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Because there is 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.

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 that 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) :

  • INSTABILITY
  • FEELINGS OF PARANOIA / DISSOCIATION
  • UNSTABLE RELATIONSHIPS
  • SELF-HARM
  • SUICIDAL BEHAVIOR
  • DESTRUCTIVE IMPULSIVENESS
  • IDENTITY PROBLEMS / UNSTABLE SENSE OF SELF
  • EXTREME OUTBURSTS OF TEMPER
  • FRANTIC ATTEMPTS TO AVOID ABANDONMENT

BPD – A Masked Illness: Other Reasons Why It’s Hard To Identify

Not only can BPD and complex PTSD be easily confused, but there are other reasons why BPD is hard to accurately identify and diagnosed and, therefore, many BPD sufferers are at risk of going undiagnosed or misdiagnosed. The reason for this is that BPD can generate a number of symptoms associated with other conditions that mask the underlying illness (BPD). Sadly, because of this, BPD can go undiagnosed for years, decades or a whole lifetime. This means many go without the proper treatment they require. When one considers that approximately ten per cent of those diagnosed with BPD end their lives by suicide, the full, tragic implications of this failure of accurate diagnosis can be appreciated.

What Symptoms Of BPD Can Mask It, Thus Making It Less Likely To Be Accurately Diagnosed?

They include :

– excessive use of alcohol, leading to a diagnosis of alcoholism

– self-harm / suicidal thoughts, leading to a diagnosis of depression

– instability of mood, leading to a diagnosis of cyclothymic or bipolar disorder

– aggression/violence, leading to a diagnosis of sociopathy (sometimes still referred to as psychopathy)

– eating problems, leading to a diagnosis of anorexia nervosa or bulimia

Whilst this list is not exhaustive, it represents some of the ways in which BPD can seemingly, upon preliminary investigation, present itself as other psychological conditions, leading to misdiagnosis or incomplete/partial diagnosis.

Because, too, many with BPD are able to work successfully, and/or socially integrate successfully, much of the time without displaying blatant signs of psychological pathology, identifying BPD in individuals becomes trickier still.

However, such individuals are still likely to display tell-tale signs of the disorder due to sudden, dramatic and unpredictable shifts in mood (such as explosions of rage) which may, by the layman (or even the professional) be put down to ‘a difficult temperament’.

In order to correctly diagnose BPD it is necessary to look at the whole tapestry of the interplay of the individual’s behaviours and emotions in the context of their lives as a whole, with a particular focus on their relationship history (tends to be tumultuous), mood stability/instability, drug/alcohol use, sexual history (tends to be promiscuous and high risk), internal/mental life (often marked by feelings of chronic emptiness and lack of identity), emotional reactiveness/lability, and, vitally, of course, the experience of childhood trauma.

In short, accurate diagnosis calls for a holistic approach; only then will all BPD sufferers get the treatment they both desperately need and deserve.

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

REFERENCE:

Marylène Cloitre, Donn W. Garvert, Brandon Weiss, Eve B. Carlson & Richard A. Bryant (2014) Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis, European Journal of Psychotraumatology, 5:1, DOI: 10.3402/ejpt.v5.25097

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