CPTSD versus Borderline Personality Disorder (BPD)

[Kizzie]

(Note - this is a repeat post)

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 into a dataset of 280 women with histories of childhood abuse by Cloitre and colleagues (2014) suggests that 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 

Their research also suggests that different treatment is required for each (which is key for any professionals in your life to know).  For example:

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.

[chairmanmeow]

Thats how they did my ex, even though she was just like me from the same background, they gave her some nasty medicines made her worst and more unstable. Her abusive family used it to their own advantage. My CPTSD got called GAD and they sent me on my way with a bottle of SSRI's. Im glad the psychological world  is starting to really grasp this........

[gonelikeyesterday]

Please... Please someone help me. There's a question I've never spoken aloud. I've only found out I have c-PTSD. I don't know who to talk to, or share with. I'm carrying a lifetime of baggage around - and only just found out most other people had theirs shipped away years ago.
Please help me.

[radical]

Hi Gonelikeyesterday,
We are here, we are all in a similar boat.
Is there a particular way anyone on the board can help just now?
Take care.

[Sceadu]

The part about "frantic efforts to avoid abandonment" always scares me.

I totally panic if I think I'm being rejected.  Totally.  When I was younger and less mature I would sometimes frantically try to get people not to abandon me, but as an adult, I usually just accept it as my lot in life.

I've had a lot of fair-weather friends who hung out with me because I was a warm body and there was no one else, and then left, or just plain stopped liking me because I'm weird.  I feel like whenever someone find out what I'm truly like, they leave.  Or whenever I assert boundaries in a relationship or express any negative feelings, they leave.  This goes for friendship or romantic relationships.  If I ever ran into someone who I felt really "got" me and I felt safe with them, and then they left, I would sometimes frantically try to get them to change their minds.  I often feel like a total reject and that no one really loves me for who I am.

Does that mean I could have BPD?

[Three Roses]

Anything is possible - it's up to you and/or a therapist to decide if it's something you should look at.

From what I'm reading, it sounds like early childhood trauma can also cause attachment disorders, so there's that to look at too. Not necessarily just BPD. (I'm starting to wonder about myself having an attachment disorder, too.)

[Kizzie]

Hey Sceadu - I agree with Three Roses that it's something to look at with your T and in particular at which symptoms (as a whole) represent how you feel.  Fear of abandonment is a major symptom of both, it's how it plays out in each and in conjunction with other symptoms that matters.

Gonelikeyesterday - how are you making out?

[steamy]

The thread is a little old now and many apologies for not keeping up to date.

I just wanted to comment on the point about abandonment and attachment disorders, I read Gabor Mate's "in the realm of the hungry ghosts," there are lots of issues that society is creating for children, who become adults, these often lead to addiction and attachment issues. They found that young rats that were taken away from their mother for only one hour per day did less well than those who stayed with their mother continuously. They also found that rats that were not licked by their mother had less seratonin receptors in their brains and were more likely to self medicate when drugs and alcohol were available. In the USA I see that most women have about two weeks off post-nataly, and the child then goes to a carer for 8 hours per day, while mother goes to work. I have no doubt that the lack of maternity leave has a direct impact on stress, anxiety and attachment disorders, even if the child is well loved and cared for. Of course it might depend on how susceptible the child is, we are all different of course and epigenetics could play a part. One does not need to be abused or neglected to develop attachment disorders.

[JusticeBeaver]

I know this is an old stickied thread, but I just wanted to comment on the "impulsiveness" aspect, that it is supposed to be just a BPD trait. CPTSD can cause impulsive behaviors like binge eating, shoplifting, compulsive overspending... I have dealt with these issues throughout my life. I also fear rejection. I would not say that I am "frantic" about stopping abandonment, but I am definitely paranoid that everyone will leave me or hate me eventually.

I am not a doctor, the following is just from my research, observations and opinion. This is not meant to insult anyone or to make anyone here worry that they are BPD. I know deep down that I am not BPD, though I have worried in the past because of the overlapping symptoms between the 2. I am not diagnosed with anything. I've barely been to a therapist prior to this year, and have just sort of "dealt with" everything on my own. Individuals with BPD tend to end up in therapy early on in life, simply because the people in their lives can't deal with their behaviors.

The main issue that I see as the difference between BPD and CPTSD (I am in therapy with BPD individuals) - is an inability to be accountable for behavior on the BPD side. The incidence of painting things to be different to maintain the image of being a victim. I can acknowledge when I am wrong, and sincerely apologize. People with BPD get increasingly argumentative when they are told they are wrong.

Another issue I see is the incidence of identity disturbance. Individuals with BPD that I have met wear "different" clothes (goth, emo, BDSM wear). Or they dye their hair a million bright colors, or they wear a lot of accessories. Or they become Wiccan, or think they are an animal spirit... they have no idea who they are and try to create a persona to "make" themselves definable. People with CPTSD have a negative self image and are less likely to try to find a persona to adopt, more likely to just be down on themselves no matter what and kind of float through life unsure of what they really like or really want.

Again, this is based on my close relationships with people with CPTSD in my own family, and people with BPD that I have met. I don't know much beyond that, and the articles and books I've read.

Edit to add: I don't think all people who dress outrageously or "different" have BPD, it just seems to be a common trait among the BPD people I have met.

[mourningdove]

Or they become Wiccan

?

[JusticeBeaver]

mourningdove, I guess I should have been more clear. I meant "seek out an alternative religion as a means to self-identify," wicca is one example, but they may be atheist, quaker, etc

here is a scholarly article that explains what I mean. Oftentimes, people with BPD feel so disconnected with others that they can't conform to their religion of origin, so they seek out a religious sect that seems like it is for people who are "different."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277802/

And again, to clarify, I'm not saying that everyone who is involved in alternative religions has BPD, just that it is something I notice, that individuals with BPD tend to involve themselves with things that are different from cultural norms. We can say correlation doesn't equal causation, of course, but when I notice a pattern I take a mental note.

[Hazy111]

Im no expert , but i ve read somewhere and agree with it, is that all types of PD, be it BPD, NPD, SPD, etc or other more extreme  mental illnesses such as schizophrenia, bipolar, psychopathy, sociopathy whatever are all a consequence of C-PTSD or trauma for short in childhood.

C-PTSD as it becomes a more accepted definition as the cause of mental illness will replace the need to constantly label people and categorize them with differing PDs.  As we know with PD, BPD and NPD often overlap and are comorbid with other forms of PD. It is all essentially a dysfunctional personality caused by childhood trauma and insecure attachment .

The degree, type, length etc of trauma/upbringing  is complex in the way it  determines the PD or later mental illness, narcissists often suffer schizoid symptoms and schizoids are now thought to suffer  a milder form of schizophrenia.

Most who come to this site, suffer from a milder form?? of C-PTSD in some form and come from families that have PD individuals in them. It follows therefore that they too have suffered from C-PTSD and it manifests itself later as PD. 

To differentiate between say BPD or NPD and C-PTSD is wrong i believe. 

The differential is those with PD and those who believe that they just suffer "EFs " and the "4fS" , is the former "act out" their condition and have little insight into the consequences of what they do to others (lack  empathy), ie the fight end of the "4fs". 

The rest who (visit this site) have empathy/insight but have been raised by them ( PD parents) and grown up alongside them ( PD siblings), but " act in" as in internalise their rage and tend to be more susceptible to depression/panic./anxiety/phobic than PDs etc

Many "high acting" BPDs and NPDs do not act "out of the norm". I know those in my family that have high powered responsible jobs.

The current POTUS to many is  classic NPD.

The common denominator for all of us is childhood trauma to varying degrees, call it/label it  what you will, when it manifests itself in later adult life.

Just my 2cents worth?? Any thoughts??

[radical]

I prefer to use the term 'abuser' to differentiate what some prefer to describe as cluster B personality disorders.  I agree that developmental abuse is an important cause of most mental illnesses.  It is not the only cause, because being abused as a child, doesn't cause most people to routinely use selfishness, maniuplation, violence,cruelty, controlling others and lack of empathy and self-reflection as ways of dealing with life, feeling better about themselves and getting their way.

Personality disorders are not considered to be mental illnesses, but entrenched, inflexible patterns of behaving and thinking.  The framework of personality disorders can useful for those who find themselves in relationships with abusers, in understanding red flags and patterns of abusive behaviour.  I don't like the way this framework associates 'abuser' and mental illness in the minds of too many people.  People with actual mentall illnesses are far more likely to be the victims that the perpertrators of abuse, and already live with unfair stigma.  For many, the stigma and marginalisation associated with mental illness is as hard as living with the mental illness itself.

It remains to be seen, whether a wider understanding about abuse, and zero-tolerance rather than widespread enabling and victim-blaming would cause many abusers to change their ways.  Unfortunately, uncecked, these behaviours, can be something of a winning formula in controlling and dominating others who approach life more cooperatively and compassionately.  It can be hard to understand that some people think very differently and to misunderstand motives and behaviours according to a projection of their own intentions, values and beliefs.

[Kizzie]

To differentiate between say BPD or NPD and C-PTSD is wrong i believe. 

One fundamental and important distinction is that PD's are personality disorders whereas CPTSD is a stress disorder.    While I agree trauma underlies both types of disorder, the end result is not the same and this is key because it influences treatment and recovery.

[Wife#2]

Hazy111, I see the points you are trying to make, and I do believe that they come from a place of deep compassion for your fellow humans. That part is wonderful. I simply cannot see these as the same because I've lived with the differences.

I've struggled with this a lot. Back and forth. Do my parents display these traits ENOUGH to be a disorder, or were they victims in their own childhood, who then turned around and parented the only way they knew? Because I do NOT want to believe that my parents are really disordered. However, I've had to realize one is. Still, that doesn't give ME permission to follow in Mom's footsteps.

As an adult, I have choices. I chose to start therapy at a young age - myself, not anyone telling me I should. I saw that my thinking wasn't quite right and I needed help. I stuck with the therapy for over a year, but ran out of funds, honestly. Still, I applied what I'd learned. Then, when I saw trauma coming my way, I got BACK into therapy, knowing I'd need a 'T's help, Mom sure wouldn't and Dad wouldn't be able to either. After a third, ongoing trauma, I was mandated into therapy, which I stuck with for two years. I learned new ways of coping with the world that did help me grow as a person. I can claim my mistakes, apologize when I hurt people and feel empathy for any hurting person.

** possible triggers to follow - mild, but possible **

Below is the tale of a single incident in a string of incidents that make up the fabric of Mom's thinking, her willingness to NOT see reality, even if it hurts herself or others.

Siblings and I work together to get Mom a car. Her responses:
1) I don't want THAT car, why couldn't you let me pick the one I wanted? ** Entitlement - it was a FREE car to her **
2) I want a newer one (the one she wanted was older than the one purchased for her). ** Entitlement **
3) I don't like that model. (It's the same as the model I drive.) ** Better than - in this case, me **
4) whispered to me AS we were signing paperwork and asking her for her insurance proof (Can you just come outside with me? I need you to bring me to the insurance company office. Nearly AT the office - I need you to cosign for my insurance. I have the money, but the ** people say it's still cancelled and I have to have someone cosign or they won't reinstate me.) ** Distance from reality - don't pay bill, lose service **
5) Why do you have to have your name on the car, too? You were only cosigning for the insurance, I thought (we explain the law and she finally agrees)
6) She gets the car, we stick around a moment with the dealer. His crew try to drive her 'trade in', that she drove to the lot uninsured, to the back of the lot. They almost wreck in the parking lot - the brakes are GONE and reverse barely works. Hubby and I are mortified that she'd do that without saying anything to anyone. The dealer assures us that we shouldn't be embarrassed - it happens all the time.  ** Special treatment and Entitlement **
7) Fast-forward just over a year. I get a letter in the mail. My license is being cancelled for failure to pay car insurance. I remember that Mom had me cosign and I'd been checking, but she'd been paying, so I slacked off checking behind her. From that moment on, she hadn't paid on time, then failed to pay at ALL. My name was first, so MY license was being cancelled. In this state, a vehicle without insurance MUST turn in the license tag to avoid continuing fines. When hubby and I went to do that, she called me names, called my husband thief (for getting the tag off her car), blamed me for not taking my name off her car previously (couldn't, still needed for insurance), called the sheriff to report hubby, then when sheriff supported hubby's actions, asked sheriff to throw him out of her apartment. All so she wouldn't have to accept consequences of her actions. She didn't care that I was being fined $200.00 or that my license was about to be revoked or that my credit would suffer because of that incident. THAT is Personality Disordered thinking. ** The worst of Narc & BPD wrapped up in one easy-to-see episode **

Do you see in that story that she's displaying entitlement (not THAT car - and she wasn't paying!), special treatment (I didn't pay my insurance, sure, but I have the money now. The stupid company wouldn't work with me to cover my tracks and NOW I HAVE to reveal that I've been slack- because THEY won't let me pay late anymore - rude people!), lack of empathy (car dealers are all crooked anyway, serves them right my car's a mess), refusal to accept reality even when presented with the facts (Throw HIM out of here, please. He's a thief and I want him REMOVED). More lack of empathy (hubby stated very sarcastically, 'Thank you for costing your daughter $200 and almost her license, that was very loving.' Her response? Sincere and pissed tone, 'You're very welcome. Get out.'. She didn't even care because she'd been proven wrong!).

Now, I'm not saying that every PD person acts this way. What I AM saying is that her behavior is well beyond what most cPTSD folks would consider. It was bite-when-cornered instead of hide-when-confronted like most cPTSD folks. This whole time that my husband and mother were snapping at each other, I was sitting on the sofa, crying, filing out the paperwork necessary to turn the car completely over to my mother (free of course). I wasn't even blaming her - in fact, I accepted into my heart her blame that it was MY fault. My fault because I didn't check on my adult mother about whether she was paying her bills or not. My fault because I'd allowed the car to remain in both of our names so that her property tax would be lower (I live in a different county, cheaper on those things). My fault because my husband was making her angry.

See, hubby had to go with me that day because he knows I won't stand up to my mother, even when I'm right. (Well, wouldn't, that incident finally convinced me that she'd throw me under the bus to save herself). He knew that I'd crumble under the first sign of anger from her. He'd seen me crumble before. This time was too important to me and my FOC. I was/am the only driver. My license gets revoked and we don't get to school, work, grocery store. My credit tanks. Then, we can't get loans to cover emergencies, interest skyrockets on credit cards. This time was too important to let my mother intimidate me with her anger. HE took the anger FOR me, so we could get done what needed to get done. Who has to do that unless you're dealing with someone whose issues go WAY beyond the normal range?

Had that been my father, if somehow he suddenly forget to pay his bills, and for some reason depended on me to help before, all I would have had to do is call him and say - Dad, what's this letter from the highway department about? He would find a way to pay the bills, get the tag turned in - AND APOLOGIZE for the trouble he caused me. HE would offer to pay the fine I'd incurred because of HIS actions. Not say, 'Your welcome, get out.'

Both had traumatic childhoods. Both lost their same-gender parent in their 20's. Both lost their opposite-gender parent before turning 50. Both dealt with alcoholic mothers and passive fathers. One turned out possible cPTSD - but dealt with his issues as an adult. Not perfectly, but dealt with them. The other slipped into PD, became the ultimate victim and blames the world for everything wrong in her life. Neither seriously sought therapy. Dad did see priests for counseling, that's as close as he would get. Mom saw therapists, got her Prozac prescript renewed, or whatever, and quit going.

Dad was a college educated engineer. Mom was a semi-college educated woman who opened and successfully ran her own business for 20 years. Both active at church, in politics and with social groups.