borderline personality disorder, BPD and PTSD (post traumatic stress disorder)

Connection between borderline personality, trauma and post traumatic disorder. Some are saying that Borderline personality disorder is part of PTSD. Explain borderline disorder only by trauma ? The truth is, of course, much more complex beyond often misleading appearances.  Clinical studies, although very interesting not bring THE answer and you will find on the last part of this document our vision which we hope more comprehensive and listening to their suffering

* Sansone RA, Sansone, Wiederman M. - Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa, the USA.
1995 Arch Fam Med - Trauma Prevalence and links with borderline personality disorder and self-destructive behaviors
Traumatic events were reported by 70.7% of the borderline subjects. (aapel: For 30% thus, the cause is different)
Among them 25.8% sexual abuse, 36.4% physical abuses, 43.7% emotional abuses, 9.3% physical negligence and 43.0% witnesses of violence (aapel: Not obligatorily "physical", this violence can be for example the death of a close relation or what the specialists call "early separation")
This provided study of the obviousnesses which the abuse is not an obligatory factor but contributes to the process .

* Gunderson JG, Sabo AN. - Personality and Psychosocial Program, McLean Hospital, Belmont, MA 02178.
1993 Am J Psychiatry - The phenomenological and conceptual interface between borderline personality disorder and PTSD.
RESULTS: These seemingly separate disorders are related. Borderline personality disorder is often shaped in part by trauma, and individuals with borderline disorder are therefore vulnerable to developing PTSD. CONCLUSIONS: The authors draw a distinction between the enduring effects that traumas can have on formation (or change) of axis II personality traits (including those found in borderline personality disorder) and acute symptomatic reactions to trauma, called PTSD, that are accompanied by specific psychophysiological correlates.

* Driessen M, Beblo T, Reddemann L,... - Medizinische Universitat zu Lubeck, Germany
2OO2 Nervenarzt - Is the borderline personality disorder a complex post-traumatic stress disorder? - The state of research
Regarding the high prevalence of traumatic experiences in patients with borderline personality disorders (BPD), we review the available literature focussing on the hypothesis that BPD is a subtype of trauma associated disorders. The criteria of BPD, of complex post-traumatic stress disorders (PTSD), and of disorders of extreme stress not otherwise specified (DESNOS) substantially overlap. Neuropsychological deficits in BPD and PTSD as well as psychoendocrinological and neuroimaging studies in BPD und PTSD also revealed common features.  Further research will have to prove BPD as a complex and early-onset post-traumatic stress disorder after multiple and/or chronic (type II) traumatic experiences during childhood and/or youth. Definitive conclusions require further research efforts.

* Zlotnick C, Franklin CL, Zimmerman M. - Butler Hospital, Povidence, RI 02906, USA
2OO2 Am J Psychiatry -  Is comorbidity of posttraumatic stress disorder and borderline personality disorder related to greater pathology and impairment?
CONCLUSIONS: The additional diagnosis of PTSD or borderline personality disorder does little to augment the pathology or dysfunction of patients who have either disorder without the other.

* Golier JA, Yehuda R, Bierer LM, Mitropoulou V,... - Department of Psychiatry, Veterans Affairs Medical Center, Bronx, NY
2OO3 Am J Psychiatry. - The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events.
METHOD: 180 male and female outpatients with a diagnosis of one or more DSM-III-R personality disorders. Path analysis was used to evaluate the relationship between borderline personality disorder and PTSD.
RESULTS: High rates of early and lifetime trauma were found for the subject group as a whole. Compared to subjects without borderline personality disorder, subjects with borderline personality disorder had significantly higher rates of childhood/adolescent physical abuse (52.8% versus 34.3%) and were twice as likely to develop PTSD

* Zanarini MC, Frankenburg FR, Hennen J,... - McLean Hospital, Belmont, USA.
Am J Psychiatry. 2OO4 - Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission
Follow-Up 2 years: 51.3% of PTSD disorder experienced by Patients With Borderline Personality Disorder

Please read also post trauma and idiopathic orofacial pain
Please read also post trauma and insomnia / nightmares

"I don't think that trauma causes BPD nor do I believe that BPD causes PTSD. These are two different conditions. Some people have both." (Laura Russell,”Post Traumatic Stress and Borderline Personality Disorder”, ptsd sanctuary)

"PTSD can develop at any age, and it is often similar to BPD in many but not all respects--similar treatment is required.  However, BPD typically develops in childhood and then is exacerbated by teen and earlyadult experiences." (Daniel c Claiborn PH D, “Ptsd and Bpd”, interview 2OO3)

"Borderline Personality Disorder. Borderline personality disorder can be associated with anhedonia, poor concentration, past history of emotional trauma and dissociative states similar to flashbacks. Other features of BPD such as avoidance of abandonment, identity disturbance, and impulsivity will distinguish BPD from PTSD" (K Hahn, ,” Post-Traumatic Stress Disorder”, Current Clinical Strategies Psychiatry 2OO2)

Here is our feeling.

What is a trauma ?
Let's say that it is a lived experiment like a shock and an emotional suffering. The result is "that continues to make pain in the head" whereas "the aggression" is not any more present

Is there several kind of trauma ?
Yes, there are a lot a levels in trauma, he can be physical or mental, deliberate or accidental, single or repeated, commit by a close or a stranger, at an early age or later.
Furthermore, we can be the victim or just a witness of the scene
It is obvious that if you are an adult in good health, you will take better take a mental trauma where you'd just the witness of an accident caused by a stranger than if you are 3 old and that each day you have physical and mental abuses by your family circle.

Is there some link between trauma and BPD ?
The answer is "yes" even if it is variable
When we consider that the personality of the borderline people has been impeded during childhood by external events, we can say "yes there is trauma", even if the child had no physical abuse. Please read data.

What is a Post Traumatic Stress Disorder (PTSD) ?
It is the result of both real life trauma and painfull.
The victim will have recurring thoughts about the event
This could lead to sleep disturbance, nigthmares, changes in appetite, loss of desire, dysthymia, feeling extremely protective of, or fearful for, the safety of loved ones, …
Experiencing anxiety and fear (even panic), especially when exposed to events or situations reminiscent of the trauma. (read dsm)
The more the trauma will be serious, the more the person will have "erased" some fact even for some people to have no one memory of the drama. Total amnesia of the events. (read memory and bpd)

Can there be confusion between post traumatic stress and borderline disorder ?
No (we suppose here that the person having traits of BPD or PTSD but not both disorder)
- If the person had no mental problem before the trauma example, a car accident, we will be able to speak without the slightest doubt about post traumatic stress
- But if on the other hand the person still had problems, that these problems seem to constitute its nature, then there is no doubt that it is borderline disorder. (The borderline disorder is a personality disorder, the personality is what you are)
In this case, it is not impossible to be in a situation were it is not possible to indentify the traum source. A sort of post traumatic stress disorder without trauma (because too far in the past) which is in fact a borderline disorder

It is possible to have both, borderline disorder AND ptsd ?
Yes, absolutely, we need then to verify that you can't see the wood for the trees.
A real post traumatic stress disorder must be treated of course, but it can hide in some circumtances a borderline disorder
Studies showed that people with a borderline disorder were more able to live new trauma events than the rest of the population. (this can undoubtedly be explained by impulsiveness, self-destructive conduits with risk, the little of case that some grant to their own life...)
It is then important not to be focused on the traumatism but on the personality of the person, knowing that this person can also be in denial. (the denial which can be to some extent the consequence of a serious childhood trauma and causes memory problems and dissociative experience)
Other criteria are present in the borderline disorder which it is necessary to take into account for the final diagnosis, like impulsivity, relationshipl problems, unstable self-image, fear of the abandonment, and sometimes self-destructive conduits...
There is of course other behaviors like euphoria, dysphoria lived by the borderline people but, here again, it is probable that because of the stress disorder, the person is into total dysphoria and perhaps even having a major depression and that consequently the euphoric episodes are no more present in their life.

Is it possible to have severe trauma during childhood and then never been borderline ?
Of course ! Not all individuals are equal and no doubt that there is some genetical / biological factors.
You can thus "escape" from the disorder if you are a "solid" person (mentally) and more especially as your traumatism is solved as soon as possible.

Is a childhood trauma can lead to PTSD which will stay until adulthood, without leading to a borderline disorder ?
Good question ! I didn't find any study giving an answer to this questions.
I have the feeling that it is not possible, a trauma, not solve, therefore not seriously took in care will show a lack of care about the parents.  So if you have trauma, lack of care et still there (trauma), we have all the necessary ingredient to "make" a borderline