You have known a friend during your college years. He joins the same debate club as you. After a while, you foster a close relationship with this friend, and you regard him as your best friend. When you have problems, you will go to him for deep emotional talk. Then, you got to know that he is actually attending regular therapy sessions to heal from a repeated trauma that he had experienced when he was a child. He tells you that he is diagnosed with Complex Post Traumatic Stress Disorder or C-PTSD.
Have you ever heard the psychiatric diagnosis of C-PTSD before? And do you know, that oftentimes, there is a crossover between C-PTSD and Borderline Personality Disorder (BPD), and these two often co-exist in one patient. However, there are also differences in presentation of symptoms that you can notice between these two.
The definition and criteria of diagnoses
C-PTSD is a subset of posttraumatic stress disorder. PTSD is a fear-based disorder, whereas C-PTSD is often referred to as a shame-based disorder that may occur following exposure to an event or series of events of an extreme and prolonged or repetitive nature that is experienced as extremely threatening or horrific and from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence or intimate partner violence, repeated childhood sexual or physical abuse, victims of survivor of human trafficking or refugees). Symptoms of C-PTSD include (Herman, 1992):
A. Severe and pervasive problems in emotion regulation
B. Forgetting traumatic events completely
C. Self-perception (feeling shame, guilt and a sense of being different)
D. Very skewed perceptions of their perpetrators (especially when it is hard to resolve the facts about the situation with the feelings about it such as when an abuser was a parent that we love very much)
E. Relations with others may be difficult and trust issues may present extra challenges.
F. Their own sense of meaning and purpose (we may feel hopeless and have no sense that things will work out).
BPD is a lifelong and pervasive that influences interpersonal relationships, mood, and behaviour. It is common for people with BPD to struggle to show patterns of stability in their relationship, in which idealization and devaluation are common. They also have unstable self-identity, self-image, and impulsivity. BPD can be diagnosed when 5 out of the following 9 criteria is fulfilled:
A. Fear of abandonment
B. Unstable relationships
C. Unstable sense of self
D. Impulsive, self-destructive behaviours
E. Recurrent suicidal behaviour, gestures, threats or self-injurious behaviour.
F. Extreme emotional/mood swings
G. Chronic feelings of emptiness
H. Inappropriate or intense & explosive anger
I. Feeling suspicious of people or out of touch with reality (severe dissociative symptoms).
If you look at the above criteria, you can clearly see the big overlap between the two, since many people can fit the criteria for both disorders.
What are the main differences between the two?
Psych2goers, have you ever wondered what are the main differences of these two psychiatric disorder? According to Southcott (2020):
1. A diagnosis of BPD does not require any history of a traumatic event to be diagnosed whereas C-PTSD does.
2. The treatment plan for C-PTSD is to focus on healing or processing through the traumatic event(s) while treatment for BPD focuses a lot on moderating behaviour and regulating emotion.
3. While both diagnoses do show symptoms of emotion dysregulation, they are expressed very differently. In C-PTSD it is expressed through emotional sensitivity, reactive anger, and poor coping skills with behaviours like drinking and addiction. People with BPD can also engage in these behaviours but someone with BPD is more likely than someone with C-PTSD to struggle with suicidal thoughts and self-injurious behaviour when experiencing emotional dysregulation.
4. In C-PTSD, there will be mood regulation symptoms (negative mood, negative self-talk, negative view of the self, negative view of relationship, distorted view of other people in the relationship)
5. Those with BPD will almost always experience some degree of fear of abandonment, and there is no requirement for that in the criteria associated with C-PTSD. In C-PTSD, it is much more about the fear of relationship itself, relationship doesn’t feel like safe spaces.
6. C-PTSD patients will view themselves very negatively as “damaged, shameful”and sometimes even taking blame for what has happened to them or believe that they deserve the abuse. In contrast, people with BPD will have a constant thought of, “I’m so bad in this relationship.”
Psych2goers, it is always good and empowering to know of these criteria of diagnoses, since it can provide you with useful information to keep up to date with your own experience of symptoms. Remember, you know yourself better than other people. If you identify with the symptoms stated above, please don’t hesitate to seek professional help from a licensed mental health provider.
Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress, 5(3), 377–391. doi:10.1007/bf00977235 Read more: http://traumadissociation.com/complexptsd
Southcott, Z. (2021, February 12). C-ptsd or bpd? Southcott Psychotherapy. https://southcottpsychotherapy.co.uk/c-ptsd-or-bpd/.
Tanasugarn, A. (2020, June 5). Is it bpd or cptsd? Psychology Today. https://www.psychologytoday.com/intl/blog/understanding-ptsd/202006/is-it-bpd-or-cptsd.