PTSD and borderline personality disorder or BPD often co-occur. Studies have found that anywhere between 25% and approximately 60% of people with BPD also have PTSD. This rate of PTSD is much higher than what is normally 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.
What is 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). Personality disorders are considered to be a long-standing pattern of problematic behaviors, thoughts, and feelings that 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
- Problems with identity, self-image or a sense of who one really is
- Being impulsive in ways that are problematic or damaging
- 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
In order to receive a diagnosis of BPD, you need to exhibit at least 5 of the above symptoms.
Conequences of Having BPD and PTSD
Several studies (although not all) have found that people with both a PTSD and BPD diagnosis experience more difficulties, such as overall general distress, other psychiatric disorders, depression, anxiety, obsessive-compulsive symptoms, worse perceived health, impulsivity, suicidal thoughts, more hospitalizations, anger problems, dissociation, and interpersonal problems.
The symptoms of BPD (for example, interpersonal problems, deliberate self-harm, difficulties managing emotions) could also interfere with treatment for PTSD. It's been found that having BPD may interfere with treatment for another disorder, such as depression and substance abuse. However, less is known about its impact on treatment for PTSD.
The Impact of BPD on PTSD Treatment
Of the few studies that have examined the impact of having BPD on PTSD treatment, it appears as though BPD does not interfere with treatment for PTSD.
One study found that women with a history of assault, as well as symptoms of BPD, were just as likely as those without BPD symptoms to benefit from cognitive-behavioral therapy (CBT). Following CBT, both women with and without BPD symptoms showed similar improvement on the severity of their PTSD symptoms, depression, anxiety, and social difficulties.
Another study looked at the effect of BPD symptoms on CBT for PTSD among women who had been raped. The women with PTSD and symptoms of BPD had a more severe case of PTSD before treatment started. However, they benefited just as much from CBT as did women without BPD symptoms. They showed similar rates of improvement in a number of areas, including the severity of their PTSD, depression, anger, anxiety, and dissociation. They were also just as likely as those without BPD symptoms to stay in treatment.
Getting Help
The findings of these studies are very hopeful. They show that, although people with BPD and PTSD may experience more psychological and physical difficulties, having BPD may not interfere with treatment for PTSD. In fact, treatment for PTSD may actually improve some symptoms of BPD (for example, dissociation and anger problems).
There are many effective treatments for PTSD. You can find a therapist in your area who treats PTSD through the Anxiety Disorder Association of America. You also can learn more about BPD and its treatment at The National Education Alliance for Borderline Personality Disorder.
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