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Mental health disorders can be of different types, and many of them share similarities. Such conditions can often be confusing to tell apart during the diagnosis process. Many of these issues co-occur or happen simultaneously, making it harder to separate one from the other. Complex posttraumatic stress disorder (CPTSD) and borderline personality disorder (BPD) are two such conditions that often look remarkably similar at first glance. Earlier research has even considered CPTSD as a subtype or a replacement diagnosis of BPD.  However, the conditions are distinct and may have slight differences in their tell-tale signs in addition to different causes and treatments. Understanding more about CPTSD vs BPD is essential to make an accurate diagnosis and seek treatment accordingly.
Complex PTSD Vs Borderline Personality Disorder: Overview and Symptoms
Mentioned below are brief overviews of complex PTSD vs BPD, along with their general symptoms, to help people grasp the basic concepts and what to expect in each of these conditions.
Many people consider CPTSD and PTSD as the same conditions; however, the two are different with variable causes. PTSD is usually a result of a one-off traumatic experience, whereas CPTSD occurs due to repeated exposure to traumatic experiences, like abuse or neglect. Following are some of the symptoms commonly seen in CPTSD:
- Flashbacks or nightmares related to traumatic events
- Struggling to self-soothe during ongoing emotional distress
- Always being on edge
- Difficulty trusting others, acting withdrawn
- Trouble sleeping and concentrating
- Viewing the world as dangerous” or “untrustworthy”
- Constantly feeling worthlessness and shame
- Numbing emotions
When an individual suffers from CPTSD, the condition can significantly affect their daily life. Such people spend a lot of time avoiding triggers that restrict where they can go and what they can do. The isolation and distrust caused by CPTSD can also make such people struggle to live healthy, well-connected lives. They commonly distrust others and fear the external world to conceal their ability to connect with others.
Borderline Personality Disorder
BPD is a personality disorder that causes an individual to have an unstable perception of self and the world around them. While the cause of BPD remains unknown, both childhood abuse and genetics are believed to contribute to its development. BPD can make it challenging for people to regulate their emotions and can make them more impulsive. Such people usually develop self-sabotaging behaviors, which can negatively affect the relationships around them. The following are some common symptoms of BPD:
- Troubled relationships
- Difficulty regulating emotions
- Significant fear of abandonment
- Feeling emotionless or hollow
- Fluctuating between idealizing and devaluing people
- Impulsive behavior
- Dissociation as a response to stress
- Self-harm or thoughts of suicide
CPTSD and BPD Similarities and Differences
Mentioned below are different aspects in which CPTSD and BPD may be similar or different.
While both conditions may be caused by trauma, CPTSD only occurs due to repeated or extended trauma. BPD can occur due to a combination of genetics or trauma, whereas environmental factors primarily cause CPTSD. Up to 50 percent of people with BPD have been known to have close relatives diagnosed with this disorder.
There is a marked difference in how the shared symptoms of CPTSD and BPD present themselves in addition to the causative factors of these symptoms. While both groups face difficulties in forming relationships, those with CPTSD do so because of their distrust of others. Those with BPD fail to form relationships because they fear that they cannot maintain them.
People living with CPTSD usually avoid forming close interpersonal relationships and may see others as untrustworthy due to their experiences. People with BPD, on the other hand, may form close relationships but struggle to sustain them. Such people may suddenly end relationships out of fear of abandonment. Another reason is the splitting phenomenon, where they only see others as good or bad.
Both CPTSD and BPD involve dissociation, which acts as a protective mechanism to help them avoid re-experiencing trauma. People with CPTSD may dissociate to avoid feeling intense emotions, and the phenomenon may manifest as memory gaps revolving around traumatic events. For those with BPD, dissociation occurs as a transient reaction to high-stress levels or as a result of real or imagined abandonment. It is more common in people with BPD who have gone through childhood abuse.
One major difference between CPTSD and BPD is a patient’s sense of self. Those with CPTSD have a more stable sense of self but may struggle with feelings of guilt, low self-worth, and shame. Those with BPD, in contrast, are more unstable in terms of their sense of self, and they may not know who they are at their core. People with CPTSD can also have their sense of self disturbed by dissociation, which they use to avoid remembering traumatic events.
Both types of mental health disorders include emotional dysregulation as a symptom but may have differences, too. For instance, people with CPTSD over-regulate their emotions and often use dissociation, withdrawal, or emotional numbing to save themselves from reminders of trauma. Those with BPD, on the other hand, experience under-regulation of their emotions, leading to self-harm and intense anger.
It is common for BPD and CPTSD to occur comorbidly. Research suggests that up to 79% of people with CPTSD also have BPD, whereas 40.5% of those with BPD had CPTSD simultaneously.
CPTSD Vs BPD: What is the Treatment?
Both BPD and CPTSD can make life difficult to manage. Fortunately, evidence-based treatments are now available to help them cope with these mental health illnesses and enable patients to establish supportive and stable relationships with other people.
Treatment for Borderline Personality Disorder
Treatment for BPD typically involves individual or group psychotherapy. Dialectical behavioral therapy, or DBT, is the most common form of psychotherapy that has been specifically designed to help people with borderline personality. DBT emphasizes the dual goal of positive change and self-acceptance to support BPD patients and encourage them to love and accept themselves. Other forms of treatment for this psychiatric disorder include the following:
- Art therapy
- Mentalization-based therapy
- Therapeutic communities
Treatment for Complex PTSD
Treating CPTSD involves various psychotherapy methods, such as the following:
- trauma-focused cognitive-behavioral therapy
- eye movement desensitization and reprocessing therapy (EMDR)
People who live with both CPTSD and BPD can benefit more from tailored therapies, such as DBT-PTSD, that take into account both sets of symptoms during treatment. This therapy combines trauma memory processing with DBT, acceptance, and commitment therapy, and compassion-focused therapy, and research suggests that it can effectively reduce depression, dissociation, and other BPD symptoms.
Can you have CPTSD and BPD together?
It is possible to have BPD and CPTSD together. Research suggests that BPD occurs more commonly in people with CPTSD than vice versa. Evidence also suggests that both conditions are more likely to be associated when the initial trauma stems from emotional abuse and physical neglect.
Do BPD and CPTSD present similar challenges in a relationship?
Complex PTSD and BPD can trigger problems in interpersonal relationships in a few common ways. However, the consequences of these issues and how they may play out can look different. As mentioned before, people with CPTSD vs BPD can struggle to maintain relationships, but for different reasons. For those with CPTSD, it is difficult to trust people, so they shy away from establishing any relationships altogether.
People with BPD, on the other hand, do not suffer from these trust issues. For them, relationship issues come from an unstable sense of self, which forces them to lash out very quickly to change their opinions about others very frequently. They also have a fear of abandonment that may come off as a lack of trust since people with BPD may also cut people off to avoid getting abandoned. Both types of people can have difficulty controlling their emotions, directly affecting those close to them. However, those with BPD have more frequent angry outbursts in addition to emotional spirals. Those with CPTSD, on the other hand, have trouble calming themselves after getting overwhelmed.
Is it possible to mistakenly consider BPD as CPTSD?
BPD and CPTSD can be mistaken for each other, particularly due to similar symptoms and causes. As two frequently co-occurring conditions, a person with BPD can have CPTSD and vice versa. CPTSD is well-known to be misdiagnosed as BPD, even though the former is much more common.
1 Ford JD, Courtois CA. Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation. 2014 Dec;1:1-7.
2 Ford JD, Courtois CA. Complex PTSD and borderline personality disorder. Borderline personality disorder and emotion dysregulation. 2021 May 6;8(1):16.