Tag Archives: Cptsd

What Are The Differences Between BPD And Complex PTSD? : A Study

difference between complex ptsd and bpd

Because there is a considerable overlap in symptoms between those suffering from borderline personality disorder (BPD) and those suffering from complex posttraumatic disorder (complex PTSD) , those with the latter condition can be misdiagnosed as suffering from the former condition (you can read my article about this by clicking here).

In order to help clarify the differences between the two conditions and help show how they are distinct from one another, this article is about a research study which sought to delineate these two very serious psychiatric conditions.

What Are The Differences In Symptoms Between Those Suffering From Borderline Personality Disorder (BPD) And Those Suffering From Complex Posttraumatic Stress Disorder (Complex PTSD)?

A study into the different symptoms displayed by sufferers of borderline personality disorder (BPD) and complex posttraumatic stress disorder (complex PTSD) involving the study of two hundred at eighty adult women who had experienced abuse during their childhoods and published in the European Journal of Psychotraumatology in 2014 compared the symptoms of those suffering from BPD with those suffering from complex PTSD.

The following results from the study were obtained :

SYMPTOMS SHARED APPROXIMATELY EQUALLY BETWEEN THOSE SUFFERING FROM BPD AND THOSE SUFFERING FROM COMPLEX PTSD :

Some symptoms were found to be shared approximately equally between those suffering from  borderline personality disorder (BPD) and those suffering from complex posttraumatic stress disorder (complex PTSD). The symptoms that fell into this category were as follows :

  • AFFECTIVE DYSREGULATION (ANGER) i.e. frequent feelings of intense rage that the individual cannot control (regulate)
  • VERY LOW FEELINGS OF SELF-WORTH
  • AFFECTIVE DYSREGULATION (SENSITIVE) i.e. feelings of hypersensitivity that cannot be controlled (regulated)
  • INTENSE FEELINGS OF GUILT
  • INTERPERSONAL DETACHMENT / ALONENESS i.e. feeling cut-off and alienated from others, isolated and apart
  • FEELINGS OF EMPTINESS

However, some symptoms were found to be significantly more prevalent amongst those suffering from borderline personality disorder (BPD) than amongst those suffering from complex posttraumatic stress disorder (complex PTSD) as shown below :

SYMPTOMS THAT WERE FOUND TO BE SIGNIFICANTLY MORE PREVALENT AMONGST THOSE SUFFERING FROM BORDERLINE PERSONALITY DISORDER (BPD) THAN AMONGST THOSE SUFFERING FROM COMPLEX POSTTRAUMATIC STRESS DISORDER (COMPLEX PTSD) :

 

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Prolonged Exposure Therapy And Posttraumatic Stress Disorder (PTSD)

Major symptom of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (cPTSD)click here to read about the difference between these two conditions – are fear, anxiety and even terror induced by :

– situations related to the traumatic experience

– people related to the traumatic experience

– places related to the traumatic experience

– activities related to the traumatic experience

Prolonged Exposure Therapy Involves Two Specific Types Of Exposure To Trauma-Related Phenomena :

a) In Vivo Exposure

b) Imaginal Exposure

In Vivo Exposure :

Prolonged exposure therapy works by encouraging the individual with PTSD / cPTSD, in a supportive manner, very gradually, to confront these situations / people / places / activities whilst, at the same time, feeling safe, secure and calm. Because this part of the therapy involves exposure to ‘real life’ situations / people / places / activities it is called in vivo exposure.

This is so important because avoiding these situations / people / places / activities, whilst reducing the individual’s anxiety in the short-term, in the longer-term simply perpetuates, and, potentially, intensifies, his/her fear of these things.

Imaginal Exposure:

The therapy also involves the PTSD / cPTSD sufferer talking over details and memories of the traumatic experience in a safe environment and whilst in a relaxed frame of mind (the therapist can help to induce a relaxed frame of mind by teaching the patient/client breathing exercises and/or physical relaxation techniques; hypnosis can also be used to help induce a state of relaxation). Because this part of the therapy ‘only’ involves mental exposure to the trauma (i.e. thinking about it in one’s mind), it is called imaginal exposure and can help alleviate intense emotions connected to the original trauma (e.g. fear and anger).

Both in vivo and imaginal exposure to the trauma-related stimuli are forms of desensitizing and habituating the patient / client to them, thus reducing his/her symptoms of PTSD / cPTSD.

How Effective Is Prolonged Exposure Therapy?

Prolonged exposure therapy is a type of cognitive behavioural therapy (CBT) and research into the treatment of PTSD suggests it is the most effective treatment currently available.

What Is The Duration Of The Treatment?

The length of time a patient / client spends in treatment varies in accordance with his/her needs and his/her therapist’s particular approach. However, the usual duration of the treatment is between two and four months, comprising weekly sessions of approximately ninety minutes each.

On top of this, the patient / client will need to undertake some therapeutic exercises/activities in his/her own time, set by the therapist as ‘ homework assignments’. These assignments will include listening to recordings of imaginal exposure therapy sessions.

RESOURCES :

The National Center For PTSD has developed a PROLONGED EXPOSURE APP, or PE APP. Click here for further information and download instructions.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

 

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Developmental Trauma Disorder

childhood_trauma

Researchers van der Kolk et al. have proposed that children who are significantly psychologically and emotionally disturbed as a result of their traumatic upbringings be diagnosed with Developmental Trauma Disorder  (although the proposed diagnosis is not yet included in the DSM or, to give it its full title, The Diagnostic and Statistical Manual of Mental Illness).

The researchers who propose the diagnosis argue that the various diagnoses disturbed children currently receive, such as Oppositional Defiant Disorder, Reactive Attachment Disorder and anxiety, are too narrow, restricted and limiting and, furthermore, do not recognize or acknowledge the ‘big picture’ (i.e. the full extent and range of the damage that has been done to child’s functioning).

childhood trauma disorder

They also argue that limited and narrow diagnoses like Oppositional Defiant Disorder lead to clinicians focusing too much on correcting the behaviour at the expense of identifying and understanding the underlying cause of it (i.e. the trauma that the child has suffered).

Van der Kolk, in his book The Body Keeps Score (see below) describes Developmental Trauma Disorder as having three prime features; these are as follows:

1) A pervasive pattern of dysregulation:

According to van der Kolk, this may entail dramatic mood swings, outbursts of extreme temper, panic, detachment, flatness, dissociation and the inability to self-sooth

2) Impaired ability to pay attention and concentrate (due to agitation and hyperarousal)

3) Impaired ability to get along with others and, as van der Kolk puts it, ‘a failure to get along with [ oneself ].’

 

Associated Physical Symptoms:

Van der Kolk also draws our attention to the fact that, because the child suffering from Developmental Trauma Disorder is constantly in a state of high stress (and, subsequently, is likely to have an abnormally high level of stress hormones – such as cortisol – coursing through his/her veins) s/he will also be susceptible to various physical symptoms; these include:

– headaches

– sleep disruption

– stomach upsets

– oversensitivity to sounds and tactile experiences

– problems with fine motion movements

Extreme Need To Relieve Stress:

The young person with Developmental Trauma Disorder, in an attempt to alleviate the severe stress s/he perpetually feels, may, also, according to van der Kolk:

– self-harm (e.g. cutting self with razor)

– masturbate excessively

– rock to and fro whilst sitting down

Neediness And Self-Hatred:

If the child has been rejected and/or largely ignored by his/her parents/caregivers this may lead him/her to become extremely ‘needy’ and ‘clingy.’

Also, s/he is likely to have internalized his/her parents’/caregivers’ negative view of him/her and therefore develop feelings of self-hatred, of being intrinsically unlovable, and of being worthless and of no value to others.

Resources:

To purchase van der Kolk’s book/eBook, click on image below:

 

To purchase Childhood Trauma And Its Link To Borderline Personality Disorder click image below:

 

BPD

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Copyright 2016 Child Abuse, Trauma and Recovery

What Is ‘Trauma Informed’ Therapy?

childhood_trauma

Many individuals who seek treatment and therapy for problems such as alcoholism, drug addiction, clinical depression, severe anxiety, anger management issues and eating disorders (or a combination of such problems) often have an underlying problem: they have experienced severe and protracted childhood trauma.

In other words, it is their experience of trauma that has significantly contributed to the existence of such problem as those mentioned above.

Such people are increasingly being said by psychiatric professionals to be suffering from complex posttraumatic stress disorder (CPTSD). However, this diagnosis has yet to be included in the DSM (Diagnostic And Statistical Manual Of Mental Disorders).

In CPTSD sufferers, the problems that go with it such as those listed above (alcoholism, drug addiction etc) are often referred to secondary problems/conditions/diagnoses whilst the the core CPTSD is referred to as the primary problem/condition/diagnosis).

Sadly, all too frequently, the diagnosis of CPTSD is missed due to practitioners focusing exclusively on the secondary problems without taking the time to discover the underlying and primary problem, namely the effects of childhood trauma manifesting as CPTSD.

Unfortunately, it is much harder to treat the secondary problems if their link to the primary problem (the experience of childhood trauma / CPTSD) is not identified. Indeed, in my own case, for years my secondary symptoms were treated without success due in large part due to the fact none of my doctors or psychiatrists I saw (and, believe me, these were numerous) thought to ask me about my childhood.

TRAUMA INFORMED THERAPY:

Trauma informed therapy is treatment which identifies the link between the primary problem (the effects if childhood trauma) and the secondary problems (alcoholism, drug addiction etc…).

Indeed, according to the principles of trauma informed therapy, if the psychiatric professional fails to make this connection and tailor the treatment accordingly, it is much less likely the patient will be able to permanently conquer his/her secondary problems, let alone the primary problem (as it remains unidentified as a causal factor and as a major problem in its own right).

Resource:


 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Wrongly Diagnosed With BPD?

It has been suspected for a while now that many people who have been diagnosed with BPD should really have been diagnosed with a different syndrome known as complex post traumatic stress disorder (CPTSD).

Whilst simple PTSD typically results from an intense, one- off, traumatic experience, complex PTSD occurs as a result of protracted and prolonged trauma. CPTSD is especially likely to occur in cases of child abuse that continued over a long period, especially when the abuser should have been acting as the child’s primary carer(eg a parent or step-parent).

It has been found that a very high percentage of those diagnosed with BPD experienced severe childhood trauma which is why (amongst other reasons, see below) many experts are now questioning whether a large number of those so diagnosed should, instead, have been diagnosed with BPD.

CPTSD is so damaging to an individual as it eats into the very core of how s/he perceives him/herself and affects, on a profound level, how s/he views others and the world in general. In short, it adversely impinges upon a person’s core and fundamental beliefs.

Symptoms of CPTSD

severe mood swings

– out of control emotions

– out of control behaviours eg shoplifting, pathological gambling, promiscuous and risky sex, severe overspending

– dissociation (click here to read my article on this)

– eating disorders

– overeating/obesity

–  impaired and distorted view of abuser (leading to emotional attachment). This is also known as Stockholm Syndrome.

– marked distrust of others

– intense jealousy

– extreme neediness

– hopelessness/despair

– feeling that life is utterly devoid of meaning

– inappropriate feelings of guilt/shame/self-disgust

– outbursts of extreme anger (sometimes with physical violence)

– severe anxiety

– suicidal thoughts/behaviour

Overlap With BPD Symptoms:

It is because these symptoms overlap substantially with the symptoms of BPD (click here) that it is thought many people are being diagnosed with BPD when they should be being diagnosed for CPTSD.

It is my belief that a main cause of such misdiagnosis is that  doctors do not spend enough (or, indeed, any!) time talking to supposed ‘BPD suffers’ about their childhood experiences.

Given the choice, I suspect, if there are valid reasons, most people would feel more comfortable with a diagnosis of CPSTD than one of BPD. This is because, sadly and wrongly, stigma still tenaciously attaches itself to a diagnosis of BPD.

Also, a diagnosis of CPTSD implicitly acknowledges the fact that the sufferer has had harm done to him/her and that CPTSD is a NORMAL REACTION TO AN ABNORMAL SET OF EXPERIENCES.

This could significantly help sufferers cast off, once and for all, the vast weigh of guilt many feel in one fell swoop.

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Possible Adverse Physical Effects of CPTSD

childhood_trauma_questionnaire

Unfortunately, as well as psychological effects, if we have developed complex post traumatic stress disorder (CPTSD) as a result of our childhood experiences (click here to read my article on the difference between PTSD and CPTSD), the condition can also give rise to adverse physical effects (i.e. bodily/somatic effects).

The main reason for this is that, as sufferers of CPTSD, we tend to be chronically locked into a state of distressing hyper-arousal (which psychologists often refer to as the fight/flight state – click here to read my article on this).

Essentially, this means that our SYMPATHETIC NERVOUS SYSTEM becomes CHRONICALLY OVER-ACTIVATED, which, in turn, can lead to harmful bodily processes resulting in, for example :

– over-production of ADRENALINE (a hormone that is produced by the body when we perceive ourselves to be in danger, preparing us for ‘fight or flight’)

– disrupted sleep (which can have a deleterious effect on our physical health).

– stomach disorders (due to a tightened digestive tract)

– excessive muscle tension

– shallow/rapid breathing (causing us to take in too much CO2 (carbon dioxide)  and not enough O (oxygen) – this can cause panic attacks

– a general inability to relax leading to unhealthy ‘self-medication’ such as excessive drinking, smoking, over-eating, use of narcotics

images

WHAT CAN BE DONE?

There are various strategies we can use to help manage this problem, including :

– stretching exercises

– yoga

– massage

– mindfulness meditation

– self-hypnosis for relaxation

(See ‘RECOMMENDED PRODUCTS’ in the MAIN MENU for mindfulness and self-hypnosis products, or click here).

The above therapies are likely to be more effective if combined with other therapies that address the root of the problem (i.e. adverse childhood experiences). In relation to this, the following may be considered :

– COGNITIVE BEHAVIOURAL THERAPY (CBT) – click here to read my article on this

– DIALECTICAL BEHAVIOURAL THERAPY (DBT) – click here to read my article on this

– EYE MOVEMENT DESENSITISATION AND REPROCESSING THERAPY (EMDR) – click here to read my article on this

RESOURCES :

HELP FOR PTSD – ROYAL COLLEGE OF PSYCHIATRY

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2014 Child Abuse, Trauma and Recovery

Complex PTSD

 

complex PTSD

Complex PTSD:

There has been some controversy regarding the difference between post traumatic stress disorder (PTSD) and complex PTSD amongst researchers.

During the early 1990s, the psychologist Judith Herman noted that individuals who had suffered severe, long-lasting, interpersonal trauma, ESPECIALLY IN EARLY LIFE, were frequently suffering from symptoms such as the following:

– disturbance in their view of themselves

– a marked propensity to seek out experiences and relationships which mirrored their original trauma

– severe difficulties controlling emotions and regulating moods

– identity problems/the loss of a coherent sense of self (click here to read my article on identity problems)

– a marked inability to develop trusting relationships

and, sometimes:

– adoption by the victim of the perpetrator’s belief system

Furthermore, some may go on to become abusers themselves, whilst others may be constantly compelled to seek out relationships with others who abuse them in a similar way to the original abuser (i.e. the parent or ‘care-taker’)

It is most unfortunate that, prior to the identification of the disorder that gives rise to the above symptoms, now referred to as complex PTSD, those suffering from the above symptoms were NOT recognized as having suffered from trauma and were therefore not asked about their childhood traumatic experiences during treatment. This meant, of course, that the chances of successful treatment were greatly reduced.

Research has now demonstrated that the effects of severe, long-lasting interpersonal trauma go above and beyond the symptoms caused by PTSD.

Complex PTSD Symptoms :

The main symptoms of complex PTSD are as follows:

1) severe dysregulation of mood

2) severe impulse control impairment

3) somatic (physical) symptoms (e.g. headaches, stomach aches, weakness/fatigue)

4) changes in self-perception (e.g. seeing self as deeply defective, ‘bad’ or even ‘evil’)

5) severe difficulties relating to others, including an inability to feel emotionally secure or empowered in relationships

6) changes in perception of the perpetrator of the abuse (e.g. rationalizing their abuse/idealization of perpetrator)

7) inability to see any meaning in life/existential confusion

8) inability to keep oneself calm under stress/inability to ‘self-sooth’

9) impaired self-awareness/fragmented sense of self

10) pathological dissociation (click here to read my article on DISSOCIATION)

The DSM IV (Diagnostic and Statistical Manual IV) first named  complex PTSD as: DISORDER OF EXTREME STRESS NOT OTHERWISE SPECIFIED (DESNOS). Now, however, complex PTSD is listed as a SUB-CATEGORY of PTSD.

Whilst it is certainly true that there is an OVERLAP between the symptoms of PTSD and complex PTSD, many researchers now argue that PTSD and complex PTSD should be regarded as SEPARATE and DISTINCT disorders.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Why can Effects of Childhood Trauma be Delayed?

childhood_trauma_delayed_effects

Delayed onset post traumatic stress disorder (PTSD) ,which can occur as a result of a severely disrupted childhood, is defined by the DSM (Diagnostic Statistical Manual) as PTSD which develops at least six months after the traumatic event/s; however, PTSD can take much longer than this to manifest itself.

One reason why PTSD may not become apparent immediately is that the individual who has been affected by  trauma is able, for a period of time, to employ coping mechanisms (either consciously or unconsciously) which keep the condition at bay. During this period, some of the effects of the traumatic experience/s lie dormant.However, due to the experiencing of  further triggers (stress-inducing reminders of the original trauma), the person’s neurobiological processes (already harmed by the original trauma) may be further adversely affected until a ‘tipping point’ is reached and the s/he meets the criteria for being diagnosed with the disorder.

In other words, there is an interaction between the original damage caused by the trauma and exposure to further stressors later on in life. It follows from this that the more severe the original trauma, and the more severe the stressors life throws at the individual subsequently, the greater is the his/her accumulated risk of developing PTSD. Indeed, this is borne out by the research.

ORIGINAL TRAUMA LEADS TO GREATER VULNERABILITY TO EFFECTS OF FURTHER STRESS :

The original trauma, then, makes the individual more susceptible to being affected adversely by further life stressors. In neurological terms, this is thought to be because the original trauma can damage an area of the brain known as the amygdala; damage to this region makes a person’s fear/anxiety response to stressors much more intense than is normally the case (click here to read my article on how the effects of childhood trauma can physically harm the brain).

The more the individual affected by the original trauma subsequently experiences stressful triggers (see above) which cause him/her to relive it, the more damaged, and hypersensitive to the effects of further stress, the amydala (see above) becomes. Eventually, the amygdala’s response to perceived threat and danger (there does not have to be any real threat or danger ; indeed, one of the hallmarks of PTSD is that it causes the sufferer to see threat everywhere, where it does not, in fact, exist)  become so exaggerated that the individual finds him/herself living in what amounts to a state of almost constant terror (indeed, I myself was in just such a state for more time than I care to recall).

VICIOUS CYCLE:

As the individual starts to perceive, irrationally, threat everywhere, the range of triggers (see above) s/he experiences grows ever wider; this, in turn, yet further sensitizes the amygdala and reinforces the individual’s stress response. Thus, a vicious cycle develops.

CRITICAL PERIOD OF BRAIN VULNERABILITY :

I will finish with a quote from the psychologist Shalev, which I think speaks for itself and requires no further elucidation from me :

‘Following trauma there is a critical period of brain plasticity during which serious neuronal changes may occur in those who go on to develop PTSD.’

NB. To learn more about BRAIN PLASTICITY, and how we can take advantage of the phenomenon to aid our own recoveries,  click here to read my article).

bpd_ebookeffects_of_childhood_trauma_ebook

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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