One of the issues we face in psychology is that it is an ever-evolving landscape. The subject is still relatively new compared to other areas of study such as mathematics, which has been around for millennia. There is something of a state of revisionism that takes place as new findings emerge and cause us to re-examine previous data. Complex post-traumatic stress disorder (cPTSD) is one of a new wave of conditions that still isn’t widely known by many therapists. It displays all the symptoms of a standard case of PTSD, but with further characteristics that muddy the waters slightly when trying to provide an accurate diagnosis. cPTSD has strong similarities with Borderline Personality Disorder (BPD) to the extent that the two conditions have often been mistaken for one another, making any treatment plan less effective.
Overview: Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a mood disorder that affects how the individual thinks, perceives, feels and interacts with the world. It is the most commonly recognised personality disorder affecting between 0.7 – 2.0% of the UK population and presenting around 20% of in-patients in psychiatric wards and between 10 – 30% of out-patients. The disorder is best characterised by a consistent pattern of unstable interpersonal relationships and self-image. Although it isn’t a gender specific condition – no psychological conditions are – women are far more likely to diagnosed with BPD than men. In fact, around 75% of people diagnosed with BPD are women. The reason for this disparity still isn’t known. It could possibly be due to gender-bias in terms of diagnosis, as men with BPD are often misdiagnosed with post-traumatic stress disorder.
Overview: Complex PTSD
Complex post-traumatic stress disorder is still a relatively new term within psychological literature. It has long been recognised that PTSD isn’t always an accurate diagnosis when dealing with trauma-based conditions. There’s a consensus among many professionals that some certain of trauma can present additional symptoms to those found in more commonly documented cases of PTSD. However, there is still a lack of agreement in quarters if what is being observed is an entirely new condition altogether. For instance, some therapists have chosen to use an alternate way of recognising cPTSD, calling it: enduring personality change after catastrophic experience (EPCACE). Or, in the US, it is also sometimes referred to as: disorders of extreme stress not otherwise stated (DESNOS). The former feeds into the current lack of any real understanding around the condition.
How Does cPTSD Differ from a Diagnosis of PTSD?
Complex PTSD is derivative – or parallel – condition to PTSD. The key difference between the two is that while the commonly occurring form of PTSD is a fear-based disorder, cPTSD is often cited as being a shame-based disorder. It generally presents in those with a history of frequent and intense exposure to traumatising events such as severe child abuse or other forms of relationship abuse – including neglect, mental and emotional abuse. If the individual in question was not able to escape their situation, it places them in a higher risk category of developing complex PTSD.
When PTSD and BPD Co-Occur with One Another
Post-traumatic stress disorder and borderline personality disorder commonly co-occur with one another. It’s estimated that between 25% and 60% of those who suffer from BPD also suffer from some form of PTSD. The reason for this is that both conditions – PTSD in particular – is the result of traumatic events. And the characteristics of someone with a diagnosis of BPD, including their thoughts feelings and behaviours are also said to be rooted in mental and emotional trauma childhood due to neglect, or, having been raised by one or more parents who either had BPD themselves or else displayed narcissistic tendencies. Depending on the severity of these earlier traumatic events, it may or may not lead to an occurrence of PTSD in later life.
Overlapping Symptoms Between Complex PTSD and BPD
BPD and cPTSD get confused with one another because there’s such an overlap between the core symptoms. In both conditions, there are issues with emotional distress and emotional triggers. These can be suicidal thoughts, dissociation, flashbacks, anxiety and depression. Even when an individual is being seen by an experienced professional, it can sometimes be hard to discern what the actual condition at is since BPD and PTSD can already be co-morbid with one another. Here are some of the key similarities between the two conditions.
- Difficulty in controlling emotions.
- Constant feelings of emptiness or loneliness.
- Feeling as you’re damaged or worthless.
- Feeling of wanting to commit suicide.
The Key Differences Between BPD and cPTSD
To help give you a better understanding of the differences between BPD and cPTSD, here’s how you can tell the two conditions apart if you’re unsure about either yourself or someone close to you.
- Although both disorders do have issues of fear within inter-personal and romantic relationships, with cPTSD, there isn’t the same fear of abandonment as with BPD. However, instead, people with complex PTSD may actively avoid relationships based on a sense of worthlessness because of the abuse they went through in their earlier years.
- In cases of cPTSD, the individual may experience intense shame surrounding the failing of their inter-personal relationships and blame themselves unnecessarily. This is also present in those with BPD. However, the distinguishing factor here is that people with complex PTSD do not self-harm, which is much more prevalent in those with borderline symptoms.
- Another big difference between the two conditions is again in how relationships are viewed. While individuals suffering from either condition may feel that relationships are generally unsafe and even threatening, they are approached very differently. Someone with cPTSD will usually avoid them outright, while the BPD sufferer will struggle being alone and actively seek them out.
- Also, while self-image can be an issue in both of those suffering from cPTSD and BPD, in borderline individuals, this will manifest as a form of an identity crisis. They change their appearance, pursuits and friends on a regular basis. Those with PTSD, on the other hand, are more self-assured in who they are but lack a sense of self-worth which can sometimes be seen as a lack of self-identity.
About the author:
Dr Becky Spelman is a leading UK Psychologist who’s had great success helping her clients manage and overcome a multitude of mental illnesses.
***If you’re struggling confused about whether you’re suffering from complex PTSD or Borderline Personality Disorder and think you might benefit from speaking to someone, we offer a FREE 15-MINUTE CONSULTATION with one of our specialists to help you find the best way to move forward. You can book yours here
Psychology Today. (5th June 2020) Is It BPD or cPTSD? Retrieved on 18th June, 2020 from, https://www.psychologytoday.com/gb/blog/understanding-ptsd/202006/is-it-bpd-or-cptsd
Very Well Mind. (25th March 2020) Having Both PTSD & Borderline Personality Disorder. Retrieved on 18th June, 2020 from, https://www.verywellmind.com/having-both-ptsd-and-borderline-personality-disorder-2797510
Psych Central. (18th Oct 2020) Difference between PTSD reactions and Borderline Personality Disorder. Retrieved on 18th June, 2020 from, https://pro.psychcentral.com/exhausted-woman/2017/10/difference-between-ptsd-reactions-and-borderline-personality-disorder/