Understanding Someone with BPD: Complex Trauma and PTSD
BPD, PTSD, and Complex PTSD are complex mental health conditions that are deeply intertwined with experiences of trauma. As we know, trauma—whether it be from childhood abuse, neglect, or other distressing events—can have a profound impact on an individual's psychological well-being.
Today, I wanted to touch on Borderline Personality Disorder (BPD), PTSD, Complex PTSD, and what it has to do with trauma and trauma recovery.
BPD, PTSD, and Complex PTSD are complex mental health conditions that are deeply intertwined with experiences of trauma. As we know, trauma—whether it be from childhood abuse, neglect, or other distressing events—can have a profound impact on an individual's psychological well-being.
In this blog, I will delve into the intricate relationship between BPD, PTSD, Complex PTSD, and trauma, exploring how these experiences can shape individuals' lives and the pathways toward healing and resilience.
One of the main reasons I’d like to discuss this topic is because of my extensive experience working with individuals diagnosed with BPD over the years.
This community has grown close to my heart, as I've witnessed a great deal of misconceptions, stereotypes, and stigma surrounding this condition, especially evident in the portrayal of BPD in mainstream media. Characters with BPD in movies and TV shows often depict stigmatized behaviors, perpetuating these negative perceptions.
I aim to bring more understanding to this subject and shed some light on the prevalence of trauma among individuals with BPD. Those with BPD must receive trauma-informed care that recognizes and addresses their experiences of trauma effectively.
Let’s dive in!
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Understanding Someone with BPD
Understanding someone with BPD, Borderline Personality Disorder is one of the cluster B personality disorders in the diagnostic manual.
**I have mixed feelings about the diagnostic manual as it has a tendency to be judgemental, particularly around personality disorders.
We label BPD as a personality disorder because the symptoms and traits associated with it manifest in every aspect of an individual's life. These characteristics are pervasive, affecting their experiences across different contexts such as work, home, relationships, and more.
Essentially, these symptoms are consistently present and shape the individual's interactions and experiences throughout their life.
To be classified as a personality disorder, it is key that the individual experiences these symptoms and traits chronically. These characteristics persist over an extended duration without significant breaks or relief.
Instances of respite or remission from these symptoms are rare, as they are consistently present over time.
When we approach these disorders with this knowledge in mind, we can understand that personality disorders—while named as such, seem to place the issue within the individual's identity rather than in the symptoms—cause a lot of pain and distress for those living with them.
Comprehending the challenges associated with a personality disorder becomes clearer when viewed through this lens.
When there is no break from symptoms, compounded by societal shame and ostracism, the situation can escalate significantly.
Common traits and symptoms of BPD:
Common traits and symptpms of BPD include:
Frantic efforts to avoid real or imagined abandonment
Pattern of intense and unstable interpersonal relationships, which are often characterized by this alternation between idealizing and devaluing.
Unstable sense of self-image.
Impulsivity and impulsive behaviors
Recurrent suicidal thoughts, behaviors, gestures, actions, or non-suicidal self-harm
Emotional instability
Feelings of emptiness
Frantic Efforts to Avoid Real or Imagined Abandonment
Frantic efforts to avoid abandonment are any type of perceived rejection or abandonment that might happen.
We emphasize perceived or imagined because oftentimes it has less to do with whether it was an actual abandonment or rejection and more to do with how it was received or experienced. Sometimes, certain words, gestures, or a lack of action or engagement can activate this trauma response.
A frantic effort is doing anything to try to prevent that from happening. This can look like trying to make nice or placate in relationships when there’s conflict (even when the conflict is necessary), over-apologizing, people-pleasing, etc.
Much of the time, people who exhibit this trait have experienced rejection or abandonment in the past, and that’s part of why this is a symptom that gets activated.
Pattern of intense and unstable interpersonal relationships, which are often characterized by this alternation between idealizing and devaluing:
Pattern of intense and unstable interpersonal relationships, which are often characterized by this alternation between idealizing and devaluing: is the stereotypical “I hate you. Don't leave me” response.
It goes hand-in-hand with the fear of abandonment and the trauma response to perceived desertion.
Idealization is often an effort to connect and attach as quickly as possible, and devaluation is an effort to say, “This doesn't matter to me at all, so it can’t hurt me.” Frequently, this happens in relationships when the person is feeling vulnerable.
When individuals with BPD want to have and keep personal relationships, they can create problems by either overwhelming people with affection, attention, and praise or by getting upset, triggered, or scared and pushing them away.
It’s hard for people who are in close relationships with someone with BPD to understand why that happens.
Unstable sense of self-image:
Unstable sense of self mage is when an individual feels like they don't really know who they are or struggles to grasp their identity—they may feel uncertain about their motives, find it challenging to discern their values and goals, and so forth.
Frequently, people with BPD have a history of complex childhood trauma, attachment-based trauma, and/or attachment ruptures.
This means that in their caregiving relationships, either something traumatic or abusive occurred that made that relationship threatening and confusing. Attachment ruptures can also look like not being seen and heard as your full self, not having your feelings validated, not being received by your caregiver in the way you needed, etc.
Those are the types of experiences that help us understand who we are, our morals, ethics, and values and give us a strong sense of self.
If there’s something that happens during that process, like trauma or attachment ruptures, it’s going to interfere with one’s ability to develop a sense of self.
Frequently, people with BPD will report that they don’t know themselves or will exhibit behaviors where they seemingly change who they are depending on who’s around to match the personalities and qualities of those around them. That’s another effort toward avoiding rejection and determining to connect or “fit in.”
Unfortunately, that results in reenacting that experience of abandonment, feeling like you can’t be yourself with people. When you can’t be yourself with people, you can’t experience truly connecting to others, and it can feel like you don’t have strong connections with people.
Impulsivity and impulsive behaviors:
These impulsive behaviors are particularly damaging to the self.
Impulsive behaviors isn’t necessarily self-harm; that’s a separate trait. Impulsive, damaging behaviors are things like excessive spending, accumulating debt, repeatedly damaging relationships, jeopardizing housing or employment, and other decisions driven by impulsivity and emotional activation.
These behaviors emerge when emotions overpower your rational, wise self that typically aligns with long-term goals and values. It's as if you become fused with your emotions, resulting in them assuming control when they overwhelm you.
Recurrent suicidal thoughts, behaviors, gestures, actions, or non-suicidal self-harm:
Recurrent suicidal thoughts and behaviors might not just involve experiencing multiple episodes of suicidal thoughts; it could manifest as chronic feelings of suicidality. Actions such as suicidal gestures may occur, where individuals take steps towards self-harm or suicide, be it making plans, executing a plan, or attempting suicide.
Non-suicidal self-harm is self-harming when they have no intentions of killing themselves but they are doing something harmful to their body. This can happen both consciously and subconsciously.
Sometimes this looks like not doing something necessary to take care of your body (denying themselves access to medication they need to take, not allowing physical wounds to heal, not eating, not drinking, not looking both ways when crossing the street, etc.).
Emotional instability:
Emotional instability is one of the most common experiences for someone with BPD. Emotional instability involves emotions being suddenly triggered and activated at any moment and when they come on, they’re really big and vivid, and it’s difficult calm down from them.
Your emotions are like a live wire - they’re triggered easily, hard to manage, and potentially overwhelming.
With emotional instability there’s also a slow return to baseline. It’s hard for that emotion to come down and for the person to feel back to normal or centered.
When an individual already has emotional sensitivity to triggers, coupled with intense responses to those triggers and a gradual return to a baseline emotional state, you may find that your emotions are already heightened when faced with another trigger.
That is like being tossed around in the ocean by the waves. It feels like one wave right after the other and you can’t get your head above water. This is referred to as emotional disregulation or crisis where it’s this constant barrage of overwhelming and painful emotions.
Feelings of emptiness:
Feelings of emptiness is when the individual feels a sense of disconnection with the self, and goes hand in hand with having an unstable self image.
People that experience feelings of emptiness often have a hard time spending time alone. There can also be episodes of dissociation that occur. That can range from feeling “spaced out” to entirely losing track of time and having long, persistent episodes of dissociation as well as derealization and depersonalization symptoms.
There can also be intense anger and difficulty regulating anger when this symptom arises.
When we look at all of these from the perspective of trauma, it makes a lot of sense how these symptoms emerge.
BPD and PTSD: co-occurring disorders of trauma
Statistically, 85% of people with Borderline Personality Disorder meet the criteria to also be diagnosed with Post Traumatic Stress Disorder (PTSD).
That’s an exceptionally large number that clear highlights the strong, interconnected relationship between the two conditions.
Our theory suggests that it's not a direct correlation where having BPD leads to PTSD. Instead, it's the presence of chronic complex trauma, which can lead to PTSD symptoms, particularly in an environment that consistently invalidates one's experiences. It's within this context that we often observe the emergence of BPD as well.
Currently, the mental health community is increasingly viewing BPD more as a disorder stemming from trauma rather than simply a personality disorder. This idea that there’s something innately wrong with who the individual is as opposed to something that happened to them that has fundamentally shaped the way they engage with the world is harmful, and we aim to change this language.
CPTSD and BPD
You’ve likely also heard me discus complex trauma or complex PTSD quite a bit on my platform. Complex trauma is a specific type of trauma and trauma response. Complex trauma is when multiple traumatic events have happened in the context of a care-giving relationship.
This means that in our relationships with our caregivers, our instinctual response system, including our fight or flight mechanism, perceives the relationship as a source of safety. However, when that same relationship is the source of the threat in our lives, it creates significant confusion within our system. This dynamic leads to the development of complex trauma, where our system adapts to cope with a relationship that is simultaneously unsafe yet vital for our survival.
This scenario can arise in situations involving abuse within the household, even if the abuse is not solely physical but also includes chronic invalidation.
Invalidation occurs when individuals dismiss or undermine our feelings by suggesting they are unjustified, inaccurate, or not valid. This can range from denying our emotions or experiences to gaslighting, where others may attempt to convince us that our perceptions are not based in reality.
In such situations, we consider complex trauma, which differs from traditional PTSD. Unlike traditional PTSD, which is typically linked to specific incidents, complex trauma encompasses ongoing and multifaceted forms of trauma.
Complex trauma develops when an individual's brain is exposed to a consistently traumatic, fearful, and threatening environment from birth, leading to a perception of the world as uniformly traumatic, frightening, and menacing.
Complex trauma can look like having intense emotions and having difficulty managing them, having chronic and persistent dissociative episodes, frequently getting overwhelmed by emotions, and having difficulty identifying your own needs.
At times, hyperindependence in relationships is a result of complex PTSD. This inclination to prioritize oneself, feeling self-sufficient without the need for community or interpersonal connections, can lead individuals to resist seeking help and distance themselves from others when support is most needed.
On the flip side, individuals may exhibit significant dependence in relationships, wherein they struggle to care for themselves independently and rely heavily on others. This intense dependency often stems from the brain being molded by the traumatic environment in which they were raised, creating a strong need for external guidance and support in their actions.
Avoidance of emotional vulnerability can serve as a self-preservation mechanism for these individuals as well, while the constant struggle with an unstable self-perception can lead to feelings of worthlessness.
Many of these challenges stem from the brain being conditioned in a traumatic setting, where survival takes precedence over other aspects of human development. Due to this prioritization of survival in life-threatening circumstances, the brain may not fully grasp nuanced concepts like moral values, ethical norms, and social skills essential for complex social interactions. Consequently, individuals with a history of complex trauma may struggle with navigating intricate social dynamics in adulthood.
We can also see that people with complex trauma often exhibit heightened sensitivity to the emotional cues of others, a trait sometimes referred to as being an empath or highly sensitive.
This heightened awareness allows one to effectively discern and interpret the emotions of those around them, likely developed as a coping mechanism in response to navigating a traumatic environment during upbringing. Predicting the emotional states of caregivers or individuals in tumultuous environments becomes a vital skill for survival, leading to this acute attunement to others' emotional expressions.
Past trauma from relationships can sometimes resurface and manifest in various ways within present relationships. For instance, receiving constructive criticism at work may trigger memories of being criticized by a caregiver in the past. This could evoke feelings of inadequacy, shame, and fear, even if the individual's present self in the workplace aims to handle feedback constructively and with a growth mindset.
Complex PTSD is considered pervasive and chronic, and we see a lot of crossover between complex PTSD and BPD. In my career, I have not seen any person that met the criteria for BPD that did not experience complex trauma. I’m sure those people exist where this isn’t the case, but I haven’t come across any.
I personally believe complex trauma and BPD are one in the same, and I think that’s the direction the mental health field will evolve as we continue to study this phenomenon.
Treatment for BPD: DBT and trauma therapy
Effective treatment for BPD includes DBT and evidence based trauma therapy.
Dialectical Behavior Therapy (DBT) is one highly effective method. It is a behavioral and skills-based intervention specifically designed for people with BPD and chronic emotional dysregulation.
DBT is now expanding as a treatment for various issues, with individuals seeking to acquire new skills and enhance their ability to live a life worth living.
The key to addressing BPD lies in the ability to connect with providers who excel in validation while also integrating skills essential for personal growth.
It is crucial for therapeutic relationships to embody radical authenticity and genuineness, with therapists maintaining their own well-being as well. Given that relational challenges stemming from complex trauma and attachment issues can arise in therapy, therapists adhering to DBT principles commit to self-care practices.
This commitment enables therapists to be fully present for their clients, ensuring that their own insecurities or personal matters do not interfere with the therapeutic process.
DBT stands out as a highly effective and evidence-based intervention, and personally, it's one of my favorite methods to offer. DBT with trauma intervention proves to be a valuable combination.
While individuals with BPD may experience symptom stabilization in terms of personality traits, improved behavioral regulation, and enhanced emotional coping skills through DBT, addressing trauma recovery remains crucial.
At this stage, interventions such as EMDR or Prolonged Exposure Therapy may be considered to further support individuals in their healing journey.
The intricate web connecting Borderline Personality Disorder (BPD), Complex Trauma, and Complex PTSD underscores the profound impact of traumatic experiences on an individual's mental health and well-being.
These interconnected disorders often shape a person's sense of self, emotional responses, and relational patterns in profound ways for the long term. By unraveling the complexity of these conditions and recognizing the role of trauma in their development, we can foster greater understanding, compassion, and more effective interventions for those navigating the challenges of BPD, Complex Trauma, and PTSD.
It is through this approach that we can pave the way for healing, resilience, and a path towards a life marked by growth and recovery.
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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.
You can listen to this episode on my podcast, “Initiated Survivor.” The episode is titled “Understanding Borderline Personality Disorder (BPD), Complex Trauma, and PTSD” and is available on Apple Podcasts and Spotify!
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Thank you for reading. Until next time!
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