CPTSD Vs. BPD: Understanding the Similarities & Differences

What Is CPTSD?

Complex post-traumatic stress disorder (CPSTD) is a form of post-traumatic stress disorder (PTSD) that can involve more severe symptoms and lasting impairments that persist for months or even years after a traumatic experience. CPTSD usually develops in people who experience repeated trauma rather than a one-time experience. Most people with CPTSD have extensive childhood trauma and a history of emotional, physical, and/or sexual abuse.^2,4,6

Recently, CPTSD was added to the ICD-11, which is a classification system that provides a unique numerical code for each mental health diagnosis. Complex PTSD is still not included in the DSM 5 (the diagnostic reference guide for all mental health conditions), meaning that CPTSD is not formally recognized as a diagnosable mental health condition. This will likely change in the coming years, especially since several recent studies have legitimized CPTSD as a distinct disorder.^1,4

Symptoms of CPTSD include:^3,4,6

• Exposure to a traumatic event or experience that’s usually extreme and prolonged in nature, difficult or impossible to escape, and extremely harmful or distressing
• The presence of core PTSD symptoms includes re-experiencing the traumatic event through dreams, memories, or flashbacks, avoiding trauma reminders, and being constantly vigilant for danger
• The development of persistent and severe impairments in a person’s mood/emotions, identity/self-concept, and ability to form and maintain close and healthy relationships

What Is BPD?

Borderline personality disorder (BPD) is one of the ten personality disorders listed in the DSM 5. People with BPD struggle with deep fears of abandonment, difficulty regulating emotions, a pattern of self-destructive behaviors, and impulsivity.¹ BPD is closely linked to childhood trauma. In fact, while only about 6% of people have BPD, over 80% report being abused, neglected, or traumatized in childhood.^2,3

The impulsive and destructive behavioral patterns in BPD make it difficult for people with the disorder to function normally. Unhealthy and even codependent or toxic relationships are one of the most common impairments among people diagnosed with BPD, and interpersonal conflicts are also a common trigger for BPD symptoms. Self-harm, cutting, and other destructive coping mechanisms are also common in BPD and can be another source of serious impairment related to the disorder.¹

The primary symptom of BPD is:¹

• A pervasive pattern of instability in relationships, self-image, mood/affect, and impulsivity beginning in early adulthood and present in a variety of situations

In addition to the primary symptoms, five or more of the following symptoms must be present:

• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable and intense interpersonal relationships that alternate between extreme idealization and devaluation
• Identity disturbance (unstable sense of self, self-concept, or identity)
• Impulsivity in at least two potentially destructive areas (i.e., sex, spending, substance use, binge eating, driving, etc.)
• Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior (i.e., cutting)
• Mood instability (i.e., more emotionally reactive, irritable, sad, moody, etc.)
• Chronic feelings of emptiness
• Inappropriate and intense anger or anger outbursts
• Transient paranoid thoughts or dissociative symptoms triggered by stress

How Are CPTSD & BPD Similar?

CPTSD and BPD have many overlapping risk factors, as well as similar symptoms and impairments. People who experience physical, emotional, or sexual abuse or neglect in childhood are more likely to develop CPTSD and BPD. In both disorders, the chronic and long-term experience of traumatic events is one of the most significant factors that can cause or contribute to the onset of symptoms.^2,3,5

CPTSD and BPD also share similar symptoms and characteristic patterns. For example, poor emotional regulation and difficulties with impulse control are common in both conditions and so is the experience of dissociative symptoms. The heightened risk for suicidal attempts and self-harming behaviors is another symptom that can show up in both CPTSD and BPD.^1,2,3

Some of the key similarities between CPTSD and BPD include:^1,2,3,5,7

• Shared risk factors: Childhood trauma, abuse, and neglect are a common risk factor for both BPD and CPTSD
• Dissociation: Dissociative episodes or flashbacks can be present in both BPD and CPTSD, especially during times of stress or hardship
• Changes in mood: Mood changes are a feature of both complex trauma and BPD and can show up as increased anxiety, depression, or other mood problems
• Emotion regulation issues: People with CPTSD and people with BPD have a hard time regulating their emotions and calming down when they’re upset or triggered
• Relationship problems: People with both CPTSD and BPD struggle to form healthy, close, and lasting relationships with other people but may have different kinds of interpersonal issues
• Self-destructive behaviors: Behaving in self-destructive, impulsive, or reckless ways is common in both BPD and CPTSD and may involve substance use, promiscuity, trauma re-enactments, or suicidal/self-harming behavior
• Functional impairment: The symptoms of both CPTSD and BPD can become debilitating for people, interfering with their ability to live, work, and function

BPD Misdiagnosis as CPTSD

Because of the overlapping symptoms, causes, risk factors, and the high rate of co-morbidity, CPTSD, and BPD are commonly confused. Sometimes, this confusion leads to a misdiagnosis of BPD when the individual, in fact, has CPTSD. A misdiagnosis of CPTSD is less likely to happen since it is not an officially recognized diagnosis at this time.¹

Differences Between CPTSD Vs. BPD

While there are many similarities between CPTSD and BPD, there are also important differences that can be used to distinguish the two disorders from one another. One of the main differences is that CPTSD symptoms begin after a major traumatic experience. In contrast, while most people with BPD have experienced trauma, it’s possible for people with no trauma history to develop the disorder.^2,3,5,7

Some of the key differences between CPTSD and BPD include:

When Symptoms Begin

CPTSD symptoms start after a traumatic event or a set of traumatic experiences, and BPD symptoms can begin anytime in adolescence or early adulthood. When a person’s symptoms begin shortly after they experience a major traumatic event, CPTSD is often suspected instead of BPD.^1,4

Underlying Fears

The core fears that drive dysfunctional behaviors in CPTSD and BPD often differ. People with BPD have an intense fear of abandonment that causes them to alternate between ‘hot and cold’ behaviors in relationships.¹ People with complex PTSD, on the other hand, are more likely to have a fear of intimacy and closeness and are more likely to withdraw and isolate themselves.^2,3,5,7

What Triggers the Symptoms

People with CPTSD are more likely to display symptoms when they’re exposed to something that reminds them of the trauma they experienced (a trauma trigger). People with BPD tend to have a wide range of potential triggers that can upset, anger, or disturb them. This is why people with CPTSD are often portrayed as more emotionally stable than people with BPD.^3,5

Coping Styles

People with CPTSD and BPD have different ways of dealing with difficult thoughts, feelings, and situations. People with CPTSD are more likely to cope by withdrawing, isolating themselves, and avoiding situations that trigger them. People with BPD are more likely to act out in destructive or impulsive ways when they’re feeling upset.^1,2,3,5

Relationship Patterns

The relationship patterns in BPD and CPTSD can look very different. For people with CPTSD, isolation and withdrawal are more common and lead them to become alienated from other people. People with BPD tend to develop intensely close relationships with others that often come to fast and traumatic endings.⁸

Trauma Memories

People with CPTSD often struggle with traumatic flashbacks, memories, and nightmares, but this is not always true for people with BPD. Traumatic memories often lessen with time, and people with CPTSD are more likely to have experienced recent traumas that continue to affect them.^1,6

Identity Confusion

People with BPD often feel confused about who they are, what they want, and what makes them unique and special from others. They may have a tendency to ‘shapeshift’ in relationships, which can worsen their identity confusion. People with CPTSD, on the other hand, have a more stable and certain sense of self.^5,8

Type of Trust Issues

People with both BPD and CPTSD often struggle with trust issues, but these might show up in slightly different ways for each. For people with borderline personality disorder, trust issues may show up as jealousy or fears of being abandoned. For someone with CPTSD, trust issues are more likely to show up as a fear of being hurt, betrayed, or taken advantage of.⁸

Self-Concept

People with BPD tend to alternate between extreme highs and lows in their self-confidence. One moment, they might feel great about themselves, and the next, they might feel extremely insecure and ashamed. For someone with CPTSD, it’s more typical to see consistently poor self-esteem instead of the fluctuating self-esteem seen in BPD.^5,7,8

Intensity of Mood

People struggling with CPTSD often have fewer and less extreme mood swings than people diagnosed with BPD. People with BPD also tend to struggle more with feelings of emptiness and confusion about who they are.^5,8

Causes of CPTSD & BPD

Because of the variation in individual responses to traumatic events, researchers are hesitant to list specific ‘causes’ for mental health conditions. Instead, most experts believe that a number of different factors can contribute to a person’s risk for CPTSD and BPD, including a person’s genetic and psychological makeup and lived experiences.^2,3,6

Certain kinds of trauma are also more likely to lead to complex trauma or BPD traits. Sexual abuse and emotional abuse in childhood are common in the childhood experiences of people with both disorders, and the abuse may have occurred multiple times or for a prolonged period of time. In many cases of CPTSD and BPD, the traumatic experiences in childhood involved a parent or other primary caregiver, which suggests insecure attachment styles could also be a potential cause of these disorders.^1,2,3,5,8

Treatment for CPTSD Vs. BPD

The treatments for CPTSD and BPD are often similar. In most cases, therapy is the frontline treatment recommended for both disorders. Some of the most effective treatments for both conditions are evidence-based treatments for PTSD, including CPT, EMDR, and therapies that use prolonged exposure therapy.⁵ Therapy provides people with CPTSD and BPD to heal from childhood trauma and learn more effective coping methods.

Some of the effective treatments for complex PTSD and BPD include^5,6,7,9

• Dialectical behavioral therapy (DBT): DBT is a structured therapy that can be offered in groups or individual counseling sessions that teaches distress tolerance, interpersonal skills, emotion regulation, and mindfulness skills
• Schema therapy: Schema therapy helps people identify and adjust negative core beliefs about themselves, others, and the world that are interfering with their ability to function
• Eye movement desensitization and reprocessing (EMDR): EMDR is a trauma therapy that helps people access and reprocess traumatic memories by using rapid eye movements or bilateral ‘tapping’ until they become desensitized.
• Accelerated resolution therapy (ART): ART is a new evidence-based practice for trauma that involves the use of imagery, eye movement, and other exercises to recondition trauma responses in the brain.
• Cognitive processing therapy (CPT): CPT helps people change the way they understand the traumatic events they experienced by adjusting their perspective on what happened, why it happened, and what it means for them and their lives.

Can You Have Both CPTSD & BPD?

Even though CPTSD is not a formal diagnosis in the DSM, many people are diagnosed with both PTSD and BPD.⁴ In fact, if you are diagnosed with either disorder, there’s about a 30% chance you will develop the other disorder at some point.² Studies have also been conducted to determine whether CPTSD and BPD are really distinct disorders, and most have determined that they are different despite having overlapping symptoms.^{12,3,4,5,7,10}

Prognosis of CPTSD Vs. BPD

CPTSD and BPD are chronic disorders that can negatively affect how a person thinks, feels, behaves, and relates to others. While there is no cure for either condition, most experts believe that it’s possible to manage and possibly overcome the symptoms with treatment. Seeking professional help from a licensed professional can improve the odds of making a full recovery from both disorders.^2,3,4,6

When to Seek Professional Support

If you are struggling with symptoms of BPD or CPTSD that are severe enough to affect your daily life or ability to function, it’s a good idea to seek professional help. You should also seek support if your symptoms or past trauma affect your ability to have healthy, close, and lasting relationships. Symptoms tend to worsen on their own, but seeking professional help can interrupt this cycle and improve your quality of life.

Because CPTSD and BPD are specialized areas of practice, it’s important to find a therapist who is knowledgeable and experienced in treating these disorders. Many people begin their search by using an online therapist directory that allows them to narrow their search results to therapists by location, insurance type, and area of specialty.

In My Experience

In my experience, complex trauma is at the root of many mental health disorders. People with personality disorders are usually victims of complex childhood trauma and attachment wounds. When this grows into abandonment issues, emotional instability, and self-destructiveness, this is often classified as trait of borderline personality disorder. When this grows into trust issues, social withdrawal, and avoidance of trauma triggers, we might categorize this as PTSD or CPTSD. Because unresolved trauma and attachment issues seem to drive both disorders, trauma-informed therapies can usually help with both conditions.