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

Abstract

Background: 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. The clarification of issues related to the different areas of study for this comorbidity is not only significant from a theoretical point of view but also relevant for clinical practice. The aim of this review is to describe the main theoretical findings and research conclusions about the comorbidity between PTSD and BPD. Methods: A literature review was carried out via PubMed and PsycINFO for the period between 1990 and September 2013. The descriptors used were ‘post-traumatic stress disorder', ‘borderline personality disorder', ‘PTSD', ‘complex PTSD' and ‘BPD'. Results: Epidemiological studies show that the risk of PTSD among BPD subjects is not regularly higher than in subjects with other personality disorders. Furthermore, there is no conclusive evidence about the main aetiopathogenic mechanism of this comorbidity, either of one disorder being a risk factor for the other one or of common underlying variables. Concerning comparative studies, several studies with PTSD-BPD subjects have found a higher severity of psychopathology and psychosocial impairment than in BPD subjects. With regard to nosological status, the main focus of controversy is the validation of ‘complex PTSD', a clinical entity which may comprise a subgroup of PTSD-BPD subjects. With regard to treatment, there are preliminary evidences for the efficient treatment of psychopathology in both PTSD and BPD. Conclusions: These findings are remarkable for furthering the understanding of the link between PTSD and BPD and their implications for treatment. The results of this review are discussed, including methodological constraints that hinder external validity and consistency of referred findings.

Sexual Traumatic Event Exposure, Posttraumatic Stress Symptomatology, and Alcohol Misuse Among Women: A Critical Review of the Empirical Literature

“…For example, a chaotic family environment, independent of the experience of specific trauma events, may confer risk for the development of PTSD and/or AUD. Consistent with this perspective, a growing body of research indicates that an unstable home environment that is characterized by abuse, particularly sexual abuse, is relatively prevalent among women diagnosed with borderline personality disorder (BPD;Fr ıas & Palma, 2015). Other work suggests that women with BPD and/or related traits (i.e., affective instability) are related to alcohol misuse (Skodol et al, 2002;Trull, Sher, Minks-Brown, Durbin, & Burr, 2000).…”

“…For instance, as highlighted above, recent research has begun to recognize the role of emotion dysregulation in PTSD-AUD comorbidity. From a broad perspective, difficulties in emotion regulation have been linked to a variety of adverse outcomes, including substance use (Sher & Grekin, 2007), PTSD (Ehring & Quack, 2010), mood/anxiety disorders (Campbell-Sills & Barlow, 2007), and BPD (Fr ıas & Palma, 2015). Women tend to report greater use of adaptive/maladaptive emotion regulation strategies in response to distress (Nolen-Hoeksema, 2012) and difficulty with goal-directed behavior when experiencing intense emotions (Tripp, McDevitt-Murphy, Avery, & Bracken, 2015).…”

Early maladaptive schemas associated with dimensional and categorical psychopathology in patients with borderline personality disorder

“…In spite of these noteworthy findings, a more ecological approach to the specificity of EMSs is needed for BPD patients, which take into account their great comorbidity or categorical psychopathology. Concretely, epidemiological studies have found that BPD samples showed lifetime prevalence rates of up to 75% for eating disorders (ED), posttraumatic stress disorder (PTSD), major depression (MD), and substance use disorders (SUD; Frías & Palma, 2015;Kienast, Stoffers, Bermpohl, & Lieb, 2014;Köhling, Ehrenthal, Levy, Schauenburg, & Dinger, 2015;Zanarini, Reichman, Frankenburg, Reich, & Fitzmaurice, 2010). The need to address this issue is also justified by the fact that these comorbid disorders have been associated with specific EMSs when assessed alone (Ahmadian, Mirzaee, Omidbeygi, Holsboer-Trachsler, & Brand, 2015;Cockram, Drummond, & Lee, 2010;Pugh, 2015;Shorey, Stuart, & Anderson, 2013).…”

Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder

“…BPD is thus frequently comorbid with posttraumatic stress disorder (PTSD), with the diagnostic overlap reported to be between 33% and 79% (Frías and Palma, 2015). Individuals with PTSD and co-occurring BPD have more severe PTSD symptoms than those with PTSD and other comorbid disorders (Bolton et al, 2006), leading to greater impairment, a worse prognosis, and higher healthcare utilization (Connor et al, 2002; Frías and Palma, 2015). …”