Having Both PTSD & Borderline Personality Disorder

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

PTSD and BPD Co-Occurrence

Post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD) commonly co-occur. Between 25% and 60% of people with BPD also have PTSD—a rate that is much higher than what is seen in the general population.

Both BPD and PTSD are believed to stem from the experience of traumatic events. The thoughts, feelings, and behaviors seen in BPD might be the result of childhood trauma. A person who experienced childhood trauma is at an increased risk for developing PTSD.

In fact, people with both BPD and PTSD often report earlier experiences of trauma compared to people who are only diagnosed with PTSD.

The impulsive behaviors and unstable relationships common in people with BPD can place them at a greater risk for experiencing a traumatic event such as a motor vehicle accident, physical assault, or sexual assault.

The symptoms of PTSD and BPD can also overlap. People with PTSD may have difficulties managing their emotions, and therefore experience intense feelings or have constant mood swings. They might also find it difficult to manage their anger.

People with PTSD—especially those who have lost a loved one—may also fear abandonment. PTSD is also associated with other personality disorders.

Symptoms

A number of studies have looked at the physical and psychological consequences of having both PTSD and BPD. People with both diagnoses tend to experience more psychological and physical symptoms, including:

  • Anger problems
  • Anxiety
  • Depression
  • Dissociation
  • Impulsivity
  • Interpersonal problems
  • More hospitalizations
  • Obsessive-compulsive symptoms
  • Other psychiatric disorders
  • Overall general distress
  • Suicidal thoughts
  • Worse perceived health

Researchers have studied people who have BPD alone versus those with BPD that is complicated by PTSD. It has been observed that there are many consequences of experiencing the conditions together.

PTSD has been found to intensify some, but not all, BPD symptoms. The symptoms that are most aggravated by the additional diagnosis of PTSD include:

  • Affect dysregulation
  • Dissociation
  • Intrusions
  • Self-mutilation and suicide attempts

Of these symptoms, dissociation might be related (at least in part) to underlying childhood sexual abuse—which is a risk factor in both disorders.

BPD Diagnosis

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

According to the DSM-5, personality disorders represent a long-standing pattern of problematic behavior, thoughts, and feelings that often start in adolescence or early adulthood.

To be diagnosed with BPD, a person must exhibit at least five of the following symptoms:

  • A pattern of unstable, intense, and stormy relationships where the person may frequently shift between idealizing and devaluing their partner
  • Being impulsive in ways that are problematic or damaging (for example, engaging in substance use, sexual promiscuity, reckless driving, binge eating, etc.)
  • Constant feelings of emptiness
  • Frequent and intense mood swings
  • Paranoia or dissociation that comes and goes as a result of experiencing stress
  • Persistent and extreme efforts to avoid real or imagined abandonment by others
  • Problems with identity, self-image, or a sense of who one really is
  • Recurring suicidal acts or threats or deliberate self-harm
  • The intense experience of anger and/or difficulties controlling anger

Only a mental health professional can provide a diagnosis of BPD or any other mental health condition.

Treatment

There are a number of effective treatments available for PTSD. Treatment for BPD, such as dialectical behavior therapy (DBT) may also reduce PTSD symptoms.

Many skills taught in DBT (for example, emotion regulation, being effective in interpersonal relationships) can also be helpful for people with PTSD.

There are also self-help resources available for BPD that may also be beneficial for people with PTSD.

If you or a loved one are struggling with PTSD and/or BPD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

BPD and PTSD are related in several ways. The symptoms of each condition are amplified by the co-diagnosis, so it is important for people with both to get the right support.

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