29 Jul 2024Complex PTSD (CPTSD) is a recently defined disorder that presents very similarly to borderline personality disorder (BPD). Following the recent publication of her systematic review on the two diagnoses, supported by NIHR ARC North Thames, Jessica Rose Atkinson of the Centre of Psychiatry and Mental Health at Queen Mary University London shares what she found and why it matters.
CPTSD and BPD have both been linked to adverse childhood experiences, resulting in affect dysregulation, negative self-concept and relationship impairments. Given their significant impacts on individuals’ well-being, it's vital to identify the best treatment and support pathways.
When starting my PhD, I had hoped to investigate which treatment was more effective for BPD and for CPTSD. My intention was to follow groups of individuals with these separate diagnoses in order to better understand the impacts of treatment.
However, I very quickly realised it was not going to be that simple. Finding individuals with a clear and separate diagnosis was not straightforward because of how similarly they present.
The similarities between the two disorders have raised questions within research as to whether they are separate mental health diagnoses, as presented in the International Classification of Diseases (ICD-11), or whether CPTSD should be classified a subtype, or even used as a replacement for the highly stigmatised 'BPD' label.
"The similarities between the two disorders have raised questions within research as to whether they are separate mental health diagnoses."
This paper systematically reviewed the similarities and differences in terms of symptom presentations between two disorders. I sought to uncover whether they should remain two distinct mental health diagnoses, as found in the ICD-11, or whether they present too similarly to be differentiated.
Method
Four peer reviews and two grey literature databases were searched. The inclusion criteria included participants 18 years or older with papers presenting the symptoms of BPD and/or CPTSD. If information was missing from a study, authors were contacted. 11 papers were included and their methodological quality was assessed. Due to the wide variety of studies included, the systematic review synthesised the results narratively.
The majority of studies I reviewed find CPTSD and BPD to be distinct profiles:
- CPTSD symptoms include: experiencing nightmares and intrusive recollections, attempts to avoid thinking about trauma, negative views of self, feeling guilt and worthlessness and feeling numb to emotions.
- BPD symptoms included impulsivity, temper outbursts, intense and unstable relationships, self-harm and suicidal behaviour, disturbances in identity and how one feels about themselves and fears of being abandoned.
While they do remain separate diagnoses, CPTSD and BPD can present together. These individuals will have likely experienced earlier and more frequent trauma, and display greater psychological impairment.
This review therefore suggests the merger or replacement of BPD is inadvisable – particularly because treatments for the condition are different.
Yet it is important to recognise that the similarities exist, and remain alert to potential confusion. The clinical assessment of the patient is very important, and needs to accurately differentiate between conditions that may seem similar.
Writing this systematic review has created fruitful discussions whenever I have presented it. I am always very intrigued to hear what others have to say in reference to BPD and CPTSD, to increase my understanding not only from a research perspective but a practical one too.
If you have any thoughts you would like to share, please do not hesitate to get in touch.