I am often asked about the difference between C-PTSD or Complex Post Traumatic Stress Disorder and BPD or Borderline Personality Disorder (also known as emotionally unstable personality disorder). This is understandable because there is often a cross over between the two in terms of symptoms, and also because these two often co-exist. But there are differences, both in presentation of symptoms and in treatment approach so it is important to differentiate between them.
C-PTSD or Complex Post Traumatic Stress Disorder occurs when someone is repeatedly traumatized, in conflict for example or through suffering prolonged abuse as a child. C-PTSD can make life really challenging and those suffering with C-PTSD may experience challenges around:
1. Emotion regulation
2. Forgetting traumatic events completely
3. Self-perception (feeling shame, guilt and a sense of being different)
4. Distorted perceptions of their perpetrators (especially when it is hard to resolve the facts about the situation with the feelings about it such as when an abuser was a parent that we love very much)
5. Relations with others may be difficult and trust issues may present extra challenges.
6. Their own sense of meaning and purpose (we may feel hopeless and have no sense that things will work out).
The treatment for C-PTSD is similar to PTSD in terms of healing the trauma however there will be more of a focus on interpersonal difficulties in the here and now. This is because those who have suffered repeated trauma have understandable challenges with trust, with anger and not lashing out, with fostering a sense of safety, and with regulating emotion.
BPD or Borderline Personality Disorder is a pervasive disorder where we can show patterns of instability in our relationships, struggles with self-image, and impulsivity. In order to be diagnosed with BPD you must have 5 of the following 9 criteria:
1. Fear of abandonment
2. Unstable relationships
3. Unstable sense of self
4. Impulsive, self-destructive behaviours
5. Recurrent suicidal behaviour, gestures, threats or self-injurious behaviour.
6. Extreme emotional/mood swings
7. Chronic feelings of emptiness
8. Inappropriate or intense & explosive anger
9. Feeling suspicious of people or out of touch with reality (severe dissociative symptoms).
You can see that there is a huge overlap between the two so you can understand how people are confused about their diagnosis, many people actually meet the criteria for both. The main differences between the two are that:
1. A diagnosis of BPD does not require any history of a traumatic event to be diagnosed whereas C-PTSD does.
2. The treatment plan for C-PTSD is to focus on healing or processing through the traumatic event(s) while treatment for BPD focuses a lot on moderating behaviour and regulating emotion.
3. While both diagnosis do show symptoms of emotion dysregulation, they are expressed very differently. In C-PTSD it is expressed through emotional sensitivity, reactive anger, and poor coping skills with behaviours like drinking and addiction. People with BPD can also engage in these behaviours but someone with BPD is more likely than some one with C-PTSD to struggle with suicidal thoughts and self-injurious behaviour when experiencing emotional dysregulation.
4. Those with BPD will almost always experience some degree of fear of abandonment, and there is no requirement for that in the criteria associated with C-PTSD.
Diagnosis can be useful in terms of accessing the best treatment for you. You are always the expert on your own experience of symptoms so that is really useful information to track and bring to your sessions with a psychotherapist, to your doctor, or to your group therapy. In general, our best thinking is that if you experience BPD, Dialectical Behaviour Therapy (DBT) is the best therapeutic approach for you, and if you are experiencing C-PTSD seeing a trauma specialist is probably most helpful. As always I feel that that one of the most important factors in having a successful therapeutic experience is the relationship and rapport you have with your therapist. You can read more about how to get the most out of therapy here.