Misdiagnosis - Borderline Personality Disorder versus Complex PTSD

Hi all,

Borderline Personality Disorder is so very similar to Complex PTSD, and yet the psychological community still fails to recognize Complex PTSD as a diagnosis in many parts of the world.

I wonder how many diagnosed Borderline sufferers would relate more to Complex PTSD?

Thanks,
HD7970ghz

I don't really know anything about this. But I have sometimes thought there was a time, when I was younger, I might have been diagnosed as having BPD. (But then as I've read just a bit about bipolar 2, I can see where I could conceivably be diagnosed with that as well.) I'm also confident I could make a good case for having cPTSD as well. So it does seem as though, at least to me, there's a thin line that separates these diagnoses.

@Skeezyks

In the U.S., they still don't recognize CPTSD as a separate disorder from PTSD, and most researchers assert that there is too much overlap between PTSD and BPD. So, many clinicians continue to diagnose both PTSD and BPD.

Any personality disorder (PD) should only be diagnosed among adults 18 and over. Children do not get such diagnoses.

That said, there is new research on developmental trauma (I think by Drs. Ford, van der Kolk, and colleagues) that are looking to propose "Developmental Trauma Disorder" (DTD), perhaps in place of conduct disorder (CD) and/or oppositional defiant disorder (ODD), which are typically the diagnoses that youth under the age of 18 receive long before a personality disorder is assessed after 18, or, in other countries, CPTSD.

Some practitioners today will differentiate CPTSD from BPD, but it's not recognized in the DSM.

Here are some links for DTD:

http://www.traumacenter.org/products...a_Disorder.pdf

Google Scholar

Addressing these issues earlier on can help with preventing a PD, I think. If not, it can detect the pathways of a PD in adulthood, and perhaps offer treatments to manage the symptoms affiliated with these disorders.

More recently, The Guardian published an article about the possible misdiagnoses of BPD among sexual abuse survivors, who are most notably women, which speaks to gender disparities, continued gender-based stigma against females, and the continued problems surrounding victim-blaming, victim-shaming, victim-labeling, rape culture, and more. Here's that article: Are sexual abuse victims being diagnosed with a mental disorder they don't have? | Life and style | The Guardian

Thank you for sharing this Lillib!

I love that Guardian article!

I heard overseas that the healthcare community has adopted C-PTSD as an official diagnosis in the ICD-11. Perhaps they can set an example for the DSM. It certainly needs to be included and further researched!

I hear a common story from those with BPD when they enter hospitals and therapy looking for help; they are treated differently and often times, poorly as a result of the BPD diagnosis they have been labelled with. I can attest to this too. The moment I was given a BPD diagnosis, I was treated ineffectively and worse. If BPD is Complex PTSD - which I believe it is - then the stigma would drop away because they would begin to treat BPD as a trauma disorder (which it is), rather than assuming it is a personality disorder with pathological traits that are seen as unfavorable / manipulative, stigmatized, etc.

Thanks,
HD7970ghz

I saw over a dozen psy’s and got over a dozen opinions. Mostly, the pro’s said the diagnosis doesn’t matter, it’s the treatment that does.

It sounds like you managed to find some competent professionals! How did you feel when they say this? Was it an indication that they could help? Did they stay true to their word?

Thanks,
HD7970ghz

I think that BPD is a distinctly different dx than CPTSD; they should therefore NOT be used interchangeably.

That said, I also think that BPD and all the other PD's (e.g., antisocial, histrionic, narcissistic, avoidant, schizotypal, obsessive-compulsive, etc.) should be changed to a different name. --What that name is, I don't know, but something that is more in line with its etiology. For instance, BPD often stems from childhood neglect and childhood emotional abuse, more so than anything else, but often in conjunction with childhood sexual abuse. Such childhood trauma profiles point to certain sequelae that exact an unresolved developmental trauma disorder for both males and females and those who do not identify as binary. That said, not everyone with childhood trauma winds up with the same symptoms in adulthood. More recently, neuroscience is advancing research in this area and finding neurological differences between those with BPD and other disorders. It may be that BPD is a neurological disorder that gets activated through childhood trauma. It may also be that BPD is on a different spectrum than dissociation (some spectra do not include BPD on dissociation, whereas others do), or even trauma.

There are those who have been abused in childhood and have other PDs, such as antisocial, narcissistic, avoidant. But childhood trauma is not the only predictive variable for such PDs, whereas it would appear that all those with BPD have some link to childhood trauma. This distinction is important, especially in terms of treatment.

There are those whose narcissism or antisocial personality disorders do not affect their job or level of functioning, even if it affects their relationships (which they largely don't care about, at least not the conventional ones who move on easily and leave those left behind in pain). Some psychologists would say that they don't have a mental disorder because they don't appear in distress and their lives are functioning, whereas other professionals assert that they are most likely reluctant to seek treatment due to their rigid beliefs and social interactions, but are nonetheless mentally ill. The stigma attached to a character flaw is segregating, stigmatizing, and uninviting, so it comes as no surprise that they (as well as others with a wide range of mental disorders) would not wish to seek treatment. There's also the notion of high-functioning mental illnesses, where the detection of distress is hidden and/or where their symptoms are managed in some naturalistic form, such as protective factors found in the environment (e.g., social support, conservation of resources, social capital).

It would appear that the main etiology of BPD is their fear of abandonment - fear that is based on trauma triggers that remind them about early childhood betrayal wounds, including emotional neglect, emotional abuse - with or without the presence of other forms of child maltreatment. It should be considered an "abandonment phobia," or specific phobia, which interferes in their relationships in many of the same ways that other PDs or even other disorders interfere in relationships. Would you say that a person's autism spectrum disorder or substance use disorder affect relationships? Yes! Would you assign a personality disorder to them? Perhaps, perhaps not. Should you assign a personality disorder to them? IMHO, NO!

Specific types of trauma exact specific types of disorders based on a person's lack of strengths, lack of protective factors, biological makeup, etc. The heterogeneity of trauma is such that different forms of trauma will exact different responses, and different cultural beliefs will exact different responses, and different levels of protective factors will determine whether or not symptoms are present or not. The etiology is what matters in terms of those who are symptomatic, and not just the etiology of trauma types, but also the historical accounts of environmental pathogens (e.g., poverty, neighborhood violence, school violence) and historical strengths (e.g., intelligence, strengths, social support, social capital, high socioeconimic status).

Those with chronic, complex, or continuous trauma will exact different behaviors than those with BPD (or what I'd like to see as abandonment phobias); those with CPTSD, chronic PTSD (as they call it at the VA), or continuous traumatic stress (as they call it on articles related to immigrants and/or human trafficking victimization) are not afraid of abandonment (which is differentiated here from rejection, in the form of social stigma, as opposed to interpersonal abandonment). many are afraid of being retraumatized (or shall I say revictimized) in ways that do not concern abandonment. For example, a rape victim may have CPTSD if she was revictimized over a period of time with sexual violence and then fears men or anyone in a position of power. Another example would be those who are minorities and experiencing continuous (not past) traumatic stress in the form of microaggressions, and their fears of being retraumatized coupled with their anger at the injustices they feel in society when they are discriminated against represent another form of traumatic stress - which is continuous in nature, not past.

While we're on the topic, the nature for which those with BPD are treated, including those who have been misdiagnosed, is CONTINUOUS traumatic stress in the form of microaggression trauma, in many of the same ways that minorities are experiencing their race-based or ethnicity-based or age-based or ability-based traumas. It's no wonder their prognosis is poor, even with the many new types of of treatments offered to them today. What may have helped the founder of DBT, Linehan, who has acknowledged her BPD, is the social support and higher SES and higher reputation and other strengths she possessed to aid her in a high-functioning form of BPD in order to arrive at a treatment for BPD. Many people with BPD, or abandonment phobia, do not hold such strengths, which is an important distinction to make, and which could explain why some are "treatment-resistant," whereas others are not.

But where's the research?

Where's the acknowledgment of strengths?

Where's the differential diagnoses challenges?

Where's the therapy abuse sequela that adds to past traumas and is tantamount to continuous traumatic stress?

It would seem that there's a lack of genuine concern and care for those with BPD.

I DO NOT have BPD, but I've had friend who did have it. It's sad what they are continuing to go through. It's sad that they are continuing to suffer.

Thank you Lillib for your in-depth post!

I plan to respond, just cannot right now as I'm SOOO far behind in school work! Tomorrow I will respond.

Thanks,
HD7970ghz

I also think that it wouldn't matter if CPTSD were a separate category and the BPD dx was abolished; the stigma would then just transfer to CPTSD, and would therefore continue.

The inherent problems include:

1. The way the therapists further the stigma about certain disorders.
2. The definition of trauma.
3. The psychometrics of trauma, based on the definition of trauma.
4. The lack of attention on continuous trauma, including microaggression trauma, harassment, discrimination, bullying, etc.
5. The stigma against mental illness as a whole.
6. The lack of appropriate laws to prevent child maltreatment, adverse childhood experiences (not necessarily considered maltreatment), and other childhood traumas.
7. The lack of warmth in the therapeutic alliance.
8. Emotional abuse that occurs within the therapeutic alliance.
9. Discrimination at the therapeutic level: how many minorities (based on race, SES, and otherwise, not necessarily diagnoses themselves) are turned away?
10. The training that perpetuates stigma, such as when professors make jokes about certain people with certain disorders or symptoms, instead of being professional about it.

I'm sure more can be added to this list.

The label of PDs themselves are inherently ad hominem attacks against a person's character, and are so defined as rigid or fixed, as opposed to being fluid and malleable. Instead of seeing people as unchangeable, they could see people as capable of change, or rehabilitation. The label itself needs to change or that entire category needs to change. If a person's conduct is unbecoming or criminal, then conduct disorder, not antisocial. If a person's relationships with others are based on phobias or traumas, then PTSD and/or a specific phobia (e.g., abandonment phobia, commitment phobia, etc., as opposed to borderline or avoidant). If a person is addicted to something, then an addiction (as opposed to histrionic). If a person has cognitive delays or psychotic features or learning disorders, then those would fall under different diagnoses. Diagnoses that are based on symptoms (e.g., phobias, conduct) and/or etiologies (e.g., trauma) sound more true and fair than labels that can inherently harm, especially when used as a microaggression. Drapetomania was a racist diagnosis, and it was abolished only years later. Drapetomania was also a microaggression and a harmful ad hominem attack on a group of people struggling with oppression, racism, and historical trauma. If anything, they had PTSD, continuous traumatic stress, and adverse life conditions to deal with. I'm sure they may have acquired phobias as well.

This us versus them is just wrong and harmful.

This "my disorder is better than yours" is just wrong.

Physicians know their limits, but when they refer clients to specialists, they rarely say ad hominem attacks like "YOU are too complex" or "YOU are treatment-resistant" or "YOU are just a typical cancer patient." Instead, they offer explanations (sometimes) and treatment options. If the mental health community could start calling their clients patients instead of clients, that might be better, especially if they are adamant about having the power dynamic stick, which I don't think will ever change.

Those are my opinions.

@HD7970GHZ

No need to respond immediately. Schoolwork comes first and is important!

When I attend grad school next year in Fall 2020, I will limit my time (manage my time) online and spend about one hour a week reading and replying, and maybe five to ten minutes per day reading and replying here. I'm not going away, but my time will be limited because I'm working on goals and have less time than I do now. I'm doing what I can now, however, to use the free time I can to benefit from learning here from everyone as well as offering and receiving support.

Healthy debates like these are good. It's also freeing.

I look forward to your responses!



Nice chatting with you today!

I have seen several mental health professionals through my life and not one correctly diagnosed me. Our laws are too lax on this problem.

They all seemed to be competent professionals.

I started going to them trying to cope with a relationship issue. It had gotten me ‘emotionally disordered’ because the frustration escallated from the inability to solve it ourselves. So I had so much soul searching as to was it me or was it the situation.

I didn’t give each professional too many sessions, thinking they weren’t helping and were hurting, or getting nowhere, just more confusion. I’d end up apologizing to them that I was just not a good client and didn’t go back.

There was one really bad experience at the end of my therapist journey with one who was literally hugging me and promising me she’d change my life and I’m finally safe, yada yada... Then when I had an anxiety attack meltdown at my house, they coerced me into going to the ER, where they kept me for 18 hours, and the experience was pretty traumatic. She outright lied and said that I told her I was sui. I said I definitely was not. Phoney baloney therapist, giving false overly affection to build trust and then betrayal. It was scary and I would never set myself up for that again.

I think I probably have some emotional issues, but I’ve also had a lot of trauma in my close relationships. It’s not that I am overreacting to small stuff. The things that have happened are outrageous!

I benefitted from talking to others here for education and support, reading all I can on psy issues, and being kind to myself, getting away from the toxic people and nurturing the real friends.

I’ve experienced such senseless trauma with ‘loved ones’. Now my beloved son turned on us and I believe he was brainwashed...seriously, not being overly dramatic. I handled it so well, as healthily as any therapist would have coached me to do. Take the high road, place a boundary, pray he grows up and comes to his senses, wish him well.

If I have a disorder, I sure learned healthy coping skills...just sayin’.

I never did anything to hurt anyone else. I didn’t deserve the bad treatment I got from my ‘loved ones’. I was definitely good and loving to them.

I just wanted to say I meet the ICD-11 criteria for CPTSD but not the criteria for BPD (I have 0 fear of abandonment or impulsive behaviours). I am diagnosed with PTSD since the ICD-11 is not official in my country till 2020

Crazy, inside and aside

"Outwardly: dumbly, I shamble about, a thing that could never have been known as human, a
thing whose shape is so alien a travesty that humanity becomes more obscene for the vague resemblance."
I have no mouth and I must scream -Harlan Ellison-

They get around my inaccurate diagnosis of BPD by saying that it was caused by trauma....which it was, but misses the hypervigilance and avoidance and dissociative flashbacks that are a major part of my symptom picture. [Though are slightly less on the meds I am on now.]

Oh joy. they are particularly skilled at inaccurate diagnoses in this forest. They get away with their errors any way they can, including blatant lies. And I can’t take the meds which they push so hard and often is ALL they offer

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In my case, I was diagnosed with "prolonged PTSD" (another way of saying complex PTSD) first...then a few sessions in to EMDR therapy, therapist stepped back and said....you also have BPD. My EMDR therapy was brought to a screeching halt, and I was tossed into DBT therapy for the BPD. So yeah, I'm one that can say diagnosed with both, can relate to both, was finding EMDR therapy helpful....not so sure about this DBT thing, but finding some parts of it helpful too.