What’s the difference between PTSD and Borderline Personality Disorder?
Finding the right treatment for any mental health condition starts with getting the right diagnosis. But that can be tricky when different conditions present in similar ways, or sometimes even occur together.
One such pairing is Borderline Personality Disorder (BPD) and Post-Traumatic Stress Disorder (PTSD). Because of the overlap in symptoms and shared association with trauma, it’s not uncommon for the symptoms of one to be mistaken for the other, or for one condition to be missed when someone has both.
So where are the similarities and differences between the two, and what happens when someone experiences both?
Is it BPD or PTSD?
BPD (sometimes called Emotionally Unstable Personality Disorder, or EUPD) is a lifelong mood disorder which can affect how someone thinks, feels, perceives, and relates to others. People with BPD may struggle with a fear of abandonment, impulsive behaviour, intense emotions and relationships, and an unstable self-image. Although there’s no single cause, research suggests genetics and brain chemistry may make someone more susceptible to the condition.
BPD often stems from prolonged childhood trauma, which can also increase someone’s chance of developing PTSD or C-PTSD. PTSD is a psychological response to a traumatic event (which of course might include childhood events). The symptoms of PTSD can include flashbacks, depression, anxiety, shame, anger and relationship problems.
Can someone have both BPD and PTSD?
It’s thought that between 25% and 60% of people with BPD also have PTSD. This could be because living with a mood disorder can both increase the risk of experiencing a traumatic situation, and make it more likely that experiencing a traumatic event leads to PTSD or C-PTSD.
When someone has both conditions, the symptoms tend to be worse than if they had BPD or PTSD/C-PTSD alone. PTSD and C-PTSD can increase the likelihood of dissociative, intrusive and suicidal thoughts in people with BPD. That’s why it’s so important to get the correct diagnosis.
Making a correct diagnosis for BPD or PTSD
BPD can sometimes be mistaken for PTSD or C-PTSD, and vice-versa. C-PTSD is a subset of PTSD which is associated with long-term or chronic exposure to trauma – much like BPD. Both can cause emotional distress, mood swings, flashbacks, anxiety and anger.
It’s thought there are some generalised key differences to look out for, but of course, everybody is different:
- Although both conditions can lead to problems maintaining personal relationships, people with BPD tend to fear abandonment, whereas people with C-PTSD may avoid intimacy or relationships altogether because of ‘feeling somehow unlovable or undeserving because of the abuse they endured’.
- People with BPD are more likely to self-harm, than people with PTSD or C-PTSD.
- ‘While both those with BPD and C-PTSD struggle with emotional regulation and often experience outbursts of anger or crying, those with C-PTSD may experience emotional numbing, emptiness, or a detachment from emotions.’
- Someone with PTSD may be calmed by going to a familiar environment and being reassured that they are safe. This might irritate someone with BPD, who may respond more positively to being told their feelings are valid.
- People with PTSD are more likely to be triggered by a specific external trigger and think and behave rationally outside those triggers. For people with BPD, the triggers tend to be internal thoughts and feelings, which can be less predictable.
Unfortunately, because of the overlap in symptoms, and because some differences appear similar from the outside, some people with C-PTSD end up being misdiagnosed with BPD, or vice-versa. Sometimes someone will have both conditions, but only one is picked up. We recommend speaking to your doctor if you think your diagnosis is incorrect or incomplete.
Treatment for PTSD and BPD
The good news is that effective treatments are available for both conditions.
Treatments for BPD include psychotherapy, group therapy and arts therapy. Dialectical behaviour therapy is a popular choice, and involves accepting your feelings while exploring ideas that contradict your own thoughts. This may also help reduce symptoms of PTSD or C-PTSD.
There’s no settled view on whether medicine works to treat BPD, though it can be helpful for related mood disorders or in the event of a crisis.
For PTSD and C-PTSD, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy.NICE guidance (updated in 2018) recommends trauma-focused psychological treatments for PTSD in adults, such as Eye Movement Desensitisation Reprocessing (EMDR) and trauma-focused cognitive behavioural therapy (CBT). You may also want to explore group and individual therapy, holistic non-pharmacological therapies, or talk to your doctor about treatment with appropriate prescription drugs.
If someone has both conditions, it can often make sense to treat the emotionally disruptive symptoms of BPD before addressing the trauma that triggered PTSD or C-PTSD – but of course everyone is different and your medical team will support you in the best way for treatment.
Please remember, these are not medical recommendations. Be sure to work with a professional to find the best methods of treatment and diagnosis for you.
For further support with BPD, Borderline Support has a great list of support services available here.
Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J. (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of psychiatric research, 44(16), 1190–1198. https://doi.org/10.1016/j.jpsychires.2010.04.016
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