6 thoughts on “How are Complex Trauma and Borderline Personality Disorder Related?

  • January 6, 2015 at 8:45 pm

    This is exactly the problem: therapists assuming people with BPD have been traumatized. Therapists also assume people with BPD are all female, even though the latest research shows the disorder is about equally found in men and women. When it comes to BPD, you have to keep up fast.

    The following is from my book The Essential Family Guide to Borderline Personality Disorder (2008. Hazelden). All of my work was checked my Robert Friedel, MD, of the NEBPD. The numbers refer to footnotes in the book. I would love this post to be an article on PsychCentral.

    Abuse: Myths and Realities
    If you’ve researched borderline personality disorder for any length of time, you’ve read that abuse causes BPD. This belief partly comes from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which states that 75 percent of people with BPD have been abused.

    The data, however, has a few flaws. First, if abuse causes BPD, than how do you explain the fact that one out of four BPs has not been abused?

    Second, a correlation is not necessarily a cause. Robert O. Friedel, MD, director of the BPD program at Virginia Commonwealth University, says, “None of the environmental risk factors I’ve discussed [early separation or loss, trauma, ineffective parenting, and adverse social customs] has been show to cause borderline disorder. Many people who are exposed to the same abuse, separations, and bad parenting do not develop borderline disorder, and some borderline patients have not experienced any of these environmental risk factors.”[8]

    Third, the 75 percent figure is based on self-reporting, meaning that it was compiled by asking adult patients if they have a history of abuse. The assumption is that the responses are 100 percent accurate, and that there is a consensus of what, exactly, constitutes “abuse,” be it emotional, sexual, or physical.

    However, as a method of data collection, self-reporting is considered to be unreliable. Dieters are notorious for underestimating their food intake, and food is a pretty simple thing to measure compared to “abuse.” Plus, the subjects have a disorder that, by definition, is characterized by faulty perception and reasoning.

    These cognitive defects, added to the vagueness of the term “abuse” and the limits of the methodology, mean that the 75 percent abuse statistic should come with a disclaimer.

    There is a middle ground here. Clinician Harriet Lefley, PhD, explains, “People biologically predisposed to develop BPD are hypersensitive to, and more intensely experience, the slights, criticisms, and punishments endured by most children in the process of growing up. And if parents are raising an exceptionally difficult child, these criticisms and punishments are likely to be frequent and generate tension in family dynamics—and later be recalled as abusive.”[9]

    Sharon is a mother of a child with BPD and maintains an online support group for parents of children with this disorder. Her group is called NUTS (parents Needing Understanding, Tenderness, and Support to help their child with borderline personality disorder). She says:

    “Throughout my ten-plus years of running NUTS, I have seen very few families pass through where abuse, neglect, trauma, etc., have been an issue. I realize that abusive parents probably won’t be joining a group and talking about it. Still, our little sampling of the world of BPD does indicate that there are many of us out here struggling with BPD where there isn’t the trauma/abuse cause involved.

    “In addition, about 70 percent of our children in NUTS have falsely accused someone of abuse; my own daughter accused me and we were under investigation. My other daughter denied that we were abusive.[10]

    Perry Hoffman, cofounder of the Family Connections program of the National Education Alliance for Borderline Personality Disorder, is concerned about the same issue. She says:

    “We have to educate clinicians not to fingerpoint family members. Certainly we know there’s abuse that goes on. But I certainly know that the family members I interface with or who have come through our Family Connections program are not the parents who have abused their children. And these are the families who are feeling so terrible when they read about abuse and [its association with BPD].[11] “

    • January 8, 2015 at 4:39 am


      I had a lot to say about this article and I am pleased to see you already have it covered. Thanks for being a strong and positive voice for us with BPD. You are truly an inspiration and have been instrumental in empowering me to find my own voice in BPD advocacy.

      Love and kindness,

      Rachel Gill
      BPD Peer advocate
      DBT Peer Mentor

    • January 8, 2015 at 7:55 am

      Thank you for sharing your insights into the research and the reminder about correlation and causation–always important to remember, and is certainly relevant here. I was actually careful to mention that the assumption that all survivors of BPD are trauma survivors isn’t correct. I agree that we need more research about the relationship between attachment, trauma and BPD. For now the attachment model is the prevalent one and is the one I, like most clinicians, lean toward, but I hear what you’re saying about how hurtful that is to families that weren’t abusive. I do appreciate your reminder that abuse being a cause is not proven, and I will be mindful of that.

  • January 8, 2015 at 8:20 pm

    My psychologist told me that many people who are diagnosed with BPD and suffer trauma actually have PTSD. That makes a lot more sense.

    • April 4, 2015 at 4:06 pm

      I had never heard of BPD when a therapist told me I had it, at age 46.
      If I had known my lifetime of seeking help, and telling every doctor, therapist, psychiatrist and pretty much everyone else I had terrible childhood experiences and an ongoing, psychologically abusive family-of-origin situation, actually proved I have complex PTSD, I would have been able to prevent what has turned into a nightmare. I got a BPD diagnosis and it has been used against me in every way imaginable. Now the “pros” are refusing to change it. They say since treatment is the same, it doesn’t matter. I feel this is completely wrong. I have managed to get into a trauma therapy framework and for the first time in my life, I am now 49, I am making sense of what happened to me. ONLY within the trauma model are my problems addressed. I am using a huge amount of time and energy to try to fight this misdiagnosis. It is so frustrating. If I get angry over the barriers, misinterpretation of symptoms, or anything else, they say…see! She has BPD. I do not. I have PTSD. These labels make a big difference. They harm. They stigmatize, and most of all, they form the foundation of a narrative that is applied to a person who does not benefit from it.

  • January 10, 2015 at 7:32 pm

    You might be interested in DBT-PE (developed by Melanie Harned at UW), a modification of DBT for prolonged exposure, primarily for patients with BPD/C-PTSD.


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