Question
How does BPD differ from complex trauma?
Answer
The DSM criteria for Borderline Personality Disorder (BPD) starts with frantic efforts to avoid real or imagined abandonment, a pattern of unstable or intense interpersonal relationships, and identity disturbance/an unstable sense of self. There can also be impulsivity in a few different areas involving self-damaging or suicidal behavior; whether it be gestures, threats, or self-harm. They may also experience highs and lows that go over a long period of time. This is more of a personality shift versus a biological mood that you may see within a mood disorder. Chronic feelings of emptiness, inappropriate and intense feelings of anger, difficulty controlling anger, transient paranoid ideation, or severe dissociative symptoms may be prominent as well.
Some of these symptoms are similar to complex trauma, but there are some specific differences. In looking at the two, they both have an impact on the self and the identity. But within BPD, it is about an unstable sense of self, while complex trauma includes a chronic, negative self-image. An individual with BPD may have days where they feel good about themselves, but changes in relationships bring down their sense of self. With complex trauma, there is a negative self-image in which they almost always feel badly about themselves. Often they cannot remember a time when they felt positive about themselves. These individuals may have had histories of emotional abuse when the negative things that they play in their mind are things that someone else has said about them. They may have someone else's voice internalized as their own.
Within both cases, you also can see interpersonal issues. With borderline personality disorder, it is more so about fear of abandonment, as well as unstable relationships due to black and white thinking. With complex trauma, there is the chronic avoidance of relationships and isolation, and not feeling like they ever belong within the family. I often see this with individuals who have been adopted and teenagers going into adulthood. They may feel like they do not have a place in the world. They do not go back and forth from love to hate because they often do not feel love from their family. I describe that as there being no bottom to their cup.
Regarding individuals with complex trauma, it does not matter how much love you put in their cup because everything just pours out. This can relate to a family that might describe how they spent all day with one foster child, but then that child did not feel cared for the minute they spent time with another child. Also, issues with emotion regulation are present in both BPD and complex trauma. Although, within BPD, there tends to be more impulsivity and difficulty with regulating mood. Whereas, with complex trauma, it is ineffective coping and reactive anger. It is chronic difficulty versus not having the right skills.
This Ask the Expert is an edited excerpt from the webinar, Addressing Complex Trauma Across the Lifespan, presented by Patrice Berry, PsyD, LCP
