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PTSD and Borderline Personality Disorder

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Updated April 16, 2014

PTSD and borderline personality disorder (or BPD) commonly co-occur. BPD has been receiving increased attention within the media over the years. It has been featured in movies (for example, Girl Interrupted), as well as articles in the New York Times and popular magazines, such as O Magazine.

In addition, it has been found that many individuals with PTSD also exhibit BPD, and conversely, a diagnosis of PTSD is quite common among people with BPD.

What is BPD?

BPD is part of a special class of mental disorders that are referred to as personality disorders by the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). According to the DSM-IV, personality disorders represent a long-standing pattern of problematic behaviors, thoughts, and feelings that often start in adolescence or early adulthood. BPD is made up of the following symptoms:

  1. Persistent and extreme efforts to avoid real or imagined abandonment by others.

  2. A pattern of unstable, intense, and stormy relationships where the person may frequently shift between idealizing and devaluing their partner.

  3. Problems with identify or an unstable self-image or sense of who one really is.

  4. Being impulsive in ways that are problematic or damaging (for example, engaging in substance use, sexual promiscuity, reckless driving, binge eating, etc.).

  5. Re-occurring suicidal acts or threats or engaging in deliberate self-harm.

  6. Frequent and intense mood swings.

  7. Constant feelings of emptiness.

  8. The intense experience of anger and/or difficulties controlling anger.

  9. Paranoia or dissociation that comes and goes as a result of experiencing stress.

To receive a diagnosis of BPD, you need to exhibit at least 5 of these symptoms. Of course, as with all mental disorders, only a mental health professional can provide a diagnosis of BPD.

The Co-Occurrence of BPD and PTSD

As mentioned previously, BPD has been found among people with PTSD and vice versa. One study of veterans with combat-related PTSD seeking treatment found that 76% of them also had a diagnosis of BPD. Likewise, another study found that approximately 56% of individuals with BPD also have a diagnosis of PTSD.

Why are these two disorders so inter-related? BPD and PTSD have both been found to stem from the experience of traumatic events. The thoughts, feelings, and behaviors seen in BPD are often the result of childhood traumas. These childhood traumas may also place a person at risk for developing PTSD. In fact, people with both BPD and PTSD report the earlier experience of trauma as compared to people with just PTSD.

The impulsive behaviors and unstable relationships seen among people with BPD may also place a person at greater risk for experiencing a traumatic event such as a motor vehicle accident, physical assault, or sexual assault.

Finally, the symptoms of PTSD and BPD do overlap. For example, individuals with PTSD may have difficulties managing their emotions. Therefore, they may experience intense feelings and have constant mood swings. They may also experience problems with anger. People with PTSD, especially those who lost a loved one, may also begin to fear being abandoned.

Treatment

There are two well-supported treatments for BPD, Dr. Marsha Linehan's Dialectical Behavior Therapy (DBT) and Drs. Anthony Bateman and Peter Fonagy's Mentalization-Based Treatment (MBT). Studies have yet to examine whether these treatments are also effective in reducing PTSD symptoms; however, many of the skills taught in these treatments (for example, emotion regulation, emotional awareness, being effective in interpersonal relationships) may address some of the problems seen among people with PTSD. Finally, there are some good self-help resources available for BPD as well.

More and more is being learned about BPD everyday and treatment for BPD is advancing quickly. You can learn more about BPD and its treatment (including those treatments listed here) at The National Education Alliance for Borderline Personality Disorder and The Borderline Personality Disorder Resource Center.

Sources:

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.

Bateman, A., & Fonagy, P. (2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: An 18-month follow-up. American Journal of Psychiatry, 158, 36-42.

Gunderson, J.G., & Sabo, A.N. (1993). The phenomenological and conceptual interface between borderline personality disorder and PTSD. American Journal of Psychiatry, 150, 19-27.

Heffernan, K., & Cloitre, M. (2000). A comparison of posttraumatic stress disorder with and without borderline personality disorder among women with a history of childhood sexual abuse: Etiological and clinical characteristics. The Journal of Nervous and Mental Disease, 188, 589-595.

Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.

Southwick, S.M., Yehuda, R., & Giller, E. (1993). Personality disorders in treatment seeking Vietnam combat veterans with post-traumatic stress disorder. American Journal of Psychiatry, 150, 1020-1023.

Wagner, A.W., & Linehan, M.M. (2006). Applications of Dialectical Behavior Therapy to posttraumatic stress disorder and related problems. In V.M. Follette & J.I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma, 2nd edition (pp. 117-145). New York, NY: Guilford Press.

Zanarini, M.C., Frankenburg, F.R., Dubo, E.D., Sickel, A.E., Trikha, A., Levin, A., & Reynolds, V. (1998). Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry, 155, 1733-1739.

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