD and complex PTSD share a number of features, such as difficulty regulating emotions and an altered sense of self. A key difference, however, is that complex PTSD explicitly frames an individual’s condition as a response to trauma, whereas BPD does not. Many people fit the criteria for both disorders. But the degree to which trauma plays a role in BPD has been the subject of intense debate among psychiatrists and psychologists.

Studies show that anywhere between 30 and 80 percent of people with BPD meet the criteria for a trauma-based disorder or report past trauma-related experiences. Most clinicians who have studied or treated people with BPD agree that not everyone diagnosed with this condition has undergone trauma – at least as it is traditionally characterized. But a growing body of evidence suggests that what constitutes “trauma” is not obvious: even when adverse experiences do not fit the textbook definition of trauma, they can leave lasting marks on the brain and heighten the risk of developing mental ailments such as BPD.

These realizations are challenging the definition and treatment of BPD.  Some clinicians and patients have called to rebrand BPD and complex PTSD, arguing that the overlap between these two conditions is significant enough to eliminate the former diagnosis.  BPD has long been harshly stigmatized – even by mental health professionals, some of whom reject patients as manipulative, difficult, and resistant to treatment. Others say that although not all BPD is complex PTSD, the evidence of early stressors playing a role in its development is enough to warrant reassessment of its label.”

“I think that borderline personality disorder does not fit in the concept of a personality disorder, Martin Bohus, a psychiatrist at the ZI tells me. “It fits much better to stress-related disorders because what we know from our clients is that there is no borderline disorder without severe, interpersonal early stress.”  

The section ““Capital T” Trauma” on p. 52 gives some history of the PTSD diagnosis. In particular, it says that it was “the first mental illness defined by an external cause”, and describes some of these “external causes”. It then describes the diagnosis “complex PTSD” as “a new diagnosis  (distinct from  PTSD)  to account for a cluster of symptoms that resulted from long-term exposure to extreme stress.  Judith Herman, the proposer of this new diagnosis, “noted [that] these problems occurred when one person was under the control of another, such as in the context of prisons or labor camps or in certain families. They included difficulties with emotion regulation, unstable personal relationships, pathological changes in identity and self-image, and self-destructive behavior.” …

At this point, I think it is more informative to quote from the website https://advantagementalhealthcenter.com/borderline-personality-disorder-vs-complex-post-traumatic-stress-disorder/, which starts,

“Unlike PTSD, which is understood to be a fear-based disorder, complex PTSD is believed to be rooted in shame. It is characterized by a low sense of self-worth, flashbacks to traumatic events, and intense feelings of fear, sadness, and shame.”

            Wow! I remember trying to tell one of my worst therapists that I had a lot of problems coping with shame; she responded by laughing, tossing her hands up in the air, and saying, “I have no idea what you mean by shame!”

I’ve had it for today!

[disequilibrium1]

Thanks, Mary.
I think shame factors many/most personalities, perhaps stemming from our upbringings where we're rewarded, "punished" and constantly assessed for our merits and error. It's hard to lose those reflexes once we emerge from such a supervised setting, even more so when negative consequences were harsh. Perhaps if children's "mistakes" had more neutral values, there would be less cover up for error. Few people I know are comfortable with their all-too-human shortcomings and errors.

It also makes sense that trauma results in what the industry labels a "personality disorder." I only know from the laboratory experiment I call my life, that I feel far less "disordered"  through the years the further I get from my early reflexes and distresses.

[Mary S]

Another (older) article focusing on shame: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330497/

The article really turns me off -- it seems to be so arrogant, so inclined to stuff people into boxes/categories/theories.

[Mary S]

In contrast, this article (that I just came across today) makes a lot of sense to me. It discusses "the overlap between bodily and emotional feelings". It discusses the roles that the insula ( a certain portion of the brain) might play in psychiatric disorders. I particularly appreciate that the author steers away from making certain-sounding statements, and explicitly acknowledges uncertainty -- thisis important in distinguishing good science from the sloppy version of science that so many psychologists practice.