A Comparison of Posttraumatic Stress Disorder with and without Borderline Personality Disorder among Women with a History of Childhood Sexual Abuse

Abstract

The overlap in definition and presentation between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) has raised questions about the relationship of these disorders. Are they separate disorders, variants of the same disorder, or comorbid conditions? The present study examined etiological variables and current functioning among two groups of outpatient women with a history of childhood sexual abuse: those with PTSD only (N = 45) and those with PTSD and BPD (N = 26). The groups did not differ in severity, frequency, or number of perpetrators of their childhood sexual abuse, or whether the perpetrator was a family member or not. The additional diagnosis of BPD was associated with earlier age of abuse onset and significantly higher rates of physical and verbal abuse by mother. Severity and frequency of PTSD symptoms were not affected by BPD diagnosis, suggesting that the personality disorder and PTSD are independent symptom constructs. The PTSD+BPD group scored higher on several other clinical measures including anger, dissociation, anxiety, and interpersonal problems. They did not differ in their frequency of use of mental health services but tended to be less compliant in their treatment. These and other findings are discussed, and implications for treatment are considered.

Clinical Features and Impairment in Women with Borderline Personality Disorder (BPD) with Posttraumatic Stress Disorder (PTSD), BPD Without PTSD, and Other Personality Disorders with PTSD

“…This study's findings that borderline women with and without PTSD lacked significant differences in BPD factors and general psychiatric morbidity indicates that the presence of PTSD does little to augment existing borderline pathology or psychiatric morbidity in borderline patients. These findings are consistent with the results from other studies that have shown that degree of borderline pathology is similar for borderline patients with and without PTSD (Zlotnick et al, 2002) and greater in patients with comorbid BPD and PTSD than those with PTSD only (Heffernan and Cloitre, 2000;Zlotnick et al, 2002). A finding consistent with the Zlotnick et al (2002) study was that those dimensions (i.e., affect dysregulation, behavioral dysregulation, and disturbed relatedness) frequently associated with complex PTSD (Herman, 1992) were less severe in PTSD patients in the absence of a diagnosis of BPD.…”

“…This study found that severity and frequency of PTSD symptoms were not significantly affected by BPD diagnosis; the PTSDϩBPD group (N ϭ 26) scored higher on measures of anger, dissociation, anxiety, and interpersonal problems than the PTSD only group (N ϭ 45). Another finding of this study was that there were no differences between the two groups in most characteristics of sexual abuse, such as frequency, severity, or number of perpetrators (Heffernan and Cloitre, 2000). In the other study (Zlotnick et al, 2002), outpatients with comorbid BPD and PTSD were compared with those with BPD without PTSD, PTSD without BPD, and major depressive disorder without PTSD or BPD in severity of PTSD-related symptoms, borderline-related traits, and dysfunction.…”

“…Only two studies exist to date that have explored whether PTSD and BPD are related disorders in terms of current symptomatology (Heffernan and Cloitre 2000; Zlotnick et al, 2002). One of these studies (Heffernan and Cloitre 2000) compared women with PTSD to those with PTSD and comorbid BPD on severity or frequency of PTSD symptoms, several other clinical features, and characteristics of childhood sexual abuse in a group of women selected for histories of sexual abuse. This study found that severity and frequency of PTSD symptoms were not significantly affected by BPD diagnosis; the PTSDϩBPD group (N ϭ 26) scored higher on measures of anger, dissociation, anxiety, and interpersonal problems than the PTSD only group (N ϭ 45).…”

“…Results of this study suggest that the comorbid PTSD and BPD group did not evidence a more severe clinical profile in terms of number of PTSD symptoms, borderline features, or impairment than those with BPD or those with PTSD. Limitations of research, to date, include the use of a relatively small sample size, which may have resulted in a corresponding lack of power to detect true differences (Heffernan and Cloitre, 2000) and the failure to examine whether BPD and PTSD differ in features associated with both disorders (Heffernan and Cloitre, 2000;Zlotnick et al, 2002); in other personality disorder comorbidity (Heffernan and Cloitre, 2000;Zlotnick et al, 2002); or in types of childhood abuse other than sexual abuse (Heffernan and Cloitre, 2000;Zlotnick et al, 2002).…”

Neurowissenschaften und Traumatherapie

“…Lang andauernde, intentionale Traumatisierungen in der früheren Kindheit -besonders während des ersten Lebensjahrzehnts -können jedoch tiefer greifende Wirkungen haben (Cole & Putnam, 1992;Heffernan & Cloitre, 2000). Betroffene, deren seelisches Leid absichtlich durch nahe stehende Bindungspersonen verursacht wurde, müssen oft noch im Erwachsenenalter die Folgen der Traumatisierung irgendwie bewältigen.…”