Complex post-traumatic stress disorder (CPTSD) is a term that was coined shortly after the initial diagnosis of PTSD came onto the scene in the 1980s. This offshoot of the original diagnosis was used to capture repeated, ongoing trauma that typically occurs in the early developmental years, often - though not always - between family members. This includes childhood sexual abuse/neglect; ongoing verbal or psychological abuse from a family member; or bullying from friends/peers. Many of the symptoms of CPTSD mirror traditional PTSD - intrusive thoughts/images, avoidance, and hyperarousal. Where CPTSD differs from PTSD is in a cluster of symptoms referred to as disturbances of self-organization, which can be broken down into three domains: affect regulation, self-concept, and relationship functioning. Affect regulation may present as emotional reactivity or self-destructive behaviors; self-concept can look like feelings of worthlessness or low self-efficacy; and relationship functioning may look like struggling to create and sustain deep relational intimacy. Do any of these symptoms sound familiar? If so, it’s probably because you’ve heard a very similar cluster pertaining to borderline personality disorder (BPD).
CPTSD vs. BPD
The ways in which the two conditions are similar include: symptoms resulting from trauma; alterations in mood; patterns of self-destructive behavior; and interpersonal challenges. Both individuals with CPTSD and BPD may find it challenging to form intimate relationships. They find it difficult to trust another person enough to fully let them in. Where individuals with a borderline personality differ, however, is in what is referred to as dissociation of paranoid ideation. This refers to the belief that other people are watching or talking negatively about them when they are not present. This phenomenon tends to get exacerbated when the two people are apart. For example, someone with BPD may feel totally safe and secure in their relationship when they are with their partner, but when they leave town for a trip, the individual may start to spiral and feel like their partner is actually against them. This feeling of betrayal often manifests in the form of extreme reactivity, such as yelling, blaming, or even physical violence. This form of emotional processing is referred to as externalizing and is unique to BPD. Individuals with CPTSD may exhibit externalizing behaviors, but this is not a requirement to meet sufficient criteria for CPTSD. Some individuals with CPTSD may experience the opposite - internalizing. This looks like turning the blame and harsh emotions inward rather than directing them at others. This can lead to a negative self-concept and various forms of emotional dysregulation.
treatment for CPTSD and BPD
When considering treatment for CPTSD and/or BPD, it is important to find a provider who is trauma-informed, as that is at the heart of both CPTSD and BPD. That being said, the specific modalities typically differ between the two diagnoses. Dialectical behavioral therapy is the gold standard for BPD, whereas CPTSD may be better supported with a trauma-specific modality like eye movement desensitization and reprocessing therapy or trauma-focused CBT.
If you are ready to seek support for unresolved trauma or deepen your skills around emotional regulation or interpersonal challenges, feel free to reach out to one of our clinicians today. We can’t wait to hear from you.
References:
Complex PTSD: History and Definitions, by the U.S. Department of Veterans Affairs
Understanding Complex PTSD and Borderline Personality Disorder, from the Psychiatry and Psychotherapy podcast
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