Complex post-traumatic stress disorder (C-PTSD) and borderline personality disorder (BPD) are two distinct mental health conditions that can share overlapping symptoms.
Both C-PTSD and BPD may cause feelings of anxiety, depression, anger, or emptiness. Both conditions also have links to trauma to varying degrees.
However, while traumatic experiences directly cause C-PTSD, their role in BPD is less certain.
Read on to learn more about the similarities and differences between C-PTSD versus BPD, including their symptoms, diagnosis, and treatment options.
Both C-PTSD and BPD can develop after traumatic experiences and have some overlapping symptoms. However, they are distinct conditions.
C-PTSD
Complex PTSD (C-PTSD) is a condition that can occur in people who have multiple or ongoing traumatic experiences.
Unlike PTSD, which results from a single, time-limited traumatic event, C-PTSD involves chronic trauma that a person feels unable to escape. This disrupts a person’s ability to feel safe and can significantly alter their view of the world, other people, and themselves.
The symptoms of C-PTSD are similar to those of PTSD. These may include nightmares, flashbacks, or feeling constantly alert. People with C-PTSD may also have:
- difficulty trusting others or forming relationships
- negative self-image
- difficulty regulating emotions
BPD
BPD is a personality disorder that causes some of the same symptoms as C-PTSD, including unstable relationships and difficulty regulating emotions.
However, BPD also causes a person to have an unstable self-image, meaning they are not sure who they are. A person’s sense of identity may shift back and forth, or they may feel empty.
The relationships of those with BPD also
Other symptoms
- fear of abandonment
- intense shifts in mood
- impulsive behavior that may be self-destructive
- self-harm or suicidal thoughts
A person with C-PTSD could also have some of these symptoms, but their sense of self will be more stable, even if it is negative.
BPD is a long-term condition that affects every aspect of thinking or behavior, whereas C-PTSD may not. BPD also tends to develop in early adulthood, whereas C-PTSD can develop at any age.
Below is a table comparing the effects of both C-PTSD and BPD:
| Effect | C-PTSD | BPD |
|---|---|---|
| Self-perception | Negative self-view | Unstable and possibly contradictory self-view |
| Relationships | May have difficulty connecting with others or | Unstable and often extreme relationships |
| Emotional dysregulation | May have difficulty managing negative emotions | May have mood changes lasting |
| Dissociation | Can be present, although not always | May experience severe dissociation |
| Avoidance | Avoids reminders of the trauma | Avoids real or perceived abandonment |
| Impulsive or self-destructive behavior | Can be present, but not a key symptom | Common |
| Hypervigilance | Common | Not a symptom |
| Flashbacks or nightmares | Common | Not a symptom |
It is worth noting that, depending on the situation, a person with C-PTSD could also have some additional symptoms overlapping with BPD.
People with PTSD can also have other conditions, such as substance use disorders, that may resemble BPD symptoms.
This potential for crossover is why it is important that people speak with a psychologist or psychiatrist for a diagnosis.
Yes, it is possible to have both C-PTSD and BPD.
A 2021 review mentions previous research in which 30% to 70% of adults with BPD also had PTSD at some point in their lives.
The similarities have led some researchers to suggest that PTSD, C-PTSD, and BPD may represent a continuum of post-traumatic stress disorders, with one potentially progressing to the next.
For example, if a child experiences one traumatic event, they may develop PTSD. With further events, they may develop C-PTSD and, in some cases, may go on to have BPD in early adulthood.
However, scientists are still researching the potential links between these conditions.
Yes, doctors can misdiagnose C-PTSD as BPD, or vice versa. This may happen for several reasons:
- Symptom overlap: In addition to the existing similarities, some cases of C-PTSD may resemble BPD in specific ways. For example, a person who experiences abandonment in childhood may develop a fear of this happening again. This can happen in people without BPD, as well as those with BPD.
- Lack of awareness: Not all diagnostic manuals recognize the existence of C-PTSD as a separate condition. As a result, some health professionals may not be aware of it.
- Gaps in memory: People who experience trauma can have dissociative amnesia, which is when they cannot remember events or significant details about those events. Treatment may help a person recover memories, but if not, a clinician may not be fully aware of their history.
- Comorbidity: A 2021 review notes that in previous research, people with BPD often received initial diagnoses of PTSD. This does not necessarily mean those diagnoses were incorrect, though. Many people with BPD also have a history of traumatic experiences and may meet the criteria for both.
Diagnosing C-PTSD and BPD involves a comprehensive evaluation by a mental health professional. This process may include:
- Clinical interviews: In-depth interviews help assess a person’s symptoms, severity, behavioral patterns, and any history of traumatic experiences. This does not always involve a detailed retelling of the events. Mental health professionals mainly need to know the overall nature, frequency, and severity.
- Assessments or questionnaires: These tests can gather more detailed information about the individual’s symptoms and functioning. They help identify specific traits and patterns present in C-PTSD and BPD.
- Consideration of coexisting conditions: Mental health professionals must consider the presence of other conditions, such as depression, anxiety, substance use disorders, and other personality disorders, as these may inform the diagnosis.
- Observation and reports: Input from family members, close friends, or caregivers can sometimes provide additional insights.
Treatment for both C-PTSD and BPD often involves a multifaceted approach. Below are the primary treatment options for each condition:
C-PTSD treatment
The main treatment for C-PTSD is trauma-focused therapy. There are
These treatments help reduce the impact of traumatic memories and the effects they have on daily life.
There are no drugs that cure PTSD or C-PTSD, but in some cases, a doctor may prescribe them to help a person begin talk therapy more easily or to manage other symptoms, such as depression.
People may also gain benefits from mindfulness or support groups.
BPD treatment
The
- mentalization-based treatment
- dialectical behavior therapy (DBT)
- schema therapy
- transference-focused psychotherapy
These treatments help individuals understand their emotional responses, develop healthier relationships, and build coping strategies for managing intense emotions and impulsive behaviors.
Health professionals may also prescribe medications to manage symptoms such as anxiety, mood shifts, or impulsivity. However, there is a lack of evidence that medication helps with the core symptoms of BPD.
People with both C-PTSD and BPD may benefit from a mixture of the above options. Trauma therapies may help address the underlying causes, while ongoing psychotherapy or medication may help improve symptoms long term.
Learn more about therapies for BPD.
It is important to seek help if a person experiences persistent emotional distress, such as overwhelming sadness, anxiety, or anger. This can indicate the need for support.
If someone has intrusive thoughts, especially thoughts of self-harm or suicide, it is crucial to speak with a mental health professional.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
C-PTSD and BPD are distinct mental health diagnoses with some overlapping symptoms, such as emotional dysregulation.
However, where BPD causes an unstable sense of self, those with C-PTSD tend to have a more stable but negative self-view. BPD also often involves extreme or intense relationships. Both conditions can occur following traumatic experiences.
People can have one or both of these diagnoses at a time. Various types of therapy, such as TF-CBT and DBT, can ease symptoms and help individuals improve their mental health.
People who believe they could have either of these conditions or who often feel distressed should speak with a doctor or mental health professional if they can.