Abstract
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understanding of the role of psychological trauma in BPD. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Findings suggest that BPD may involve heterogeneity related to psychological trauma that includes, but extends beyond, comorbidity with PTSD and potentially involves childhood victimization-related dissociation and affect dysregulation consistent with cPTSD. Although BPD and cPTSD overlap substantially, it is unwarranted to conceptualize cPTSD either as a replacement for BPD, or simply as a sub-type of BPD. We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD.
Highlights
Complex posttraumatic stress disorder (PTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization, and (3) relational security
We will review clinical and scientific findings regarding: (1) comorbidity and clinical phenomenology of PTSD, Complex PTSD (cPTSD) and borderline personality disorder (BPD); (2) the role of traumatic victimization in BPD and the possibility that cPTSD could represent a sub-type of BPD; (3) the psychobiology of PTSD, cPTSD, and BPD; and, (4) whether a cPTSD conceptualization could clarify the relationship of two hypothesized core mechanisms in BPD, dissociation and affect dysregulation
While preliminary and not directly testing associations with cPTSD, taken together these findings suggest that emotion dysregulation in BPD may involve brain alterations associated with deficient self-awareness, intolerance of interpersonal rejection or abandonment, inability to recover from intense negative affect states, and dissociative analgesia
Summary
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. BPD-diagnosed women in a clinical sample had more affect regulation problems in general than non-BPD controls, a sub-group with comorbid avoidant personality disorder was found to have severe deficits in tolerating distress and accessing adaptive emotion regulation strategies cognitively and physiologically
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