Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis

Abstract

BackgroundThere has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD.ObjectiveTo determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD.MethodA latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD.ResultsThe LCA revealed four distinct classes of individuals: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness.ConclusionsFindings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

“…However, evidence suggests that different aspects of affect dysregulation may be more salient in certain types of trauma. For example, symptoms that fall into the hyper-activation domain include uncontrollable anger, which has been found to have a relatively low endorsement in adult survivors of child sexual abuse (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014), whereas it has been found to be highly endorsed in survivors of mass conflict and severe human rights violations (Hinton, Hsia, Um, & Otto, 2003; Murphy, Elklit, Dokkedahl, & Shevlin, 2016; Rees et al, 2013). Moreover, in a study of survivors of an industrial disaster, anger was the only symptom that increased over a period of 30 months (Weisæth, 1984).…”

“…Finally, a criticism with the CPTSD construct is that some argue that it is PTSD with comorbid borderline personality disorder (BPD) due to symptom overlap, particularly in regard to emotional dysregulation, which we did not address in the current study. However, findings from a latent class analysis revealed qualitatively distinct CPTSD and BPD profiles that were distinguishable on key BPD indicators, such as fear of abandonment and self-harming behaviours (Cloitre et al, 2014). Furthermore, while both conditions include DSO symptoms, BPD, for example, is typically characterized by an unstable sense of self that can alternate between highly positive and negative self-evaluation, whereas CPTSD is characterized by a stable negative sense of self (Brewin et al, 2017).…”

Testing the ICD-11 proposal for complex PTSD in trauma-exposed adults: factor structure and symptom profiles

“…The concept of a sibling disorder is based on the fact that PTSD and cPTSD are both traumatic stress disorders, which show a related but distinct set of symptoms. PTSD is a fear-related disorder in which the core symptoms are associated with trauma-related stimuli (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014). The specific symptom picture of cPTSD (besides the core PTSD clusters) refers to more complex disturbances in self-organization which are not necessarily linked to trauma-related triggers, and it occurs across different settings and more complex traumatic events (Brewin et al, 2017; Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013).…”

“…a PTSD and three specific cPTSD factors called ‘affect regulation’, ‘interpersonal problems’ and ‘negative self-concept’, e.g. Cloitre et al, 2014; Knefel & Lueger-Schuster, 2013) and also a six-factor structure (i.e. three PTSD clusters called ‘re-experiencing’, ‘avoidance’ and ‘hyperarousal’ and three specific cPTSD clusters; Hyland et al, 2016; Karatzias et al, 2016).…”

Psychotraumatology on the move

“… In EJPT, the almetric score is highest for this paper: Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis (Cloitre et al, 2014). …”