Is It Borderline Personality Disorder or Is It Really Complex PTSD?

Borderline personality disorder (BPD) is a pervasive and lifelong mental disorder that affects interpersonal relationships, mood, and behavior. Those diagnosed with BPD often struggle with an unstable self-identity and self-image, difficulty in regulating their emotions, self-sabotaging behavior, a fear of abandonment, feelings of emptiness, and a pattern of highly unstable relationships where idealization and devaluation are common.

Although those who develop BPD may have a history of child abuse or neglect, the causes of BPD are often not fully understood. However, some research suggests links to genetics with a family history or a biological predisposition to the disorder, while other research supports an environmental link.

Complex PTSD, or cPTSD, is a subset of PTSD. Whereas PTSD is a fear-based disorder, cPTSD is often referred to as a shame-based disorder originating from a history of chronic, and long-term exposure to traumatic events such as ongoing severe child abuse or long-term relationship abuse.

Those who have experienced repeated trauma at a young age and/or where escape from the situation was not possible are at a greater risk for developing cPTSD, such as children who cannot escape their home environment. Symptoms include flashbacks of the events, fear, despair, shame, chronic devaluation of self, terror, and avoidance of socialization or relationships. Unfortunately, those who have experienced severe ongoing trauma in childhood are at an increased risk for being re-traumatized in adulthood—especially in romantic relationships—thus increasing their risk of developing cPTSD or a worsening of existing symptoms.

Similarities Between BPD and cPTSD

BPD and cPTSD often get confused because of their similar and often overlapping behavior and affective patterns. Both often come with significant overall emotional distress and/or emotional “triggers,” dissociation, anxiety, and depression. Even with sophisticated diagnostic criteria, there are behavioral and affective overlaps between the two disorders which can complicate whether symptoms are exclusive to one disorder or a combination of the two.

Additionally, both diagnoses struggle with issues of negative self-concept, difficulties in regulating their emotions—including outbursts of crying or rage—and significant interpersonal relationship issues. Both BPD and cPTSD may be dually diagnosed in a person where symptoms can range from high to low in one, or both disorders.

Key Differences Between BPD and cPTSD

• While both disorders may experience symptoms associated with fear within relationships, one distinguishing factor seen in BPD that is not often seen in cPTSD is a fear of abandonment. Those with cPTSD, however, may avoid relationships based on feeling somehow unlovable or undeserving because of the abuse they endured. Those with cPTSD often avoid relationships altogether or push others away as unsafe or threatening; these behaviors may be confused as a fear of abandonment seen in those with BPD.
• Those with cPTSD often feel shame and blame themselves for their interpersonal problems—a symptom that is also similar to the experiences of those with BPD. Yet, another key difference is that those with cPTSD may not engage in self-injurious behavior. While a person with cPTSD may engage in self-destructive behaviors (substance abuse, unsafe sex, or outbursts or emotional dysregulation within interpersonal relationships), impulsive, self-injurious behavior is more commonly seen in BPD, where stressors in interpersonal relationships may trigger an episode. This may include suicidal ideation or a suicide attempt. However, this is not to suggest that no person with a diagnosis of cPTSD self-harms; each person is unique and their circumstances have to be examined individually.
• Another key difference between the two is that whereas both may feel relationships are seen as unsafe or threatening, a person with cPTSD may often choose to avoid intimacy or relationships altogether. A person with BPD, on the other hand, may struggle with being alone and may use relationships to prevent feelings of loneliness or abandonment.
• While both those with BPD and cPTSD struggle with emotional regulation and often experience outbursts of anger or crying, those with cPTSD may additionally experience emotional numbing or detachment from emotions.
• Additionally, while both those with cPTSD and BPD can struggle with a solid self-concept, those with BPD often struggle with an understanding of who they are at their core which is akin to self-identity. They may change their interests or hobbies depending on who they associate with because of a limited sense of self-identity. On the other hand, those with cPTSD usually have an understanding and awareness of who they are and have a more stable self-identity. However, they struggle with feeling "damaged" or deserving of the pain they’ve suffered and carry misbeliefs about themselves as unworthy of love or undeserving of happiness, which are aligned with a damaged self-concept. These experiences impact relationships, which may be confused as a problem with self-identity or self-awareness.
• Lastly, both those with BPD and cPTSD often have difficulty overcoming traumatic pasts. With successful treatment, those with cPTSD may experience less emotional reactions or behavioral disruptions by engaging in trauma-informed, evidence-based behavioral interventions that help with managing stressors, while providing tools and strategies for re-establishing safety, working through traumatic memories, challenging negative feelings, and helping to change negative thoughts. Contrarily, those with BPD often require long-term specialized treatment such as Dialectical Behavior Therapy (DBT), including possible in-patient treatment settings.

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