Hi Liese,

This can get really technical. First of all there is a difference between complex PTSD and straight PTSD. Complex PTSD usually develops over time in conjunction with abuse and neglect as opposed to straight PTSD which is usually from a large type trauma such as being in an earthquake, a fire, an accident, seeing someone die in a shocking way etc. Complex trauma is usually caused through interpersonal or relational damage and abuse.

So then we talk about complex trauma and BPD (borderline personality disorder). They are listed in the DSM as appearing on two different Axis of diagnosis. C-PTSD is considered an anxiety disorder and is on Axis I while BPD is considered a personality disorder and is listed as Axis II. BPD is related to abusive backgrounds and there may also be a biological weakness towards that type of personality or way of relating. I think this is why some Ts feel it is harder to work with. I need you to know that I'm not an expert on BPD and don't want to say anything that is wrong and that would upset anyone here. Unfortunately, over time borderline became a perjorative term used for women and it tended to scare off some Ts. I do feel this is very unfair.

People with C-PTSD have a lot of the traits of people with BPD but tend to be more stable in relationships and in work/career. This is the biggest difference I can find in what I have read about it. Some of the traits they share are big fears of abandonment, emotional dysregulation and also attachment injury, both may self-harm. All of this comes from an abuse/trauma interpersonal history.

I have some good articles on C-PTSD I can link to you when I have some time to find them. Hope this helps a little.

TN

Excellent points MH. Yes there is no individual classification for C-PTSD in the current DSM. I don't have a copy of it but from what my T read to me from his book it seems that C-PTSD is in some sub-category of PTSD and so you are correct they use the PTSD DSM code if they need to provide a dx for insurance.

Van der Kolk writes a lot about including the category of DESNOS (disorder of extreme stress, not otherwise specified) in the new DSM V but I guess, as you say MH, this is meeting with a lot of resistence for some reason. And I have also read that some researchers and experts in this area feel that C-PTSD is BPD or a variation of it. And like in most other things, there is a variation of severity of the traits and symptoms.

And I do agree and recognize that there is a stigma to BPD which is unfortunate. And I often wonder if this is because it most often affects women. Whether or not they replace BPD with C-PTSD I do think that C-PTSD needs to be defined and placed in the DSM. In any event, I don 't care what my T calls it as long as they understand it, how it specifically impacts me and they know how to treat correctly and without prejudice.

This is actually a good conversation to have with newT.

TN

So really, the two are very similar? And PTSD is also very similar to BPD? I worked in a group home after college and two of the girls were diagnosed with BPD. And, they were very unstable. I do consider myself to be much more stable than they were. I did ask my T last night on the phone if I was BPD and I expected him to say no based on my experience after college. And he wouldn't answer me. He said we will pull out the book on Monday and look at it together. He also wanted to know why I thought I was BPD. I told him because of the self-image stuff and my suicidal feelings. He said that people with depression also suffer from self-image problems and suicidal feelings. SO, he didn't say yes or no. Just we'll look together on Monday. When I have suicidal feelings, it's because I'm in terrible emotional pain and I don't know how to cope with those feelings. The sense, though, that I get from the BPD stuff is that BPD'ers threaten suicide for attention? Does that distinction make sense? OR am I splitting hairs? Like, for instance, I've never told anyone about my suicidal feelings until my current T. And, we've really only begun to discuss them. I've told him I've made a commitment to myself and my children (mentally) that I would never kill myself because I know how devastating that would be for them but it's coping with the emotional pain that I find difficult and overwhelming.

I hope I didn't offend anyone by asking about it. I guess it is what it is. If I am BPD, I will have to deal with it. I just didn't expect it because he never indicated otherwise in the past. He just told me I'm a people pleaser. That didn't sound too bad. I mean, I know people walk all over people pleasers ... but ....

Hi,

TY Liese for bring up this topic as I am also very interested in it as well.

TYVM, TN and MH for your replies and some very interesting information about this.

I have C PTSD and my T has told me also BPD as a dx but she uses the PTSD and DESNOS for the dx for the Ins. Co. I guess I am rebelling that BPD dx because I feel that it is C PTSD has the sympoms I display.

But she did tell me that they may be dropping BPD down from Axis II to Axis I on the next DSM V. She says I am very highly functioning. Well I am not too sure about that though. I certainly hope so.

Hi Marsh,

At least you've had the discussion. That's good. And, that's good to know you're very high functioning. I know you probably don't always feel that way. You don't have to be specific if you don't want, but what do you think gets in the way of your functioning better or feeling better?

Liese it is not upsetting to me at all for you to bring up this topic. It's a good topic. Why do you think you are BPD? Did your T dx you with this?

I came across this blog on Psychology Today and the P writes about all of what we are discussinig....Complex Trauma/Abuse where this all fits in the DSM's etc. If you look at the additional articles on the left and right margins there is also info on dissociation.

http://www.psychologytoday.com...where-do-they-belong

Hope that link works!

TN

Hi Liese,

Well my T & I do continue to have those discussions. I guess I am just very hard headed. So many times I don't feel very high functioning, more than I care to admit or to be let known. It's difficult for me to talk in detail....but it's a culmination of all my issues.

The C Depression, C Pain, CSA, incest, emotional, psychological, physical abuse, the threats. Panic/Anxiety/agoraphobia/claustrophobia (am not good around people or with going out in public). Bits and pieces of memories from nightmares and flashbacks. Abandonment & attachment injuries & grief from loss of our son. Also, like you the emotional pain, it all does become quite overwhelming.

((((MARSH))))) So much pain. On top of all the other stuff and then to lose a child. I'm so sorry. How could you be high functioning? I mean, I'm sure you are, but in the sense that your emotions are squared away and on the same level as the rest of you.

I have a friend who tells me I appear to be better functioning than I am. So for that, I am grateful. I know it's not good to hide my pain, but on the other hand, I certainly don't want to let it all hang out for everyone to see, right?

DF, I just wasn't sure what that quote meant when it said, "a different set of self-function failures"? Do you know what that means? That would be interesting to learn. Maybe that'll be the difference for me. Does one have to self-harm in order to be diagnosed as BPD?

Tn, I called t on Thursday night because I had a really really bad night Wednesday night and bad day Thursday. I actually tried to get an appointment but he had nothing free. So I called and asked for him to call me. Of course, I had to wait about 4 hours for him to return my call - but I knew he was seeing patients. After we talked for a while about what was going on for me, I asked him flat out if I was BPD. I'm not sure I really think I am. I can go back and forth with myself about it. But, it is a fear of mine. I was just hoping that he'd say no and it would clear that fear up. But he didn't say no and he wanted to know why I thought I was. I could only think of two the criteria off the top of my head, the suicidal feelings and the self-image stuff. And, he said that those could be symptoms of depression also. And, he said we'd take out the manual on Monday to go over it together. I guess I wouldn't have asked him this over the phone if I possibly thought the answer was yes because it's been a bit of torture to have to wait 4 days to have this discussion with him. But, on the other hand, I am really scared to find out how he sees me, so while I know it's a really important discussion to have, I am really scared. I just feel like my family will be justified. They always told me it was me. Regardless of what he says, even if he does wind up saying no, I'm sure I'll walk away with a lot of information about myself.
I know reckless sex is one of the criteria and he and I haven't talked about sex at all, except for the fact that my H and I don't have any. And, so, I suppose it could open up that can of worms. At first I was thinking that I didn't have reckless sex. But then again, he may have a different opinion. And when I went back and really counted, the number was a little higher than I was admitting to myself. Not terrible, just a little higher. So how many partners would you consider reckless? And would consider lack of birth control reckless? Would you consider sleeping with someone you just met reckless? So basically, sex is only not reckless if it's with a long-term partner? I feel like myself and everyone I know has had reckless sex at least once or twice.

The substance abuse is definitely a yes. He already knows all about that.

I was also wondering if he was wondering if I SH. Because in my last session, I told him that I pick my wounds, but I meant my emotional wounds, - although I didn't say that. And I've never threatened suicide. He's the only one I've ever talked about my suicidal feelings with and I just tell him so he'll know. At first I was really afraid of my suicidal feelings. They scared me. But I think can learn to deal with them better if I can learn to cope with the emotional pain. But maybe he needs to clear all this up in his mind also. I've talked about suicide. I've told him I won't do it.

The self-image stuff is hard. Maybe I'm thinking more of identity stuff. I definitely blend my needs with others, meet their needs and get resentful when mine don't get met. In my mind, though not clinically, that comes from being in an enmeshed family.

So, TN, that's what's been going on in my mind. I have had people tell me I'm the least manipulative person they know but then again? Who knows? Maybe I am manipulative.

I do think Mondays session will be an important one for me. A reckoning of sorts. Wish me luck. At the end of the day, I'll have to love myself regardless of the outcome, right?

Just curious...what does the phrase "not otherwise specified" mean? It seems so terribly cold and almost inhumane somehow to me.

When I think about everyone's various trauma's and trials here, it seems strange to me that we all fall somewhere within some kind of technical diagnosis in some big book, and that makes me wonder how useful the diagnoses actually are.

I don't think any of us were born with these maladies. Instead, they are the result of horrific neglect and abuse, whether it was overt and flagrant or subtle but profound.

That said, to me it seems just as accurate (if not more) to say that someone is suffering from a broken heart, a trampled soul or an assaulted spirit.

Russ

I agree with you Russ. I'm going to go with broken heart diagnosis. I hate the diagnosis stuff. My T doesn't like it either but maybe it will lead to a good discussion and a deepening of understanding.

Hi Liese,

Actually I feel I was more high functioning before our son's death, Panic/Anxiety/agoraphobia/claustrophobia was present before his death but it was much milder. I was able to go out in public and do whatever was needed to do. But I was also very good at hiding my feelings, emotions, thoughts, etc.

Whereas after his death, everything got worse. I believe that his death was the trigger that started the landslide of everything else. His death brought forth so much anger, rage, grief, pain & hurt that as it came forth I couldn't seem to stop it all. Even the childhood issues started pouring out as my walls tumbled.

My DH and daughter never knew what happened during my childhood until around March 2009, I felt I had to tell them as I was about to start therapy. Even then I only told them a minimal amount. I did have to admit to them what I had started and actually began to do at the gravesite of the boy who was driving the vehicle.

I am not sure if I should continue this conversation in this thread with these details. I do not wish to hijack you thread.

It's okay Marsh. Go ahead and hijack, if you want. Or you can PM me. Again, so sorry. And, Marsh, you don't have to talk about anything you don't want to. It's okay. Only if you want to.

Hi Liese,

TY, for your kindness but I think it would be better to start a different thread.

**NOTE** POSSIBLE TRIGGERS TO SI/SH

As to BPD and whether or not that is what I have, I don't know.

But I have tried suicide 2x's and failed. 1st time a dear friend(RN)came over unexpectedly because of my C Depression and found me and stopped me. 2nd time, my husband came home 4 hrs. early and found me and took me to my P.

This was back in the early to mid 80's. This was before my son's death.

Back when I was 16 to 18 I did a lot of heavy drinking to just to be able to cope with childhood things, incest/rape when I was 13, and the abusive marriage/divorce I got myself into. But I was able to stop that on my own.

So I guess that would be considered SH. I do slip now and then and do have a social drink when am having difficulty and I do still at times have ideation of suicide but I push that out of my mind because I know how My DH and Daughter were also devastated by our son's death. I also have a grandson now who will be 5 in 6 months and I have to be here for him as well.

I am so sorry you also are struggling. I hope things get better for you as well!

Hugs to you (((((((((((Liese)))))))))))

When My T told me I was also BPD, (because I made her promise to tell me everything). Or I couldn't feel like she could be trusted.

She also told me that she never puts a dx on a clients record that would be a permanent record for the Ins. Co. or even my P. She only puts it in her private notes. She said P's will usually note that in the records.

So now I am a little concerned if I should/could ask his opinion as to whether I am BPD or not. So to the internet I go to find answers.

Hi Marsh,

Thanks for the hugs. Yeah, just like you, I was much worse in my late teens, early 20's. But then again, it seems like so many people I know were really bad then also. It seemed like everyone was drinking and having sex. Were we all BPD??? I was looking on the internet for answers but it's so hard because what do they mean by frantic attempts ... I can't remember the rest of it? You have to read and interpret each word and probably only a P could do it.

I think things will get better for all of us because we are all trying, right Marsh?

Late to the boards on this- but I found it most interesting.
My t never talks about this stuff, never. Once I was determined to find out and I had to point blank- ask him what he tells the ins co. when he sends in the paperwork. He told me ptsd, but we've never discussed it.
Maybe it is time I learn a thing or 2 about this.
I like what you say Russ- yes - a broken heart,not loved or protected enough when I was young.

HI Mayo,

Well there seems to be a bit of overlap between all the trauma stuff and BPD. Has there been a definite link made between trauma and BPD? Or just speculation? Whereas with PSTD and C-PSTD there is a definite trauma link?

Okay, so the good news. I don't have BPD. Some mild symptoms of three of the nine traits that could come under another diagnosis, like anxiety and/or depression.

I have more to post about this alter but right now have to drive my daugther to guitar.

You caught that, huh, MH? Those freudian slips!