PTSD, BPD, or Complex Trauma? Understanding Shared Wounds

Posttraumatic Stress Disorder (PTSD), Borderline Personality Disorder (BPD), and Complex Trauma share a lot in common, and can even co-exist in the same person, making accurate assessment, and diagnosis that much more complicated.

Unlike a single traumatic event, complex trauma involves repeated or prolonged exposure to stress and trauma, including relational trauma. Due to its impact on emotional, neurological, and psychological development, PTSD and BPD, while distinct mental health conditions, are both often rooted in complex trauma.

​For example, complex trauma can disrupt the development of a stable sense of self and ability to feel safe and secure, common features of both BPD and PTSD. ​Here are 6 more overlapping features often experienced in both BPD and PTSD:

1. Disrupted Attachment

People who experience complex trauma often have disrupted attachment patterns, making it difficult for individuals to develop healthy relationships and regulate emotions effectively. People diagnosed with PTSD or BPD have often had disrupted early attachment relationships. 

2. ​Emotional Dysregulation

Emotional dysregulation is a common symptom of both PTSD and BPD. Complex trauma can lead to difficulties in regulating emotions, which can contribute to the development of both disorders. People who have experienced complex trauma may have intense emotions that are difficult to manage, leading to impulsivity, self-destructive behaviors, and mood swings.

3. Interpersonal Difficulties

Interpersonal difficulties are common in both PTSD and BPD. Folks who have experienced complex trauma may struggle to establish healthy boundaries, feel mistrustful of others, have difficulties forming secure attachments, or may experience a fear of abandonment, contributing to unstable relationships.

4. Hypervigilance

Hypervigilance is a common symptom of both PTSD and BPD. Hypervigilance is characterized by a heightened sense of alertness, feeling on edge, jumpy, or easily startled. Complex trauma can lead to hypervigilance due to the constant exposure to threats and danger, leading to difficulty relaxing and feeling safe.

5. Trauma-Related Triggers

Trauma-related triggers is a common feature of both PTSD and BPD. Folks who have experienced complex trauma often have emotional and somatic memories or triggers related to their traumatic experiences. These triggers can result in experiences of flashbacks, intense emotional reactions, and significant difficulty regulating emotions.

6. Dysfunctional Coping Strategies

​People who have experienced complex trauma may develop dysfunctional coping strategies as a way to manage their emotions and cope with the trauma. These coping strategies can include avoidance of reminders of traumatic experiences, self-harm, or substance use, all of which can be common with both PTSD and BPD.

There are many more shared features of these PTSD, BPD, and complex trauma, as outlined in this Venn diagram: 

This diagram is a very simplified representation of some complex mental health presentations. Each person's symptoms and experiences can vary widely. A mental health professional can help determine whether an individual's symptoms are more indicative of BPD, PTSD, or both, and develop an appropriate treatment plan to support them in their healing journey.

While BPD and PTSD can share symptoms, including anxiety, and depression, each condition has its unique set of symptoms and diagnostic criteria. Recognizing the role of complex trauma in the development of both PTSD and BPD can help us gain insight into root causes, core wounds, and pathways of treatment and recovery.

If you or someone you love is struggling with any of the above symptoms or conditions, know that help is available. Connect with us today.

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References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
2. ​Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior therapy, 36(2), 119-124.
3. Fonagy, P., Target, M., Gergely, G., & Allen, J. G. (2003). The developmental roots of borderline personality disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23(3), 412-459.
4. Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37(1), 14-25.
5. Van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389-399.