The Relationship Between PTSD and Personality Disorders

Compared to those without posttraumatic stress disorder (PTSD), people with PTSD tend to have higher rates of personality disorders, particularly borderline personality disorder (BPD), more severe symptoms, and a higher risk for certain other conditions, such as substance abuse or deliberate self-injury.

What Is a Personality Disorder?

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), defines "personality disorder" generally as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment."

This article reviews some of the research and information on PTSD and its relationship to several important personality disorders.

Borderline Personality Disorder

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Although BPD has received a growing amount of attention in the media, the information provided is often inaccurate. As a result, many people do not clearly understand the symptoms. If you have BPD or know someone who does, having knowledge of which symptoms are and are not part of the diagnosis can help you better understand your, or another person's, experience of having this disorder.

If you have both BPD and PTSD, it's important to understand other conditions for which you may have a higher risk (for example, substance abuse, depression, or deliberate self-harm). Armed with this knowledge, you can take steps to develop healthy coping skills that will help you minimize those risks.

Avoidant Personality Disorder

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As the name implies, people with avoidant personality disorder are shy and tend to keep at a distance from other people, particularly in social situations. They may avoid relationships or interpersonal interactions even though they desire them. Avoidant personality disorder shares many features with social anxiety disorder, but the symptoms are much more severe. (The American Psychiatric Association describes the diagnostic criteria for avoidant personality disorder here.)

PTSD often co-occurs with avoidant personality disorder. Few studies have looked at the relationship between PTSD and avoidant personality disorder; however, those that have been done indicate that people with both PTSD and avoidant personality disorder may be at higher risk for some serious problems, such as deliberate self-harm.

Antisocial Personality Disorder

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Studies have shown a relationship between PTSD and antisocial personality disorder. Some studies have found that people with PTSD have higher rates of antisocial personality disorder than people without PTSD. In addition, the symptoms of PTSD and antisocial personality disorder may overlap.

Some of the symptoms of antisocial personality disorder (such as greater impulsiveness) could lead to behaviors or situations (for example, substance abuse) that put a person at greater risk for a traumatic event—which, in turn, could contribute to the development of PTSD. Learn more about antisocial personality disorder in this article from the U.S. Department of Health and Human Services.

Explanations for the Connection

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One theory suggests that both personality disorders and PTSD may be linked to childhood trauma and attachment injury. While not every single person with attachment injury will go on to develop PTSD, they will be impacted by the attachment injury in some form or another. However, it is possible to develop secure attachment in spite of that particular injury. In one study that looked at participants with personality disorders, severe attachment malfunction along with high levels of childhood trauma was common.

Could Dialectical Behavior Therapy Help?

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Dialectical behavior therapy (DBT), a form of cognitive-behavioral therapy (CBT), has been found to be very effective for treating symptoms of BPD. DBT helps people better manage their emotions and relationships. Although DBT was originally developed as a treatment for BPD, many DBT skills have also helped people with PTSD as well as those with both disorders. 

14 Sources
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By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.