2021 Feb 2;12(1):1863579. doi: 10.1080/20008198.2020.1863579. Similarly, while psychotic symptoms occur in a substantial subset (i.e., 20-50%) of BPD cases [42], psychotic disorders rarely (1%) co-occur with BPD [24]yet psychotic disorder cases often (50-67%) involve a history of interpersonal trauma [101, 112]. Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Reduced interhemispheric structural connectivity between anterior cingulate cortices in borderline personality disorder. [Research Support, Non-U.S. Govt]. doi:10.1097/01.nmd.0000239898.48701.dc, Mauchnik J, Schmahl C: The latest neuroimaging findings in borderline personality disorder. Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. Spontaneous brain activity in combat related PTSD. However, if assessment indicated the presence of affectively charged (or incongruously emotionally numbed) schemas representing self and relationships as simultaneously irreparably damaged but essential and irreplaceable, and this conflict was associated with affective over- as well as under-regulation, cPTSD offers a unique focus distinct from that of either BPD or PTSD. BPD and cPTSD get confused with one another because theres such an overlap between the core symptoms. Childhood trauma in borderline personality disorder. The success of psychiatric treatment is almost always dependent on the therapist finding the right diagnosis for the patient. What Does the Term Emotionally Unstable Mean? When the trauma from domestic abuse interferes with your ability to function daily, you may be experiencing PTSD. Although, as noted above, the DSM-5 PTSD criteria have been expanded to include aspects of affect, relational, and self-dysregulation, the emphasis in PTSD remains upon re-experiencing and hypervigilance with dysregulation not a fully delineated as in cPTSD and BPD. Research Support, U.S. Govt, P.H.S.]. 2022. Zimmerman M, Mattia JI. For example, BPD diagnosed adults did not evidence a distinct pattern of physiological emotional processing despite being physiologically activated in response to interpersonal challenge scripts compared to those diagnosed with obsessive-compulsive disorder [184]. doi:10.1002/jclp.20396, Gratz KL, Tull MT: Exploring the relationship between posttraumatic stress disorder and deliberate self-harm: the moderating roles of borderline and avoidant personality disorders. doi:10.1016/j.janxdis.2005.04.003, Bryant RA: The complexity of complex PTSD. Similarly, ACC hypo-activation occurred when individuals diagnosed with BPD underwent a physical pain induction, although they showed decreased rather than increased amygdala and insula activation, increased dorsolateral PfC activation, andof notedissociative analgesia [116]. Four decades after complex posttraumatic stress disorder (cPTSD) was first defined and proposed as an alternative diagnosis to borderline personality disorder (BPD) for Thus, the neurobiology of pain in PTSD is complicated and appears to range from acute analgesia (associated with dissociation) to chronic hyperalgesia (associated with affective distress and hyperarousal). A 10-year follow-up of adults diagnosed with BPD found that most (85%) who initially were diagnosed with PTSD continued to meet criteria for BPD but experienced a remission of PTSD [26, 27]. Psychiatry. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Cerutti R, Manca M, Presaghi F, Gratz KL. doi:10.1016/j.pneurobio.2013.06.003, Niedtfeld I, Schulze L, Kirsch P, Herpertz SC, Bohus M, Schmahl C: Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Mellor R, Werner A, Moussa B, Mohsin M, Jayasuriya R, Tay AK. Compr Psychiatry 2014,55(1):113122. 2005-2022 Psych Central a Red Ventures Company. 8600 Rockville Pike Trauma-informed therapy can help you reduce the emotional and mental effects of trauma. [Review]. Association of childhood trauma-by-primary-caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Interpersonal victimization in childhood has been found to be highly prevalent among adults with BPD [7173] and adolescents with BPD features [74, 75]. The most common profile for BPD patients (40%), with or without comorbid Axis I somatoform or other psychiatric disorders, was a combination of under- and over-regulation of affect. Frankenburg FR, Zanarini MC. [Research Support, U.S. Govt, P.H.S.]. Another difference is victims of Complex PTSD can quickly reset with calming stimuli. doi:10.1017/S0033291712001390, Jin C, Qi R, Yin Y, Hu X, Duan L, Xu Q, Li L: Abnormalities in whole-brain functional connectivity observed in treatment-naive post-traumatic stress disorder patients following an earthquake. Psychiatry Res 2011,189(3):426432. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Epub 2022 Aug 16. Posttraumatic stress disorder treatment outcome research: the study of unrepresentative samples? Most (82%) of the DID-diagnosed patients met criteria for BPD, but about half of the BPD-diagnosed patients were not diagnosed with DID. Here are the best options for trauma-focused treatments. Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Contact Our Admissions Team. Eur J Psychotraumatol. Christine A Courtois, Email: moc.loa@siotruoc. Maltreatment by primary caregivers is, however, consistently associated with childrens emotion dysregulation [195, 196]. Frankenburg FR, Zanarini MC. Yet, a high proportion of individuals with BPD report clinically significant dissociative symptoms [7, 169]. Complex PTSD is characterised by The deficits in adaptive emotion regulation and problems with impulsivity and avoidance/self-medication characterizing this putative sub-group are consistent with descriptions of cPTSD. Ludascher P, Valerius G, Stiglmayr C, Mauchnik J, Lanius RA, Bohus M, Schmahl C. Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study. Google Scholar. Pain and suicidality: insights from reward and addiction neuroscience. 2012;3. doi: 10.3402/ejpt.v3i0.19566. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Ruan WJ: Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. Most (82%) of the DID-diagnosed patients met criteria for BPD, but about half of the BPD-diagnosed patients were not diagnosed with DID. If youre ready to get help or know someone who is, contact us today. J Trauma Stress 1992,5(3):377391. Perugi G, Angst J, Azorin JM, Bowden C, Vieta E, Young AH, Group, B. However, affect dysregulation has been shown to play a major role in most Axis I and Axis II psychiatric disorders [190, 191]. Arch Gen Psychiatry 2012,69(10):9931002. Am J Orthopsychiatry 2012,82(2):187200. Finally, both groups react differently to their triggers. J Child Psychol Psychiatry 2010,51(6):706716. Peter M, Schuurmans H, Vingerhoets AJ, Smeets G, Verkoeijen P, Arntz A. Borderline personality disorder and emotional intelligence. When physical pain was induced following script-based recall of traumatic events, PTSD symptom severity was found to be associated with activation in brain areas related to stress-induced analgesia (e.g., caudate, thalamus), and dissociative symptoms were correlated inversely with activation of the putamen and amygdala [155]. BPDs sensitivity to abandonment and rejection, PTSDs arousal and positive affect dysregulation, and cPTSDs altered declarative memory, hypo-arousal, and self-perception are potential foci for a more differentiated description of core impairments that could justify distinct classifications and better tailored treatment strategiess. If avoidance of perceived or actual threat of suffering or causing harm in current relationships (along with dysphoria, dissociation, and/or hyperarousal) was debilitating, PTSD would be focal. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions Frisman LK, Ford JD, Lin H, Mallon S, Chang R. Outcomes of trauma treatment using the TARGET model. Potential neurobiological substrates for dissociation in BPD have been identified, including increased glutamate concentrations in the ACC and impulsivity [170], and increased volume of the precuneusthe component of the self-referential DMN specifically implicated in episodic self-relevant memory [171]. Taking steps to care for your mental health can help you manage both symptoms and improve your mental well-being. The role played by PTSD or childhood traumatic victimization in dissociation in BPD has not been definitely established. 2016;7:1373. doi:10.3389/fpsyg.2016.01373, Fras , Palma C. Comorbidity between post-traumatic stress disorder and borderline personality disorder: A review. eCollection 2021. These findings closely parallel those for remission, recurrence, and new cases of substance use disorders (SUD) [26, 27], suggesting a need for examination of the course and risk factors for complex comorbid combinations of PTSD, SUD, and BPD. Aust N Z J Psychiatry 2007,41(7):598605. These findings raise the possibility that affect dysregulationparticularly under-regulation of affect due to impaired adaptive strategies and high levels of distress intolerancemay be a marker for a sub-group among BPD-diagnosed persons distinct from the majority who also struggle with affect dysregulation but tend to be tonically tolerant of distress and intermittently overwhelmed. doi:10.1080/15299730902956838, Hoerst M, Weber-Fahr W, Tunc-Skarka N, Ruf M, Bohus M, Schmahl C, Ende G: Correlation of glutamate levels in the anterior cingulate cortex with self-reported impulsivity in patients with borderline personality disorder and healthy controls. (2012). Gratz KL, Rosenthal MZ, Tull MT, Lejuez CW, Gunderson JG. However, in PTSD, pain-related impairment, hyperalgesia rather than analgesia, is prominent. Dissociative symptoms are a cardinal feature of the BPD diagnosis, but as transient and not chronic states that occur during periods of extreme stress most frequently in response to real or imagined abandonment (American Psychiatric Association, 2013, p. 664). J Trauma Dissociation 2012,13(1):931. In addition, individuals with a BPD diagnosis or symptoms have been shown to have distinct psychophysiological profiles when PTSD is a comorbidity, including; (1) structural brain abnormalities (i.e., increased gray matter volume) prefrontal cortex areas associated with cognitive control [47], (2) altered brain function (i.e., increased insula and decreased parahippocampal activation in association with increasingly severe dissociation symptoms) [48], (3) reduced amygdala volume [38, 49] and altered amygdala metabolism [50], (4) reduced hippocampus volume and increased impulsivity [49], and, (5) neuroendocrine stress hyporeactivity (i.e., cortisol suppression) [5153]. Drug abuse and addiction in medical illness: causes, consequences, and treatment. BPD and avoidant personality disorder patients showed dorsal ACC hypo-activation after viewing repeated emotionally distressing pictures, as well as smaller increases in insula-amygdala functional connectivity and a lack of habituation in their ratings of the emotional intensity of the images [118]. J Abnorm Psychol 2008,117(3):502519. However, two BPD diagnostic criteria specifically related to attachment disorganization or insecurity [63] are quite distinct from PTSD in the DSM- 5 and from cPTSD: terror of abandonment or rejection, and alternating idealization and devaluation of others. Complex trauma and intimate relationships: the impact of shame, guilt and dissociation. Addiction 2011,106(2):342348. Google Scholar. doi:10.1007/s0011501234896. van Dijke A, Ford JD, van der Hart O, Van Son MJ, Van der Heijden PG, Buhring M: Childhood traumatization by primary caretaker and affect dysregulation in patients with borderline personality disorder and somatoform disorder. Thus, it becomes even more important to sort Thus, unlike the biologically-based emotion dysregulation characterizing fear-related syndromes (e.g., PTSD; avoidant PD), BPD may involve altered brain connectivity associated with emotional instability in response to actual or perceived interpersonal rejection. Obesity and obesity-related illnesses in borderline patients. Problems with distrust and interpersonal lability and aggression in BPD have been linked to perceptual biases and cognitive deficits related specifically to a tendency toward perceived social exclusion/abandonment [163]. (2018). Zimmerman M, Rothschild L, Chelminski I: The prevalence of DSM-IV personality disorders in psychiatric outpatients. J Personal Disord 2006,20(1):7180. cPTSD prevalence estimates have not been reported in community or primary healthcare samples. What Are Emotional Flashbacks? doi:10.1080/15299730902956564, Brand BL, Lanius R, Vermetten E, Loewenstein RJ, Spiegel D: Where are we going? Differentiating symptom profiles of ICD-11 PTSD, complex PTSD, and borderline personality disorder: A latent class analysis in a multiply traumatized sample. J Personal Disord 2013,27(6):783794. For example, in a sample of adults in psychiatric treatment diagnosed with BPD, 81% reported histories of interpersonal trauma in childhood, including physical abuse (71%), sexual abuse (68%), and witnessing domestic violence (62%) [76]. Axis II pathology in outpatients with dissociative identity disorder. Since then, hundreds of clinical or scientific studies of cPTSD and cognates (e.g., Disorders of Extreme Stress [11, 12]; Developmental Trauma Disorder [13, 14] have been published. Psychiatry Res 2007,156(2):139149. Edited by: Dell PF, ONeill JA. [Comparative Study Research Support, N.I.H., Extramural]. Accessibility Moreover, severe intra-familial early childhood adversity is a well-established risk factor not just for BPD but for the onset of a wide range of adolescent and adult psychiatric disorders [106, 107]. What's It Like to Live with Borderline Personality Disorder? xii-xvii). Wingenfeld K, Lange W, Wulff H, Berea C, Beblo T, Saavedra AS, Driessen M. Stability of the dexamethasone suppression test in borderline personality disorder with and without comorbid PTSD: a one-year follow-up study. Frequent changes in mood and extreme changes in point of view are common symptoms, as well as turbulent feelings about oneself and relationships with others. Herman JL, Van der Kolk BA. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Am J Psychiatr 2010,167(8):879881. Neacsiu AD, Lungu A, Harned MS, Rizvi SL, Linehan MM. DAndrea W, Ford JD, Stolbach B, Spinazzola J, van der Kolk BA. J Trauma Stress 2005,18(1):1321. Preissler S, Dziobek I, Ritter K, Heekeren HR, Roepke S. Social cognition in borderline personality disorder: evidence for disturbed recognition of the emotions, thoughts, and intentions of others. Can You Recover from Trauma? Ford JD, Fournier D. Psychological trauma and post-traumatic stress disorder among women in community mental health aftercare following psychiatric intensive care. PubMed Central In addition, there may be emotional numbing and a lack of ability to experience pleasure or positive emotions. Complex PTSD and borderline personality disorder Julian D. Ford1* and Christine A. Courtois2 Abstract Background: This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a Part of Bethesda, MD 20894, Web Policies We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD. Cloitre M, et al. The site is secure. 2021. Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self Similarly, ACC hypo-activation occurred when individuals diagnosed with BPD underwent a physical pain induction, although they showed decreased rather than increased amygdala and insula activation, increased dorsolateral PfC activation, andof notedissociative analgesia [116]. J Personal Disord 1997,11(1):93104. The new PMC design is here! Thus, unlike the biologically-based emotion dysregulation characterizing fear-related syndromes (e.g., PTSD; avoidant PD), BPD may involve altered brain connectivity associated with emotional instability in response to actual or perceived interpersonal rejection. However, the high drop-out rate reported even by potentially efficacious combined BPD+PTSD interventions [210] may signal the need for alternative therapeutic frameworks such as those offered by cPTSD therapies that do not modify exposure-based interventions but instead directly address dissociation [213] or severe affect dysregulation [215]. Where things get complicated is when patients are struggling with psychological disorders that were created by trauma. Individuals who experience complex (i.e., developmentally adverse interpersonal) 2020 Jan;11(1):36-45. doi: 10.1037/per0000346. The impact of posttraumatic stress disorder on the symptomatology of borderline personality disorder, Personality disorder: A disease in disguise, Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research, Emotion regulation in schema therapy and dialectical behavior therapy, Comorbidity between post-traumatic stress disorder and borderline personality disorder: A review, The comorbidity of borderline personality disorder and posttraumatic stress disorder: Revisiting the prevalence and associations in a general population sample, A pattern of unstable, intense, and stormy relationships where the person may frequently shift between idealizing and devaluing their partner, Being impulsive in ways that are problematic or damaging (for example, engaging in substance use, sexual promiscuity, reckless driving, binge eating, etc. Carpenter RW, Trull TJ: Components of emotion dysregulation in borderline personality disorder: a review. If youre someone struggling with your mental health and have a history of trauma, its important to know the differences of Borderline Personality Disorder vs CPTSD. BPD and CPTSD are treatable, even if they occur together. In Treating traumatic stress disorders: an evidence-based guide (pp. To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. Although BPD and cPTSD overlap substantially (as do cPTSD and PTSD), it is unwarranted to conceptualize cPTSD either as a replacement for or sub-type of BPD. bord personal disord emot dysregul 1, 9 (2014). Briere J, Rickards S. Self-awareness, affect regulation, and relatedness: Differential sequels of childhood versus adult victimization experiences. J Trauma Dissociation 2012,13(2):244257. Extending extant models of the pathogenesis of borderline personality disorder to childhood borderline personality symptoms: the roles of affective dysfunction, disinhibition, and self- and emotion-regulation deficits. Psychiatry Res 2004,126(1):3342. Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, van Balkom AJ, Smit JH, Veltman DJ.