The phenomenological and conceptual interface between borderline personality disorder and PTSD

Abstract

The authors draw a distinction between the enduring effects that traumas can have on formation (or change) of axis II personality traits (including those found in borderline personality disorder) and acute symptomatic reactions to trauma, called PTSD, that are accompanied by specific psychophysiological correlates. They describe the implications of these conclusions for DSM-IV, therapy, and future research.

Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population

“…Trauma appears to have a role in the etiology of both PTSD and BPD although the mechanisms by which trauma influences the genesis (and convergence) of these two disorders is uncertain (Sabo, 1997; Murray, 1993). Gunderson and Sabo propose that early trauma may affect personality development in a way that increases vulnerability for developing PTSD later in life (Gunderson & Sabo, 1993). Characterological traits may comprise an important part of the vulnerability that predisposes only a minority of individuals exposed to trauma to develop PTSD (Kessler et al 1995).…”

“…The overlap in phenomenological and conceptual aspects of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) has been recognized since their initial inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; Gunderson & Sabo, 1993; American Psychiatric Association, 1980). While placed on different axes of the DSM classification system, both disorders have important relationships with trauma.…”

Comorbidity between Post-Traumatic Stress Disorder and Borderline Personality Disorder: A Review

“…On the one hand, a study comparing different personality disorders found that subjects with BPD tend to suffer more sexual abuse in adulthood [18], probably as a result of a chaotic lifestyle characterized by an unsafe and impulsive sexual activity, among other risk behaviours. On the other hand, some research argues that the higher emotional dysregulation evidenced in BPD subjects could increase the likelihood of anxious reactions in response to a subsequent traumatic event [1,20]. With respect to childhood PTSD as a risk factor for BPD into adulthood, there are no prospective studies aimed at addressing this concern.…”

“…In this respect, it is stated that patients with PTSD who additionally show chronic impairments in the development of their personality could be classified as suffering from severe forms of PTSD, in the absence of BPD per se. A construct called ‘complex PTSD' [2], formulated in the 1990s, integrates PTSD with other diagnostic criteria/symptomology, that is: intense emotional dysregulation, negative self-esteem, and interpersonal problems (hostility and/or isolation) deriving from negative schemas about others [1,67,68]. An antecedent to this approach appears in the ICD-10 [61], which refers to the construct ‘enduring personality change after catastrophic experience' (F62.0), a category used to classify those subjects submitted to very traumatic stressors who show prolonged impairments at a cognitive, affective, or interpersonal level.…”

“…Traditionally, the presence of post-traumatic stress disorder (PTSD) in subjects diagnosed with borderline personality disorder (BPD) has been the object of scant empirical research, thus disregarding the role that this post-traumatic psychopathology may have in the evolution and clinical phenotype of the disorder, and the therapeutic approach to patients with BPD [1]. From the 1990s, many studies were conducted from ‘trauma models' [2], followed by other neurobiological approaches [3], resulting in an incoherent theoretical background for the comorbidity between BPD and PTSD.…”