Recently I have been sent many queries about Borderline Personality Disorder and PTSD and why they seemingly co-exist together quite frequently. Is this true people ask or does it just seem that way? I did a lot of reading around the subject and yes it does appear they are comorbid and often coexist together particularly in those with child abuse histories. (European Journal of Psychotraumtology)
During my research I found an article written by Matthew Tull, PhD What are the consequences of having both borderline personality disorder (BPD) and post-traumatic stress syndrome (PTSD) together? What does this mean for treatment ?
The Co-Occurence of PTSD and BPD
PTSD and Borderline personality disorder (BPD) have been found to commonly co-occur. In fact, it has been found that anywhere between 25 and approximately 60 percent of people with BPD also have PTSD—a rate much higher than what is seen in the general population.
Likewise, one study of veterans with combat-related PTSD seeking treatment found that 76 percent of them also had a diagnosis of BPD.
Why Do PTSD and BPD Occur Together?
It is not suprising to see that borderline personality disorder and post-traumatic stress syndrome often occur together when we look at the causes and symptoms. The situations which tend to cause BPD are also often risk factors for PTSD. For example, childhood sexual abuse is an underlying factor in both BPD and PTSD.
In addition, the symptoms of BPD can put someone at risk of being in a situation which may result in PTSD.
It is not only BPD, however, PTSD is associated with several different personality disorders.
Diagnosis of PTSD and BPD
Later on we will review the diagnosis of BPD for those who do not know the specific criteria. If you have already been diagnosed, however, we will begin with the consequences of having these two conditions together and what it means with regard to treatment.
A number of studies have looked at the physical and psychological consequences of having both PTSD and BPD. It has generally been found that people with both diagnoses experience more psychological and physical difficulties, including, for example:
- Overall general distress
- Other psychiatric disorders
- Obsessive-compulsive symptoms
- Worse perceived health
- Suicidal thoughts
- More hospitalizations
- Anger problems
- Interpersonal problems
PTSD Aggravating BPD
As noted above, there are many consequences of experiencing both PTSD and BPD together, but researchers have looked a little deeper at those with BPD alone vs those with BPD complicated by PTSD. PTSD aggravates some, but certainly not all symptoms of BPD. Symptoms that are most aggravated most by the addition of PTSD include affect dysregulation, intrusions, dissociation, suicide attempts, and self mutilation. Of these, dissociation may be at least partly related to underlying childhood sexual abuse as a risk factor in both disorders.
There are a number of effective treatments available for PTSD. Seeking out treatment for BPD, such as dialectical behavior therapy (DBT) may also help reduce PTSD symptoms and address BPD symptoms.
Many of the skills taught in DBT (for example, emotion regulation, being effective in interpersonal relationships) may address some of the problems seen among people with PTSD. Finally, there are some good self-help resources available for BPD as well that may help with both disorders.
The Diagnosis of 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). According to the DSM-IV, personality disorders represent a long-standing pattern of problematic behaviors, thoughts, and feelings that often 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 where the person may frequently shift between idealizing and devaluing their partner
- Problems with identity, self-image or a sense of who one really is
- Being impulsive in ways that are problematic or damaging (for example, engaging in substance use, sexual promiscuity, reckless driving, binge eating, etc.)
- 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
To receive a diagnosis of BPD, you need to exhibit at least 5 of these symptoms. Of course, as with all mental disorders, only a mental health professional can provide a diagnosis of BPD.
Bottom Line With the Combination of BPD and PTSD
BPD and PTSD are related in several ways, but it is difficult to separate out if one of the conditions predisposes to the other or if some of the relationship and symptoms originate with a common causation earlier in life such as childhood sexual abuse.
Seeing that the consequences with regard to many of these symptoms are amplified by the co-diagnosis, it would seem extra important for those suffering from the combination of conditions to seek out help.
Cackowski, S., Neubauer, T., and N. Kleindienst. The Impact of Posttraumatic Stress Disorder on the Symptomatology of Borderline Personality Disorder. Borderline Personality Disorder and Emotion Dysregulation. 2016. 3:7.
Frias, A., and C. Palma. Comorbidity Between Post-Traumatic Stress Disorder and Borderline Personality Disorder: A Review. Psychopathology. 2015. 48(1):1-10.
Scheiderer, E., Wood, P., and T. Trull. The Comorbidity of Borderline Personality Disorder and Posttraumatic Stress Disorder: Revisiting the Prevalence and Associations in a General Population Sample. Borderline Personality Disorder and Emotion Dysregulation. 2015. 2:11.