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The Acute Differences Between Borderline Personality Disorder and Complex PTSD

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If you struggle with self-harm or experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741. For a list of ways to cope with self-harm urges, visit this resource.

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You can contact The National Sexual Assault Telephone Hotline at 1-800-656-4673.

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You can also contact the Crisis Text Line by texting “START” to 741741.

As someone who was diagnosed with borderline personality disorder (BPD) for years, then was shifted to a comorbid diagnosis of bipolar disorder and complex post-traumatic stress disorder (C-PTSD), I’ve seen firsthand how easily BPD and C-PTSD can get confused. For years, I wasn’t receiving the appropriate care because it was assumed I had borderline personality disorder. It turns out it was C-PTSD, which is a completely different diagnosis to BPD despite having some similar characteristics.

• What is PTSD?

For those who are unfamiliar, BPD is a personality disorder focusing on having an intense fear of abandonment, difficulty managing emotions and/or behaviors, and impulsive behavior. Many people associate things like anger, suicidal ideation and identity struggles to be common with people who are diagnosed with borderline personality disorder — all of which I had as a 17-year-old kid who was just coming out of a childhood that was based on continuous trauma.

C-PTSD, on the other hand, is a version of PTSD that is a result of prolonged trauma. Some examples include being a prisoner of war, ongoing abuse, or prolonged periods of neglect. And, to be fair, it is similar to BPD in some ways. It often also involves emotional turbulence, difficulty with holding down relationships and negative self-image. I experience anger, suicidal ideation and struggles with my identity, as mentioned before. However, these symptoms are manifested in different ways.

The biggest differential is trauma responses. All of my “symptoms of BPD” only came out when I experienced a trauma response, which is something that triggers memories of the trauma you experienced. For me, this looks like intense, irrational anger, which usually causes an emotional flashback, which then evolves into a panic attack. That being said, when I was experiencing trauma, my protective factor was always the thought, “If things get too bad, I can always kill myself.” Suicidal ideation was what I used to cope as a child. Even now, it’s almost always present as an option because it’s my escape fantasy. When life seems like too much, my automatic thought process is to think of ways I could end my life.

However, I usually have no intention of acting on suicidal thoughts. They also don’t stem from a fear of abandonment. If anything, I push people away because I have a hard time trusting anyone’s intentions. To be really honest, I don’t care if people leave my life and I find it extremely easy to cut ties with toxic people due to them causing unwanted trauma responses. These interpersonal characteristics are unlikely of those diagnosed with borderline personality disorder, as one of the most well-known symptoms is the fear of abandonment associated with the diagnosis.

Another key difference is how I experience my intense emotions. As mentioned before, trauma responses can make me extremely angry and cause intense crying that’s alarming to bystanders. With borderline personality disorder, they may not need a trauma response for this to occur, as it can be an automatic response to anything — even if it’s not trauma-related. Additionally, people with C-PTSD often experience emotional numbness, which is not typically seen in BPD. For example, there are periods where I completely shut down. I don’t feel anything. I can become so emotionally exhausted that nothing can make me sad, anxious, happy or angry. I call it periods of being “done” with trauma. The exhaustion of having trauma responses come up can create times where my emotional brain shuts down and I have no empathy, or even compassion — as hard as that is to admit.

Lastly, the concept of identity generally looks extremely different between folks with C-PTSD versus BPD. For me, my identity crises entail self-degradation, shame over things I have no reason to be ashamed of, and feeling like no one will ever fully understand me due to my complex trauma history and gut reactions in response to my trauma triggers. However, my goals don’t shift based on my emotions, which is typical of BPD. For those diagnosed with borderline personality disorder, it’s common to have an unstable identity. Their goals may change frequently, their passions might be different from one day to the next, and oftentimes it can be hard for the diagnosed person to identify what they truly believe in or value due to these identity shifts. All of those are not symptoms of C-PTSD.

So, yes. In some ways, these diagnoses are incredibly alike. Both diagnoses are often caused by childhood trauma, but in BPD that trauma becomes a part of your personality and identity, where with C-PTSD, there are usually specific trauma triggers that cause knee-jerk reactions or intense emotions.

Either way, each diagnosis is serious and can impact a person severely if it’s not properly treated. That being said, it’s equally important that medical professionals start acknowledging symptoms of C-PTSD instead of misdiagnosing someone with borderline personality disorder. Getting a hasty diagnosis of BPD due to common misconceptions of what C-PTSD looks like can prevent someone from getting the appropriate treatment and care that they need.

As someone with C-PTSD, I hope the medical community becomes more diligent and less rushed in handing out a diagnosis that may not be accurate. I want people to get the treatment they deserve.

Photo by Kirill Balobanov on Unsplash

Originally published: April 26, 2021
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