Complex PTSD and borderline personality disorder

Abstract

Background This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. Main body The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment. Conclusion The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.

Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder

“…This is consistent with findings from studies with adults (Brewin et al, 2017) and adolescents (Kazlauskas et al, 2020) showing that distinct sub-groups of adults can be identified based on PTSD symptoms alone, DSO symptoms alone, or a combination of PTSD and DSO symptoms, There may be a continuum of PTSD severity, ranging from the minimal symptoms class to the pPTSD class to the DTD + PTSD class, similar to findings with the ICD-11 CPTSD framework and high risk children who were in foster care (Haselgruber et al, 2020b), receiving trauma-focused cognitive behavior therapy (Sachser et al, 2017), or exposed to mass violence (Crum et al, 2018). This also is similar to findings with trauma-exposed adults suggesting that PTSD, CPTSD, and Borderline Personality Disorder (BPD) may be on a continuum of severity (Ford & Courtois, 2021), and raises the question of whether (and for whom) DTD is a precursor to adult CPTSD or BPD.…”

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

“…ED is a consequence of exposure to direct or indirect physical or sexual violence associated with posttraumatic stress symptoms [e.g., ( 184 )] and BPD pathology [e.g., ( 322 , 323 )]. Ford and Courtois ( 324 ) provide an extensive summary of the role of trauma and ED in BPD. Buckholdt et al ( 172 ) examined the mediating role of ED in the relation between exposure to violence and PTSD or BPD pathology in adolescents.…”

Complex PTSD: what is the clinical utility of the diagnosis?

“…The latter can be considered as a post-traumatic symptom of avoidance, as social interactions can trigger trauma responses. Similarly, as certain DSO- and BPD symptoms co-occur in some, but not all sub-groups in the referred studies, recent findings indicate that there are more multifaceted symptom combinations to complex trauma than simply PTSD and DSO (Ford & Courtois, 2021 ).…”