Having Both PTSD & Borderline Personality Disorder

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What are the consequences of being diagnosied with both BPD and PTSD?. Istockphoto.com/Stock Photo©KatarzynaBialasiecwicz

What are the consequences of having both borderline personality disorder (BPD) and post-traumatic stress syndrome (PTSD)? What should this mean with regard to treatment?

PTSD and BPD Co-Occurrence

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 are these two disorders so interrelated? BPD and PTSD have both been found to stem from the experience of traumatic events. The thoughts, feelings, and behaviors seen in BPD are often the results of childhood traumas. These childhood traumas may also place a person at risk for developing PTSD. In fact, people with both BPD and PTSD report the earlier experience of trauma as compared to people with just PTSD.

The impulsive behaviors and unstable relationships are seen among people with BPD may also place a person at greater risk of experiencing a traumatic event such as a motor vehicle accident, physical assault or sexual assault.

Finally, the symptoms of PTSD and BPD also overlap. For example, individuals with PTSD may have difficulties managing their emotions. Therefore, they may experience intense feelings and have constant mood swings. They may also experience problems with anger. People with PTSD, especially those who lost a loved one, may also begin to fear abandonment.

Symptoms

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
  • Depression
  • Anxiety
  • Obsessive-compulsive symptoms
  • Worse perceived health
  • Impulsivity
  • Suicidal thoughts
  • More hospitalizations
  • Anger problems
  • Dissociation
  • Interpersonal problems

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.

BPD Diagnosis

BPD is part of a group of mental disorders that are referred to as personality disorders by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I5). According to the DSM-V, 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.

Treatment

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.

A Word From Verywell

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 is important for those suffering from the combination of conditions to seek out help.

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