Misdiagnoses - BPD vs CPTSD

[Kizzie]

As you read through the various threads in the forums you will probably see that many of us have been misdiagnosed with Borderline Personality Disorder (BPD).  Or if not misdiagnosed, many of us worry that we have BPD rather than CPTSD because the two appear to be alike, despite the fact that BPD is a personality disorder and CPTSD a stress disorder.  The good news is that I came across a very current research study that provides some data about the differences. 

Unfortunately, I can't reproduce it/upload it here due to copyright, but here's the reference and a short summary if you want to take it to your GP or T (or just tuck under your pillow so you feel reassured!); no doubt they will be able to access the full version through their databases (and nothing speaks to louder to professionals than empirical evidence):

The Difference between CPTSD and BPD

There has been much debate by clinicians and researchers about whether and how Complex Post Traumatic Stress Disorder (CPTSD) is distinct from Borderline Personality Disorder (BPD), in particular when BPD is comorbid with PTSD (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014).  Research involving 280 women with histories of childhood abuse by Cloitre and colleagues (2014, p. 2) suggests differences in the symptoms of BDP and CPTSD as shown below:

Symptoms of CPTSD

• Re-experiencing the past – flashbacks, nightmares
• Avoidance – of thoughts, feelings, people, places, activities
• Sense of threat - Hypervigilance (being especially alert constantly on guard) and strong startle response
• Emotion regulation – Anger and hurt feelings
• Negative self-concept - Feeling of worthlessness and guilt
• Interpersonal problems - Never feeling close to another person, feeling disconnected or distant or cut off from other people

Symptoms of BPD

•   Frantic efforts to avoid abandonment
•   Relationships - Unstable and intense relationships with alternating
•   extremes of idealization and devaluation
•   Unstable sense of self - Markedly and persistently unstable sense of self
•   Impulsiveness - that is potentially self-damaging
•   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
•   Mood changes - Affective instability due to reactivity to mood
•   Emptiness - Chronic feelings of emptiness
•   Temper - Frequent displays of anger, constant anger, recurrent physical fights
•   Paranoid/dissociation - Transient, stress-related paranoid ideation or severe dissociative symptoms

As Cloitre and her colleagues (2014) write there are clear differences between CPTSD and BPD:

In Complex PTSD, as proposed in ICD-11, the fear of abandonment is not a requirement of the disorder, self-identify is consistently negative rather than shifting and relational disturbances highlight chronic avoidance of relationships rather than sustained chaotic engagement. While emotion regulation difficulties are central to both Complex PTSD and BPD, their expression is quite different. In Complex PTSD they predominantly include emotional sensitivity, reactive anger and poor coping responses (e.g., use of alcohol and substances). In BPD, some of the preceding may be observed, but the criteria, perhaps the defining characteristics of the disorder, include suicide attempts and gestures as well as self-injurious behaviors, events which occur much less frequently in complex forms of PTSD than in BPD samples (p. 3).

As a result of these differences, they contend that different treatment is required for each (which is key for any professionals in your life to know):

The focus of treatment for BPD concerns reduction of life interfering behaviors such as suicidality and self-injurious behaviors, a reduction in dependency on others and an increase in an internalized and stable sense of self (e.g., Dialectical Behavior Therapy, Linehan, 1993). In contrast, treatment programs for CPTSD focus on reduction of social and interpersonal avoidance, development of a more positive self-concept and relatively rapid engagement in the review and meaning of traumatic memories (e.g., Cloitre et al., 2006).

Reference: Cloitre, M., Garvert, D., Weiss, B., Carlson, E. & Bryant, R. (2014). Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European Journal of Psychotraumatology, 5.

[Dutch Uncle]

The Difference between CPTSD and BPD

[...] there are four main symptoms of BDP which distinguish it from CPTSD including:

•   frantic efforts to avoid abandonment
•   unstable sense of self
•   unstable and intense interpersonal relationships, and
•   impulsiveness 

It's not quite clear to me: are these are BPD diagnostics or CPTSD criteria?

edited to add:

Note: I added more detail to the original post in this thread.

Thanks so much. Even while my SCID-II proved conclusively I have not BPD, the fear installed in me that something disturbingly is 'wrong' with me is still hard to shed. It's reassuringly clear to me now I personally relate to the CPTSD criteria. Again. Touch base. 

[Kizzie]

These are symptoms of BPD that those with CPTSD don't tend to exhibit.

[Dutch Uncle]

Thanks. 

[Kizzie]

Note: I added more detail to the original post in this thread.

[IAMstronger]

Hi, Im new to this forum. This topic really interested me b/c I am always trying to learn what is wrong with me. I was dx with BPD, BIpolar and CPTSD. That scares me. yet for bipolar there is no medication that works. I never related to the intense swings. With BPD, I wasnt self injurious. Today as an adult I do not depend on others ....I have had nightmares for years, I startle VERY easlity, but I also have paranoia which I figured out that it was the severity of my mothers narcissitic gaslighting behaviors. I was made to be their scapegoat. I think I am just questiong about the paranoia??

[Kizzie]

I'm not much for labels per se either Artemis, but in terms of getting a correct diagnosis and receiving relevant treatment, it can be very helpful to know how they are distinguished, especially given CPTSD is relatively new or at least is not widely known/understood. 

[Kizzie]

Got it -     

[mourningdove]

Hi artemis23, 

You might be interested in this: http://outofthefog.net/C-PTSD/forum/index.php?topic=19.msg7938#msg7938, particularly the last two quotes.

[Dutch Uncle]

Here's a YouTube video from a cPTSD-affected women who speaks on this, and has some links to articles on cPTSD and BPD as well.

***possible triggers: about halfway in the video it gets a bit confusing, and a more personal story***
Complex PTSD & Misdiagnosis