Layman Terminology.

Layman Terminology of the 4F's, C-PTSD, PTSD, DESNOS and BPD. Also upcoming revisions to the upcoming DSM-V to be released in May.

Simple PTSD: Single incident trauma

Complex PTSD: Repetitive trauma

Some people who experience trauma do not have PTSD but everyone who has PTSD has experienced trauma.

DESNOS: Develops when extreme trauma “compromises the fundamental sense of self and relational trust at critical developmental periods.”

Those diagnosed with BPD will recognize many elements of that diagnosis in this condition. In many circles, the terms “complex trauma” and DESNOS have replaced “borderline,” though the official name of the diagnosis has not changed.

DESNOS has as well in many ways been used in place of C-PTSD since it is not acknowledged by the DSM.

BPD: They think in general it is a combination of early childhood trauma combined with a genetic predisposition towards high emotionality.
However, some people appear to have BPD without any serious traumatic causes.

The term C-PTSD has not been listed in the DSM. So even though a person can have symptoms of what’s been referred to as this subtype of PTSD, the technical diagnosis would be PTSD and not C-PTSD. In a draft of the revised DSM, which is due to come out in 2013 as DSM-V, what people currently refer to as C-PTSD will officially be referred to as Post Traumatic Stress Disorder - With Prominent Dissociative Symptoms. (I will list these changes at the bottom)

What are the symptoms of Complex PTSD:

1. Alterations in emotional regulation, which may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
2. Alterations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body.
3. Alterations in self-perception, which may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings.
4.Alterations in the reception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge.
5. Alterations relations with others, including isolation, distrust, or a repeated search for a rescuer.
6. Alterations in one’s system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.

Disturbances in the above six areas of functioning are required for the DESNOS diagnosis.

This is more recent claims and modifications to the above six, explained in different wording:

1. Attachment: problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy.
2. Biology: sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems. Affect or emotional regulation – poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulty communicating needs, wants, and wishes.
3. Dissociation: amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events.
4. Behavioral control: problems with impulse control, aggression, pathological self-soothing, and sleep problems.
5. Cognition: difficulty regulating attention, problems with a variety of executive functions such as planning, judgment, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with cause-effect thinking, and language developmental problems such as a gap between receptive and expressive communication abilities.
6. Self-Concept: fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self.

You can experience PTSD symptoms (emotional numbing, hyper arousal, dissociation, etc.) from prolonged exposure to an abusive environment, and not necessarily meet the criteria for BPD.

DESNOS vs BPD:
Research has established that the BPD and DESNOS diagnoses in general represent overlapping but distinct symptom profiles. On the surface, these disorders may appear to be quite similar, as both relate to aspects of four of the six domains of self-regulatory deficit captured by DESNOS construct. Several important distinctions exist, however between DESNOS and the classic BPD construct, including notable differences in the relative importance and nature of disruptions in these four domains of self-regulation. For instance, whereas chronic affect dysregulation is the hallmark feature of DESNOS, this symptom is secondary to disturbances in identity and relationships with others in BPD. In essence, BPD represents a disorder of attachment, while DESNOS is considered by most leading clinicians and researchers in the field to be better understood as a disorder of self-regulation.

Affect regulation:
Affect in DESNOS patients is more chronically and persistently emphasized in the direction of a downward dysregulation than is the case in most BPD patients, who in contrast exhibit greater range in their capacity for transient upward emotional spikes. The continuum of mood in patients with DESNOS typically ranges from a dysthymic/anxious baseline to profound states of rage, terror, or hopelessness. The brief periods of excitement, positive anticipation, and euphoria observed in BPD patients are often associated with transient idealizations of new intimate others or treatment providers and are less commonly observed to be components of a true DESNOS symptom presentation. In fact, a cardinal but under-recognized feature of DESNOS patients is their profound deficit in the capacity to sustain positive emotional states, experience pleasure, and become absorbed in positive and present-focused states of awareness.

Relationships:
The nature of interpersonal dysfunction characterized by the DESNOS construct varies from that of the BPD diagnosis as articulated in the DSM-IV. The BPD patients fundamental interpersonal orientation is an active one: an approach-based stance characterized by the duality of desire and disillusionment. BPD is often characterized by the oscillation between intense longing and search for idealized (and therefore unrealistic and ultimately untenable) relationships, and the equally intense devaluation and ultimate sabotage of these relationships. Conversely, when an intimate other threatens to pull out of what had been perceived by the patient to be an unsatisfying relationship, the BDP patient can become overcome with a resurgence of desire to maintain this relationship occasioned by desperate fear of abandonment and rejection by the other. In other instances, the BPD patient will concoct, and become temporarily consumed by vaguely articulated fantasies of a perfect future with a new caregiver or potential lover, only later to feel the sting of disappointment at the others inability to fill the profound emptiness at the core of his or her own being. As has been well established and the subject of much of the clinical literature on BPD, these patterns typically manifest themselves early in these patients transference responses to new treatment providers.

In contrast, the basic interpersonal orientation of the DESNOS patient is passive in nature, characterized by a duality of avoidance and revictimization. For example, these patients often engage in prolonged periods of self-inflicted social isolation and avoidance of intimate contact. At other times, however, they report abruptly discovering themselves to be in the midst of an intense emotional relationship that feels unsafe or out of control. In fact, when DESNOS patients do enter intimate relationships, it is often as a result of being the target of victimizing others who have been drawn to these patients emotional vulnerability, underdeveloped capacity to identify danger cues, and tolerance for violence and boundary violations as an inherent component of intimate relationships. DESNOS patients are often observed, to the chagrin of their therapists, to reenact their interpersonal traumas, repeatedly finding themselves helplessly playing out the role of victim, or, alternately, compelled to victimize others in ways similar to those experienced in their own history of childhood traumatization.

DESNOS patients not only tend to fear and believe themselves to be unworthy of meaningful relationships with others; they are generally incapable of imagining a future for themselves in which they can love and be loved in a relationship that is free of abuse. Given this pessimism about the potential for positive interpersonal connection and general distrust of others, DESNOS patients are not surprisingly somewhat less likely than patients with BPD to engage in boundary violations and intrusiveness with their therapists at the outset of treatment. In contrast, they often present as apprehensive, guarded, and at times hostile toward new treatment providers. The establishment of safety and trust is perhaps the most important component of the initial phase of treatment with these patients.

Dissociation:
Dissociative symptom presentations differ notably in patients with these two disorders. Dissociative symptoms associated with BPD are characterized by transient responses to stress, the occurrence of which is not required to meet diagnostic criteria. Clinical research on dissociative symptomatology as measured by the DES has consistently found that patients with BPD report lower levels of dissociative symptoms than patients with PTSD. 88 In contrast, the presence of significant dissociative symptomatology is an essential and required component of the DESNOS diagnosis. These symptoms may take a variety of forms ranging from episodic experiences of derealization to lasting psychogenic amnesia for portions of ones traumatic experiences, to the presence of Dissociative Identity Disorder.

Self-Perception:
The following distinctions can be made regarding the type and extent of disturbances in self-perception observed in these two disorders. Whereas the primary feature of disturbance in self-perception for patients with BPD involves a fundamental confusion about self, the DESNOS patient experiences a self that has been permanently damaged and alienated from others. At the core of identity disturbance for patients with classic BPD lays the absence of a sense of self or ego identity, and the persistent affective experience of emptiness associated with the void left by the unformed self. Perhaps the key component of the severe psychopathology of these patients is the intolerable black hole of this void that always beckons, making the risk for suicide a constant consideration in treatment. DESNOS patients, in contrast, although plagued by negative affect states of guilt, shame, and ineffectiveness associated with their experience of a damaged self, nevertheless possess, on some fundamental level, a basic core sense of identity, albeit often the problematic dual identity of victim and patient. In fact, their desperate clinging to trauma-based identities as victim/patient is often quite pronounced, as it becomes a source of personal meaning-making and provides a compelling explanatory model for and source of proof of their chronic experience of interpersonal suffering and emotional pain. For such patients, this identity formation is perhaps the greatest obstacle to genuine treatment progress.

I think it would benefit everyone to read this below.
The 4F's: A Trauma Typology in Complex PTSD
By: Pete Walker

This paper describes a trauma typology for differentially diagnosing and treating Complex Post Traumatic Stress Disorder. This model elaborates four basic defensive structures that develop out of our instinctive Fight, Flight, Freeze and Fawn responses to severe abandonment and trauma (heretofore referred to as the 4Fs). Variances in the childhood abuse/neglect pattern, birth order, and genetic predispositions result in individuals "choosing" and specializing in narcissistic (fight), obsessive/compulsive (flight), dissociative (freeze) or codependent (fawn) defenses. Many of my clients have reported that psychoeducation in this model has been motivational, deshaming and pragmatically helpful in guiding their recovery.

Individuals who experience "good enough parenting" in childhood arrive in adulthood with a healthy and flexible response repertoire to danger. In the face of real danger, they have appropriate access to all of their 4F choices. Easy access to the fight response insures good boundaries, healthy assertiveness and aggressive self-protectiveness if necessary. Untraumatized individuals also easily and appropriately access their flight instinct and disengage and retreat when confrontation would exacerbate their danger. They also freeze appropriately and give up and quit struggling when further activity or resistance is futile or counterproductive. And finally they also fawn in a liquid, "play-space" manner and are able to listen, help, and compromise as readily as they assert and express themselves and their needs, rights and points of view.

Those who are repetitively traumatized in childhood however, often learn to survive by over-relying on the use of one or two of the 4F Reponses. Fixation in any one 4F response not only delimits the ability to access all the others, but also severely impairs the individual's ability to relax into an undefended state, circumscribing him in a very narrow, impoverished experience of life. Over time a habitual 4F defense also "serves" to distract the individual from the accumulating unbearable feelings of her current alienation and unresolved past trauma.

Complex PTSD as an Attachment Disorder:
Polarization to a fight, flight, freeze or fawn response is not only the developing child's unconscious attempt to obviate danger, but also a strategy to purchase some illusion or modicum of attachment. All 4F types are commonly ambivalent about real intimacy because deep relating so easily triggers them into painful emotional flashbacks (see my article in The East Bay Therapist (Sept/Oct 05): "Flashback Management in the Treatment of Complex PTSD". Emotional Flashbacks are instant and sometimes prolonged regressions into the intense, overwhelming feeling states of childhood abuse and neglect: fear, shame, alienation, rage, grief and/or depression. Habituated 4F defenses offer protection against further re-abandonment hurts by precluding the type of vulnerable relating that is prone to re-invoke childhood feelings of being attacked, unseen, and unappreciated. Fight types avoid real intimacy by unconsciously alienating others with their angry and controlling demands for the unmet childhood need of unconditional love; flight types stay perpetually busy and industrious to avoid potentially triggering interactions; freeze types hide away in their rooms and reveries; and fawn types avoid emotional investment and potential disappointment by barely showing themselves - by hiding behind their helpful personas, over-listening, over-eliciting or overdoing for the other - by giving service but never risking real self-exposure and the possibility of deeper level rejection. Here then, are further descriptions of the 4F defenses with specific recommendations for treatment. All types additionally need and benefit greatly from the multidimensional treatment approach described in the article above, and in my East Bay Therapist article (Sept/Oct06): "Shrinking The Inner Critic in Complex PTSD", which describes thirteen toxic superegoic processes of perfectionism and endangerment that dominate the psyches of all 4F types in varying ways.

The Fight Type and the Narcissistic Defense:
Fight types are unconsciously driven by the belief that power and control can create safety, assuage abandonment and secure love. Children who are spoiled and given insufficient limits (a uniquely painful type of abandonment) and children who are allowed to imitate the bullying of a narcissistic parent may develop a fixated fight response to being triggered. These types learn to respond to their feelings of abandonment with anger and subsequently use contempt, a toxic amalgam of narcissistic rage and disgust, to intimidate and shame others into mirroring them and into acting as extensions of themselves. The entitled fight type commonly uses others as an audience for his incessant monologizing, and may treat a "captured" freeze or fawn type as a slave or prisoner in a dominance-submission relationship. Especially devolved fight types may become sociopathic, ranging along a continuum that stretches between corrupt politician and vicious criminal.

TX: Treatable fight types benefit from being psychoeducated about the prodigious price they pay for controlling others with intimidation. Less injured types are able to see how potential intimates become so afraid and/or resentful of them that they cannot manifest the warmth or real liking the fight type so desperately desires. I have helped a number of fight types understand the following downward spiral of power and alienation: excessive use of power triggers a fearful emotional withdrawal in the other, which makes the fight type feel even more abandoned and, in turn, more outraged and contemptuous, which then further distances the "intimate", which in turn increases their rage and disgust, which creates increasing distance and withholding of warmth, ad infinitem. Fight types need to learn to notice and renounce their habit of instantly morphing abandonment feelings into rage and disgust. As they become more conscious of their abandonment feelings, they can focus on and feel their abandonment fear and shame without transmuting it into rage or disgust - and without letting grandiose overcompensations turn it into demandingness.

Unlike the other 4Fs, fight types assess themselves as perfect and project the inner critic's perfectionistic processes onto others, guaranteeing themselves an endless supply of justifications to rage. Fight types need to see how their condescending, moral-high-ground position alienates others and perpetuates their present time abandonment. Learning to take self-initiated timeouts at the first sign of triggering is an invaluable tool for them to acquire. Timeouts can be used to accurately redirect the lion's share of their hurt feelings into grieving and working through their original abandonment, rather than displacing it destructively onto current intimates. Furthermore, like all 4F fixations, fight types need to become more flexible and adaptable in using the other 4F responses to perceived danger, especially the polar opposite and complementary fawn response described below. They can learn the empathy response of the fawn position - imagining how it feels to be the other, and in the beginning "fake it until they make it." Without real consideration for the other, without reciprocity and dialogicality, the real intimacy they crave will remain unavailable to them.

The Flight Type and the Obsessive-Compulsive Defense:
Flight types appear as if their starter button is stuck in the "on" position. They are obsessively and compulsively driven by the unconscious belief that perfection will make them safe and loveable. As children, flight types respond to their family trauma somewhere along a hyperactive continuum that stretches between the extremes of the driven "A" student and the ADHD dropout running amok. They relentlessly flee the inner pain of their abandonment and lack of attachment with the symbolic flight of constant busyness.

When the obsessive/compulsive flight type is not doing, she is worrying and planning about doing. Flight types are prone to becoming addicted to their own adrenalization, and many recklessly and regularly pursue risky and dangerous activities to keep their adrenalin-high going. These types are also as susceptible to stimulating substance addictions, as they are to their favorite process addictions: workaholism and busyholism. Severely traumatized flight types may devolve into severe anxiety and panic disorders.

TX: Many flight types are so busy trying to stay one step ahead of their pain that introspecting out loud in the therapy hour is the only time they find to take themselves seriously. While psychoeducation is important and essential to all the types, flight types particularly benefit from it. Nowhere is this truer than in the work of learning to deconstruct their overidentification with the perfectionistic demands of their inner critic. Gently and repetitively confronting denial and minimization about the costs of perfectionism is essential, especially with workaholics who often admit their addiction to work but secretly hold onto it as a badge of pride and superiority. Deeper work with flight types - as with all types -gradually opens them to grieving their original abandonment and all its concomitant losses. Egosyntonic crying is an unparalleled tool for shrinking the obsessive perseverations of the critic and for ameliorating the habit of compulsive rushing. As recovery progresses, flight types can acquire a "gearbox" that allows them to engage life at a variety of speeds, including neutral. Flight types also benefit from using mini-minute meditations to help them identify and deconstruct their habitual "running". I teach such clients to sit comfortably, systemically relax, breathe deeply and diaphragmatically, and ask themselves questions such as: "What is my most important priority right now?", or when more time is available: "What hurt am I running from right now? Can I open my heart to the idea and image of soothing myself in my pain?" Finally, there are numerous flight types who exhibit symptoms that may be misperceived as cyclothymic bipolar disorder; I address this issue at length in my article: "Managing Abandonment Depression in Complex PTSD".

The Freeze Type and the Dissociative Defense:
Many freeze types unconsciously believe that people and danger are synonymous, and that safety lies in solitude. Outside of fantasy, many give up entirely on the possibility of love. The freeze response, also known as the camouflage response, often triggers the individual into hiding, isolating and eschewing human contact as much as possible. This type can be so frozen in retreat mode that it seems as if their starter button is stuck in the "off" position. It is usually the most profoundly abandoned child - "the lost child" - who is forced to "choose" ad habituate to the freeze response (the most primitve of the 4Fs).

Unable to successfully employ fight, flight or fawn responses, the freeze type's defenses develop around classical dissociation, which allows him to disconnect from experiencing his abandonment pain, and protects him from risky social interactions - any of which might trigger feelings of being reabandoned. Freeze types often present as ADD; they seek refuge and comfort in prolonged bouts of sleep, daydreaming, wishing and right brain-dominant activities like TV, computer and video games. They master the art of changing the internal channel whenever inner experience becomes uncomfortable. When they are especially traumatized or triggered, they may exhibit a schizoid-like detachment from ordinary reality.

TX: There are at least three reasons why freeze types are the most difficult 4F defense to treat. First, their positive relational experiences are few if any, and they are therefore extremely reluctant to enter the relationship of therapy; moreover, those who manage to overcome this reluctance often spook easily and quickly terminate. Second, they are harder to psychoeducate about the trauma basis of their complaints because, like many fight types, they are unconscious of their fear and their torturous inner critic. Also, like the fight type, the freeze type tends to project the perfectionistic demands of the critic onto others rather than the self, and uses the imperfections of others as justification for isolation. The critic's processes of perfectionism and endangerment, extremely unconscious in freeze types, must be made conscious and deconstructed as described in detail in my aforementioned article on shrinking the inner critic. Third, even more than workaholic flight types, freeze types are in denial about the life narrowing consequences of their singular adaptation. Because the freeze response is on a continuum that ends with the collapse response (the extreme abandonment of consciousness seen in prey animals about to be killed), many appear to be able to self-medicate by releasing the internal opioids that the animal brain is programmed to release when danger is so great that death seems immanent. The opioid production of the collapse or extreme freeze response can only take the individual so far however, and these types are therefore prone to sedating substance addictions. Many self-medicating types are often drawn to marijuana and narcotics, while others may gravitate toward ever escalating regimes of anti-depressants and anxiolytics. Moreover, when they are especially unremediated and unattached, they can devolve into increasing depression and, in worst case scenarios, into the kind of mental illness described in the book, I Never Promised You A Rose Garden.

The Fawn Type and the Codependent Defense:
Fawn types seek safety by merging with the wishes, needs and demands of others. They act as if they unconsciously believe that the price of admission to any relationship is the forfeiture of all their needs, rights, preferences and boundaries. They often begin life like the precocious children described in Alice Miler's The Drama Of The Gifted Child, who learn that a modicum of safety and attachment can be gained by becoming the helpful and compliant servants of their parents. They are usually the children of at least one narcissistic parent who uses contempt to press them into service, scaring and shaming them out of developing a healthy sense of self: an egoic locus of self-protection, self-care and self-compassion. This dynamic is explored at length in my East Bay Therapist article (Jan/Feb2003): "Codependency, Trauma and The Fawn Response" (see http://www.pete-walker.com). TX. Fawn types typically respond well to being psychoeducated in this model. This is especially true when the therapist persists in helping them recognize and renounce the repetition compulsion that draws them to narcissistic types who exploit them. Therapy also naturally helps them to shrink their characteristic listening defense as they are guided to widen and deepen their self expression. I have seen numerous inveterate codependents finally progress in their assertiveness and boundary-making work, when they finally got that even the thought of expressing a preference or need triggers an emotional flashback of such intensity that they completely dissociate from their knowledge of and ability to express what they want. Role-playing assertiveness in session and attending to the stultifying inner critic processes it triggers helps the codependent build a healthy ego. This is especially true when the therapist interprets, witnesses and validates how the individual as a child was forced to put to death so much of her individual self. Grieving these losses further potentiates the developing ego.

Notes:
What sets the subtype C-PTSD from PTSD are the symptoms of depersonalization and derealization. To better explain this, listed is the criteria put forth by the soon to be released DSM-V.

A1. Depersonalization: Experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling as though one is in a dream, sense of unreality of self or body, or time moving slowly.

A2. Derealization: Experiences of unreality of one’s surroundings (e.g., world around the person is experienced as unreal, dreamlike, distant, or distorted)

B. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts, or behavior during alcohol intoxication), or another medical condition (e.g., complex partial seizures).

Not only will C-PTSD receive revisions and a new name in the upcoming DSM-V, the symptoms and criteria for PTSD will also be revised. After I read through the revised criteria for PTSD in DSM-V, it appears they’ve taken some of the symptoms formerly associated exclusively with C-PTSD and added them to the general PTSD criteria. For example, the exaggerated expectations of oneself that was formerly connected with C-PTSD, have now been added to general PTSD. The same goes for a persistent, distorted blame of oneself or others about the cause or consequences of the traumatic event(s), and reckless or self-destructive behavior. From what I understand, the criteria revisions for PTSD have been made in order to clearly differentiate it from other trauma and anxiety disorders.

C-PTSD has been known to present some challenges in treatment. I believe one reason is because the standard treatments for PTSD don’t always address the characteristics of extreme distrust/fear, low self-worth, dissociation and attachments that are often associated with this subtype.

The ICD-11 has accepted and will now include a new diagnostic category for C-PTSD.

BPD will also be reformulated in the upcoming DSM-V as listed below.

The Work Group is recommending that the DSM-IV borderline personality disorder be reformulated as the borderline type of the single general category of personality disorder with five options for personality types (borderline, antisocial/psychopathic, avoidant, obsessive-compulsive, and schizotypal) in the DSM-V. The DSM-V general category of personality disorder identifies failure in the development of identity and interpersonal difficulties as its basic features with a particular emphasis on dissociation in the borderline type. In our view, the DSM-IV description of borderline personality disorder is overinclusive and catch patients with chronic dissociative disorders (dissociative identity disorder and allied types of DDNOS) who may not have a personality disorder. It is not clear if the proposed revisions on definition of personality disorder in DSM-V (and its borderline type) would prevent this overinclusiveness either. According to the criterion D of personality disorder in general, adaptive failure (which has to be associated with one or more personality traits and has to be stable over time according to the criteria B and C) should not be solely explained as a manifestation or consequence of another mental disorder. Thus, the criterion D provides a limit at least principally. However, the shift of the general definition of personality disorder toward a disturbance in self-identity may create a challenge in delineation of a chronic dissociative disorder in conditions when dissociative amnesia is not a prominent part of the clinical picture. Nevertheless, the DSM-V Work Group recommends fusion of the first three axes of DSM-IV into a single one, which would no longer allow concurrent personality disorder diagnosis in a separate axis. Given the current conceptualization of DSM-V, introduction of a category of trauma-related personality disorder is unlikely.

Overthinking and tangled.

Thought was PTSD can seem much like BPD. But isn't. And you can put the Complex before the PTSD but really....it doesn't exist. So DESNOS (disorder of extreme stress not otherwise specified) is used instead. But then when I research more it seems as though some believe BPD to be C-PTSD/DESNOS.

Confused.

I am going to re-enter therapy. This time for me. New therapist though. I feel as though I have the knowledge I just don't know what to do with any of it.

The symptoms of PTSD are extremely similar to those of BPD.

Are you asking for all of that to be put into layman terms?

If so then I'd put it this way...

Anyone with any of that s**t taking place in their life is more then likely really f**ked up... I think that's about this gist of it...

cboxpalace wrote:Anyone with any of that s**t taking place in their life is more then likely really f**ked up... I think that's about this gist of it...

I hope that your response was not meant to come across as directly rude and towards me. Which is how I took it.

In answer though. No. What I am questioning is that many who come here may not necessarily have BPD but may instead have PTSD. Myself included in that. Not that I believe it has any significance on being here and seeking support but if one is confused it could easily be misinterpreted.

It would be another area in which to look if on a path of self discovery without current treatment.

I was not familiar with the knowledge that those with PTSD may also exhibit dissociation, suicidal thoughts, self harm, intimacy issues, attachment issues, emotional regulation, impulsiveness, lack of identity, shame, low self esteem and so on.

PTSD was brought to my attention and so I then decided to read on it. Which then led me to articles with BPD and then comparisons of the 2.

I had never even heard of DESNOS or Complex PTSD. I was only familiar with trauma.

I posted large parts of the information that I had found to see if anyone else may be familiar with it. Or if I was interpreting it correctly.

reflection wrote:

cboxpalace wrote:Anyone with any of that s**t taking place in their life is more then likely really f**ked up... I think that's about this gist of it...

I hope that your response was not meant to come across as directly rude and towards me. Which is how I took it.

I found it funny, but I should've put the LOL... forgot that!

What I am questioning is that many who come here may not necessarily have BPD but may instead have PTSD. Myself included in that. Not that I believe it has any significance on being here and seeking support but if one is confused it could easily be misinterpreted.

1. I think that shows the importance of being diagnosed by a psychiatrist/psychologist rather than self diagnose or put too much emphasis on our opinions.

2. I believe it does have significance in regards to where a person chooses to post. If they have bpd they should post here, and if it's related to post traumatic they should post in that forum. It's not because they're not welcome here, it's because they'd probably receive better support in the appropriate forum where people can relate better.


I do believe that many of us (myself included) have to some degree ptsd. I've been diagnosed bpd, on more then one occasion, and I definitely relate to it, but I also believe that I have some level of ptsd which hasn't been officially diagnosed. There are others here that could probably go into far more detail then me.

Just FYI - When you copy and paste a large amount of text like you did most people won't bother to read all the way through... I think had your thread been what you replied to me you would've received several replies. It's valid, interesting, and thought provoking!!


Found this..

The Co-Occurrence of BPD and PTSD

As mentioned previously, BPD has been found among people with PTSD and vice versa. One study of veterans with combat-related PTSD seeking treatment found that 76% of them also had a diagnosis of BPD. Likewise, another study found that approximately 56% of individuals with BPD also have a diagnosis of PTSD.

Why are these two disorders so inter-related? BPD and PTSD have both been found to stem from the experience of traumatic events. The thoughts, feelings, and behaviors seen in BPD are often the result of childhood traumas. These childhood traumas may also place a person at risk for developing PTSD. In fact, people with both BPD and PTSD report the earlier experience of trauma as compared to people with just PTSD.

The impulsive behaviors and unstable relationships seen among people with BPD may also place a person at greater risk for experiencing a traumatic event such as a motor vehicle accident, physical assault, or sexual assault.

Finally, the symptoms of PTSD and BPD do overlap. For example, individuals with PTSD may have difficulties managing their emotions. Therefore, they may experience intense feelings and have constant mood swings. They may also experience problems with anger. People with PTSD, especially those who lost a loved one, may also begin to fear being abandoned.

cboxpalace wrote:I found it funny, but I should've put the LOL... forgot that!

Thanks for that. I immediately went on the defensive. And I will have you know that was hours of reading multiple articles.

cboxpalace wrote:1. I think that shows the importance of being diagnosed by a psychiatrist/psychologist rather than self diagnose or put too much emphasis on our opinions.

2. I believe it does have significance in regards to where a person chooses to post. If they have bpd they should post here, and if it's related to post traumatic they should post in that forum. It's not because they're not welcome here, it's because they'd probably receive better support in the appropriate forum where people can relate better.

1. Yes. I agree 100%. It's just too much to attempt to sort and make sense of.

2. Yes. I guess it would. There would be differences. There would have to be or it would all be one. Which in reading is part of what I found confusing. Some circles do believe it all to be one. Only if complex though.

cboxpalace wrote:I do believe that many of us (myself included) have to some degree ptsd. I've been diagnosed bpd, on more then one occasion, and I definitely relate to it, but I also believe that I have some level of ptsd which hasn't been officially diagnosed. There are others here that could probably go into far more detail then me.

If you don't mind me asking was your childhood abusive/traumatic I actually am interested in hearing an answer from others on this as well. I have spaces of time in my past I have no memory of. That has always bothered me.

cboxpalace wrote:Just FYI - When you copy and paste a large amount of text like you did most people won't bother to read all the way through... I think had your thread been what you replied to me you would've received several replies. It's valid, interesting, and thought provoking!!

I didn't know what it was going to be finished. There was so much. I knew what I wanted to say/ask but I didn't have my own words for it and so this way I was able to present it. I struggle terribly with that.

And once I started I was completely focused on it.

cboxpalace wrote:As mentioned previously, BPD has been found among people with PTSD and vice versa. One study of veterans with combat-related PTSD seeking treatment found that 76% of them also had a diagnosis of BPD. Likewise, another study found that approximately 56% of individuals with BPD also have a diagnosis of PTSD.

Why are these two disorders so inter-related? BPD and PTSD have both been found to stem from the experience of traumatic events. The thoughts, feelings, and behaviors seen in BPD are often the result of childhood traumas. These childhood traumas may also place a person at risk for developing PTSD. In fact, people with both BPD and PTSD report the earlier experience of trauma as compared to people with just PTSD.

I am going to assume that the other study was done on those that were not combat related. I question if genetics do play a role in BPD in that there is maybe more sensitivity. Then if raised in a traumatic environment that would bring about PTSD if it would as well alter the symptoms of BPD.

It's 3:00am here so I won't even attempt to go into detail but there has been testing performed on the brain of those with BPD and the results differed from those without. Too technical tonight though.

Thank you for posting.

Very interesting, thank you. Can I ask if this is an amalgamation of several different sources of information?
I would also like to ask about the self harming/impulsive aspect of the bpd criteria - would someone who displays a c-ptsd profile who also self harms be more likely to be diagnosed with bpd or would that still be a c-ptsd symptom?

tigertim wrote:Very interesting, thank you. Can I ask if this is an amalgamation of several different sources of information?
I would also like to ask about the self harming/impulsive aspect of the bpd criteria - would someone who displays a c-ptsd profile who also self harms be more likely to be diagnosed with bpd or would that still be a c-ptsd symptom?

Yes. It is. Thank you for using that word.
The 4F's (fight, flight, freeze, fawn) was just something I came across that I found interesting so it became included as well.

I don't have the answer for you on if self harm would more likely be diagnosed as BPD or PTSD. It can be a symptom of both and you could as well be diagnosed with one or even both. Only someone who is qualified would be able to answer that for you.

Sorry I wasn't able to be of more help.