Borderline Personality Disorder (BPD) and Trauma: Finding Treatment

Many people with Borderline Personality Disorder (BPD) and trauma struggle to find good therapy, and therapists who are effective to work with. While it is very possible to treat Borderline Personality Disorder (BPD) and trauma and offer people tremendous relief, that can be hard to find. In this post, I discuss Borderline Personality Disorder (BPD) and trauma, and how the two are linked and how to find helpful therapy.

Is it BPD or CPTSD?

BPD and CPTSD are often discussed as an either/or diagnosis, you can have one and not the other. While sometimes true, it is very common that people with BPD and BPD traits also have symptoms of CPTSD or experienced things in life that would qualify as complex trauma. So what does this mean?

Borderline Personality Disorder (BPD) is “a pervasive pattern of instability of interpersonal relationships, self image, and affects, and marked impulsivity beginning in early adulthood one present in a variety of contexts”. Borderline Personality Disorder (BPD) is a cluster of symptoms that include at least five of the nine following traits:

Frantic efforts to avoid real or imagined abandonment
a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Persistently unstable self image or sense of self
Impulsivity that is potentially self damaging in at least two areas, for example finances, sexual relationships, substance abuse, reckless driving/risk taking behavior, etc
recurrent suicidal behavior, gestures, threats, ideation, or non-suicidal self harm behavior
emotional instability with intense reactivity, sensitivity, and prolonged return to baseline
Chronic feelings of emptiness
Intense anger or difficulty regulating anger
stress related paranoid ideation or dissociation symptoms

Key to BPD is that symptoms are “pervasive” and chronic, which means the symptoms occur in most or all settings and relationships like family, friends, work relationships, romantic relationships, at home alone and with others. That makes BPD difficult to experience without support and therapy, as it affects all parts of a person’s life.

As there are many different combinations of traits and symptoms a person may have, everyone’s BPD experience may be very different from one another, and therefore treatment must be customized to each person’s specific needs.

Complex PTSD

Complex PTSD (or C-PTSD) is a trauma and stressor related disorder in which a person develops on-going trauma symptoms in response to experiences of repeated traumatic exposure, chronic and ongoing trauma symptoms, and traumatic exposure occurring in the context of a caregiving relationship and/or environment. For example, complex trauma can result from experiencing ongoing abuse as a child at home, witnessing persistent and volatile verbal abuse, neglect. Complex trauma can also result from multiple incidents of trauma occurring outside of primary relationships, when the primary relationships are marked with chronic invalidation of emotional expression and needs.

Complex PTSD (C-PTSD) includes these symptoms:

difficulty managing big emotions
frequent emotional overwhelm
difficulty identifying needs including not attending to medical needs
difficulty building trust in relationships
hyper independence in relationships
significant dependence in relationships
avoidance of emotional vulnerability
unstable sense of self
sense of worthlessness
sense of not knowing what your values or needs are
hypervigilance to the emotions of others (being an “empath”)
difficulty keeping and maintaining relationships
additional ongoing trauma symptoms like flashbacks, intrusive thoughts, mood disturbance, impaired sleep, anxiety and hyperarousal.

Complex PTSD symptoms are also pervasive and chronic, and can be experienced in most if not all areas of someone’s life including personal relationships, work or school life, self care and time at home.

BPD and PTSD Similarities

BPD and PTSD share a lot of similarities. Many people who develop PTSD and C-PTSD experience a similar sense of hypervigilance in relationships, to assess ongoing safety in relationships, and persistent worry about potential risks in relationships and surroundings.

Many people with BPD and PTSD experience similar dissociation symptoms, emotional overwhelm, and intrusive thoughts.

BPD and PTSD share so many similarities that many believe that BPD is a result of chronic and complex PTSD. The majority of people diagnosed with BPD also meet criteria for diagnoses of PTSD and C-PTSD. However, there are many people who develop PSTD and C-PTSD without developing BPD symptoms.

It is believed that the difference between BPD with PTSD and PTSD without BPD is based upon an accumulation of traumatic experiences, how pervasive and chronic those traumatic experiences were and the degree of helplessness the person experienced during these events. The younger we are when we experience trauma, the more helpless we are, and more likely we are to experience repeated traumatic events that can lead to developing PTSD, C-PTSD. When that occurs in a caregiving relationship or environment with chronic invalidation we can see the development of BPD traits.

BPD and PTSD Differences

The differences between BPD and PTSD lie around what happens when a person is “triggered”. The term “triggered” means when a prompting event activates trauma symptoms and dysregulation.

People with BPD often respond to triggers with emotional dysregulation, losing control of their emotions and behaviors, feeling overwhelmed and flooded with distress, and may engage in impulsive or harmful behaviors in an effort to resolve overwhelming emotions. Many people with BPD report that feeling triggered makes them overwhelmed with emotional pain and desperate to stop this pain as soon as possible.

People with PTSD often respond to triggers with sensory and cognitive symptoms like flashbacks, intrusive memories, physiological activation or numbing, disorientation or dissociation, resulting in behaviors to try to regain a sense of presence and safety in that moment and environment. Many people with PTSD reported being triggered feels like their brain is taken over, their body and brain override their conscious thinking with efforts to protect and focus on safety.

Borderline Personality Disorder (BPD) Treatment

Borderline Personality Disorder (BPD) Treatment is well researched and highly effective. Borderline Personality Disorder (BPD) is primarily and often treated with Dialectical Behavior Therapy, a comprehensive skills based intervention designed by Marsha Linehan specifically for the needs of people with Borderline Personality Disorder (BPD).

Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan, Ph.D., ABPP, in response to the great need for effective treatment for people suffering from chronic suicidality, self harm, emotion dysregulation, and instability of the self.

Through an evidence-based approach, Dr. Linehan methodically developed an adaptive and comprehensive treatment for Borderline Personality disorder (BPD). Dr. Linehan and her associates continue ongoing research to modify DBT to maintain superior effectiveness and expand DBT to treat complex diagnoses and psychological needs including substance use, trauma, eating disorders, mood disorders, and family conflict.

Is Borderline Personality Disorder (BPD Treatment and DBT right for me?

I find this modality is quite helpful for many people wanting to learn how to manage painful and uncomfortable emotions, communicate better with others, set boundaries, and work to align more closely with their personal values. My clients use DBT to build effective skills to use to support trauma recovery, cope with difficult emotions, enhance healthy relationships, and connect with their values.

I offer DBT informed therapy and am intensively trained in practicing DBT. DBT informed therapy means that most but not all components of the entire model are offered. For example, I offer DBT skills training in groups and individually, as well as individual DBT therapy aligned with the DBT treatment model.

Read more information here if you are interested in taking a virtual DBT skills group with me.

You can find more information about my DBT individual therapy services here.

Learn more about DBT as an intervention here.

PTSD Therapy Goals

PTSD Therapy Goals are often around reducing active symptoms like flashbacks, anxiety, hyperarousal, dissociation, intrusive thoughts, and building practical coping skills to manage triggers and feel safe and grounded in the body and present moment. PTSD Therapy Goals also include reconnection in supportive relationships as many people with PTSD experience isolation from their community. PTSD Therapy Goals can include processing traumatic events so that trauma symptoms are not activated when reminders arise in the environment.

An effective treatment for PTSD and C-PTSD is EMDR (Eye Movement Desensitization and Reprocessing). Eye Movement Desensitization and Reprocessing, or EMDR, is an evidence based multimodal intervention to treat trauma as well as significant upsetting experiences that shaped how we feel about ourselves, our world, our relationships. EMDR is widely researched and continues to grow and be shown as highly effective at helping people reduce symptoms of trauma, emotional distress, and increase connection to the present moment and ability to act in alignment with one’s goals and values.

EMDR is safe and uses ongoing assessment and support to ensure clients can proceed with trauma processing in a safe way, preventing retraumatization. EMDR uses multiple stages that include assessing background and targets to focus processing on, set up helpful supports to create safety throughout trauma processing, process emotion-based memories and experiences, and set up future expectations grounded in acceptance and resilience.

I am an EMDR therapist that offers attachment-focused EMDR, this specialized approach engages more safety building, supportive resources, and techniques to connect to early memories and experiences that shape us growing up. Attachment focused EMDR is highly effective for early childhood trauma and significant experiences from childhood that effect people today, as well as safely processing trauma memories and significant experiences from adulthood as well.

I offer Trauma Recovery Skills Group to help bring together a community of trauma survivors to learn and build effective coping skills together, including EMDR resources. I also offer individual EMDR and Attachment focused EMDR, find more information here.

For more information check out EMDRIA and Parnell Institute: Attachment Focused EMDR

Want to learn more about YOUR specific trauma recovery style? Take the QUIZ and get unique skills specific to you!

If you want to start therapy today, sign up to work with me here. I offer trauma therapy with multiple approaches to best meet the needs of trauma survivors. You can sign up for my mailing list to get tips for trauma recovery right to your mailbox. You can also listen to my podcast, Initiated Survivor, anywhere you hear podcasts. Follow me on Instagram, TikTok, Facebook, and Youtube to get awesome survivor content.

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Borderline Personality Disorder (BPD) and Trauma