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Having Both PTSD and Borderline Personality Disorder

The Consequences of Living with Both

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Updated June 19, 2014

PTSD and Borderline personality disorder (BPD) have been found to commonly co-occur. In fact, it has been found that anywhere between 25 and approximately 60% of people with BPD also have PTSD -- a rate much higher than what is seen in the general population. Likewise, one study of veterans with combat-related PTSD seeking treatment found that 76% of them also had a diagnosis of BPD.

The Diagnosis of BPD

BPD is part of a group 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:
  • Persistent and extreme efforts to avoid real or imagined abandonment by others

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

  • Problems with identity, self-image or a sense of who one really is

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

  • Recurring suicidal acts or threats, or deliberate self-harm.

  • Frequent and intense mood swings

  • Constant feelings of emptiness

  • The intense experience of anger and/or difficulties controlling anger

  • 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 Consequences of Having Both PTSD and BPD

A number of studies have looked at the physical and psychological consequences of having both PTSD and BPD. It has generally been found that people with both diagnoses experience more psychological and physical difficulties, including, for example:
  • Overall general distress
  • Other psychiatric disorders
  • Depression
  • Anxiety
  • Obsessive-compulsive symptoms
  • Worse perceived health
  • Impulsivity
  • Suicidal thoughts
  • More hospitalizations
  • Anger problems
  • Dissociation
  • Interpersonal problems

The findings of these studies suggest the importance of seeking out help if you have both PTSD and BPD.

Getting Treatment for PTSD and BPD

There are a number of effective treatments available for PTSD. Seeking out treatment for BPD, such as dialectical behavior therapy (DBT), may also help reduce PTSD symptoms and address BPD symptoms. Many of the skills taught in DBT (for example, emotion regulation, 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.

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.

Bolton, E.E., Mueser, K.T., & Rosenberg, S.D. (2006). Symptom correlates of posttraumatic stress disorder in clients with borderline personality disorder. Comprehensive Psychiatry, 47, 357-361.

Golier, J.A., Yehuda, R., Bierer, L.M., Mitropoulou, V., New, A.S., Schmeidler, J., et al. (2003). The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. American Journal of Psychiatry, 160, 2018-2024.

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.

Mueser, K.T., Goodman, L.A., Trumbetta, S.L., Rosenberg, S.D., Osher, F.C., Vadaver, R., et al. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psycology, 66, 493-499.

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.

Zlotnick, C., Johnson, D.M., Yen, S., Battle, C.L., Sanislow, C.A., Skodol, A.E., et al. (2003). Clinical features and impairment in women with borderline personality disorder (BPD) with posttraumatic stress disorder (PTSD), BPD without PTSD, and other personality disorders with PTSD. Journal of Nervous and Mental Disease, 191, 706-713.

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