Continuing the dissection of this massive study which was featured in Borderline Personality Disorder and Emotion Dysregulation Vol. 8
Part two of the study conducted by Julian D. Ford & Christine A. Courtois focuses on the Clinical phenomenology of BPD, PTSD, and cPTSD. This section of the article is data dense. Its focus is on the prevalence and comorbidity (when things occur together) of PTSD, BPD, and DSO.
PTSD=Post Traumatic Stress Disorder
BPD=Borderline Personality Disorder
DSO=Disturbances in Self-Organization – DSO is a primary criteria for the recognition of CPTSD.
The article moves on to frame each of the disorders in terms of the observed and reported symptoms. BPD and PTSD demonstrate the potential for substantial overlap in symptoms.
PTSD symptoms: dissociative amnesia and flashbacks, emotional numbing, anger, pervasive negative changes in cognition, mood, and behavior.
BPD symptoms: transient dissociation, chronic emptiness, and intense anger, identity disturbance, interpersonal mistrust, dysphoric affective instability, impulsivity, self-harm.
CPTSD symptoms: DSO domains including emotion dysregulation, negative self-perception, impaired relationships.
The authors continue by differentiating between the similar symptom categories of CPTSD and BPD. In general, CPTSD/DSO symptoms are chronic in regard to emotional dysregulations such as difficulty in self-calming, emotional numbing. The self perception in CPTSD centers on a chronic sense of guilt, shame and worthlessness. Relational dysregulation follows a pattern of avoidance and detachment stemming from a fear of closeness.
Between BPD and CPTSD, although they share some of the same DSO symptoms, there is a distinction able to be drawn between the two. In general, DSO symptoms for BPD tend to be more intense and periodic in nature. Similar symptoms in CPTSD are of a chronic nature. Plus, ongoing study is demonstrating that BPD and CPTSD are two disorders which are capable of being comorbid. In other words, a person can suffer from both.
However, the article goes on to state “Additional research is needed across a range of different clinical and general population samples to determine whether BPD or specific BPD symptoms can be consistently distinguished from cPTSD and its symptoms.”
The researchers then look at three different studies and their respective findings.
The studies were conducted in Great Britain, and in the United States. They used samples draw from different populations. Among the groups were –
- a sample of outpatient treatment-seeking women with childhood abuse histories
- a sample of adults in outpatient psychiatric treatment in Great Britain
- a general population sample of adults from the US who disclosed a history of sexual trauma
- a different trauma-exposed non-clinical population sample from the United Kingdom
- a sample of adults with histories of institutional child abuse
Methodology of these studies included network analyses and structural equation modelling.
The results from the studies produce a dizzying conglomeration of numbers. It is interesting reading, but very dense. In my opinion, the only way I could accurately convey the information would be with a table of all the studies, their variables, and their findings. In the interest of readability I will forego the table and direct the reader to the actual article. The link is below.
The research at this point indicates:
- cPTSD/DSO symptoms are distinct from the symptoms of both PTSD and BPD
- BPD symptoms tend to occur primarily in combination with PTSD and/or cPTSD/DSO symptoms rather than in isolation.
- severe cumulative childhood interpersonal victimization is more likely to provoke cPTSD/DSO or PTSD symptoms in combination with BPD symptoms than without.
- DSO typical of CPTSD can occur without PTSD
BPD can occur without PTSD or CPTSD
PTSD and cPTSD/DSO can occur without BPD symptoms
At the moment PTSD, BDP and CPTSD are all seen as sharing many symptoms to varying degrees, but still each is a separate and distinct disorder. It is not a given that a person suffering from one condition will automatically have either of the others.
However, the researchers end on this note. They propose that additional study is needed using different population samples to determine whether BPD or specific BPD symptoms can be consistently distinguished from cPTSD and its symptoms.
Ford, J.D., Courtois, C.A. Complex PTSD and borderline personality disorder. bord personal disord emot dysregul8, 16 (2021).
PTSD Research Quarterly Vol. 32 put out by the National Center for PTSD this resource also touches on CPTSD.
Literature on DSM-5 and ICD-11: An Update [https://www.ptsd.va.gov/publications/rq_docs/V32N2.pdf]