As we have worked our way through the nine symptoms of Borderline Personality Disorder (BPD) on the DSM IV and the personality traits of the DSM 5, we have encountered a major section, and perhaps the core issue, on symptom six, namely anxiety. Deeper investigation into the relationship between anxiety disorders and BPD led us to the discovery that 90% of people with BPD suffer from one or more anxiety disorders.  In past blogs, we have looked at the impact of Generalized Anxiety, Anxiety Attacks, and Social Adjustment Disorder (SAD).    Today we want to take a look at the link between Post Traumatic Stress Disorder (PTSD) and BPD.

PTSD is receiving a lot of attention in the media especially in connection to military experiences. The second and perhaps more common cause of trauma involves long-term physical, and/or sexual abuse. Recent work in this area  has led some psychologists to create a subcategory called Complex PTSD (CPTSD). These intense experiences of fear create a powerful link to the Sympathetic System and to feelings of helplessness so that the traumas are difficult to resolve. In addition, the reticular system is activated putting the individual on constant high alert thereby picking out and reacting to seemingly harmless triggers from the environment.

But what about other causes of CPTSD?  Jane Leonard[1] lists the following:

• experiencing childhood neglect
• experiencing other types of abuse early in life
• experiencing domestic abuse

Do these emotional experiences constitute a major insult to the body as well as the mind?

According to Leonard, People with CPTSD may exhibit these behaviors, all of which are also shared with people with BPD:

• abusing alcohol or drugs
• avoiding unpleasant situations by becoming “people-pleasers”
• lashing out at minor criticisms
• self-harm

We can see that emotional, cognitive, and behavioral similarities come into play with BPD and CPTSD, but what is the relationship if any between the causes of the two disorders? I once read in an article that bisexuals have suffered from PTSD because of the emotional and mental wounds from a thousand cuts due to their life style.  But does that really constitute CPTSD? In my opinion, PTSD and CPSTD have to include major insult to the body as well as the mind; whereas, BPD is a disorder exclusively of the mind.

Cloitre et al[2] in a study involving over three hundred subjects with complete measures of PTSD, BPD, general psychopathology, and functional impairment, concluded that four BPD symptoms separated BPD patients from PTSD, namely:

• Frantic efforts to avoid abandonment,
• Unstable sense of self,
• Unstable and intense interpersonal relationships,
• And impulsiveness.

Both groups experienced chronic feelings of emptiness. I would suggest that these symptoms have more to do with neglect and unstable home environment than actual physical or sexual injury. We would also have to consider that there may be a genetic predisposition involved in BPD, including hyper sensitivity and a need for soothing and acceptance that was denied them in childhood.

I think it is safe to say that BPD and CPTSD are different disorders; however,  we have to consider that some people may be suffering from a  combination of both, thus compounding the problem. As noted in an earlier blog, this is literally a deadly combination resulting in suicidal thoughts and an alarming number of suicide attempts.

Here are my five suggestions for Bisexuals with BPD and CPTSD:

1. If you are one of the few who are coping with this combination of disorders, then you are a remarkable human being. Rejoice in the amazing powers of your mind and soul.
2. If you are struggling with flashbacks from physical and sexual abuse, feelings of emptiness, and any of the above four symptoms or above four behaviors, you are in danger of an emotional crisis and you need to put supports in place.
3. Seek professional counselling and medical treatment. There is no shame. There is no blame. According to research, begin with CPTSD therapy as these symptoms seem to be easier to deal with than BPD.
4. Create a support group of people who love you. Do not be afraid to call upon them whenever you are experiencing emptiness and self-doubt. It’s surprising how powerful and effective a ten minute conversation can be in reestablishing our sense of self-control.
5. If our feelings reach a crisis level , we seek physical contact with one of our support people or with a professional counselor. There is something powerful about physical and emotional connection with another human being who loves us  and understands our struggles.

[1] Leonard, Jane.  What to know about complex PTSD.  Medical News Today.  August 2018.      https://www.medicalnewstoday.com/articles/322886.php

[2] Cloitre, Marylene; Garvert, Donn W; Weiss, Brandon; Carlson, Eve B; and Bryant, Richard A. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. Eur J Psychotraumatol. 2014.