Post-Traumatic Stress Disorder

PTSD and its Connections to Borderline Personality Disorder

Before you start reading, you may want to check out this highly informative overview of the basics of PTSD & its concept as a psychological category: Usefulness and validity of post-traumatic stress disorder as a psychiatric category by Gillian Mezey and Ian Robbins.

PTSD is a very difficult beast to get a grip on, all the more so because its classification as a mental health disorder has always had a problematic status. As has been pointed out, "the entire canon of diagnostic categories in DSM-IV is phenomenological and descriptive, bar post-traumatic stress disorder. Aetiology [the causes] is not included in definitions because it is invariably multifactorial. Only post-traumatic stress disorder supposes a single cause."

Viewed as a time-limited 'normal human response' to extraordinary external stressors, PTSD is not pathological. Viewed as a chronic response that is limited to people with certain prior life experiences, it is. There are strong arguments to be made for drawing a distinction between the two. Read the commentary and resources below, and make up your own mind: the jury is still out.

Symptoms of PTSD:

* Recurring thoughts or nightmares about the traumatic event or events.
* Trouble sleeping or changes in appetite.
* Anxiety and fear, especially when exposed to events or situations reminiscent of the trauma.
* Being on edge, being easily startled or becoming overly alert.
* Depression, sadness and low energy.
* Memory problems including difficulty in remembering aspects of the trauma.
* Feeling "scattered" and unable to focus on work or daily activities.
* Difficulty making decisions.
* Irritable, easily agitated, or angry and resentful.
* Feeling emotionally "numb," withdrawn, disconnected or different from others.
* Spontaneously crying, feeling a sense of despair and hopelessness.
* Feeling extremely protective of, or fearful for, the safety of loved ones.
* Not being able to face certain aspects of the trauma, and avoiding activities, places, or even people that remind one of the event.

Psychological trauma is at the very core of understanding personality disorders.

People who have survived early and/or repetitive trauma can suffer acute and chronic physiological changes: traumatic stress affects the catecholamine system, hypothalamic-pituitary-adrenal axis (HPA), and the hypothalamic-pituitary-gonadal axis (HPG). If the trauma is early enough in life, severe enough, lasts long enough over time, or a genetic vulnerability is present (all of which may be the case with BPD), it can cause profound neurological damage to the brain. Recent research also suggests that there may exist a specific genotypic vulnerability to this form of early environmental trauma.

If you are intimately familiar with the emotional dynamics of someone suffering from Borderline Personality Disorder, the above descriptions of PTSD symptoms will not be new to you. In fact, recent research has suggested that a dual diagnosis of BPD and PTSD is redundant. Studies comparing the symptomatology of BPD and PTSD found that a physiological reaction to abandonment scripts in patients diagnosed with BPD may be the major distinguishing difference between the two.

Many researchers consider BPD to be a form of "Chronic PTSD" or "Complex PTSD": the long-standing, seemingly permanent result of early traumatic experiences that went unacknowleged and untreated. This is both a psychodynamic viewpoint and a neurobiological one: in a kind of life-long static feedback loop, the physiological fight-or-flight response to stress feeds upon itself, continually placing the sufferer in alternating states of hyperarousal and numbness. (This begs the question of how to appropriately categorize that small percentage of BPD sufferers who self-reportedly experienced no forms of early abuse or trauma -- that research can be found in my section on Neurological Origins of BPD. See also Related & Comorbid Disorders: Bipolar Disorder for some theories on BPD as a biochemical variant of mood disorders.)

This article abstract sums up the resarch on developmental factors for Chronic PTSD and BPD extremely well:

Stress activates the central and peripheral components of the stress system, i.e., the hypothalamic-pituitary-adrenal (HPA) axis and the arousal/sympathetic system. The principal effectors of the stress system are corticotropin-releasing hormone (CRH), arginine vasopressin, the proopiomelanocortin-derived peptides alpha-melanocyte-stimulating hormone and beta-endorphin, the glucocorticoids, and the catecholamines norepinephrine and epinephrine. Appropriate responsiveness of the stress system to stressors is a crucial prerequisite for a sense of well-being, adequate performance of tasks and positive social interactions.

By contrast, inappropriate responsiveness of the stress system may impair growth and development, and may account for a number of endocrine, metabolic, autoimmune and psychiatric disorders. The development and severity of these conditions primarily depend on the genetic vulnerability of the individual, the exposure to adverse environmental factors and the timing of the stressful event(s), given that prenatal life, infancy, childhood and adolescence are critical periods characterized by increased vulnerability to stressors.

The developing brain undergoes rapid growth and is characterized by high turnover of neuronal connections during the prenatal and early postnatal life. These processes and, hence, brain plasticity, slow down during childhood and puberty, and plateau in young adulthood. Hormonal actions in early life, and to a much lesser extent later, can be organizational, i.e., can have effects that last for long periods of time, often for the entire life of the individual. Hormones of the stress system and sex steroids have such effects, which influence the behavior and certain physiologic functions of individuals for life.

Exposure of the developing brain to severe and/or prolonged stress may result in hyperactivity/hyperreactivity of the stress system, with resultant amygdala hyperfunction (fear reaction), decreased activity of the hippocampus (defective glucocorticoid-negative feedback, cognition), and the mesocorticolimbic dopaminergic system (dysthymia, novelty-seeking, addictive behaviors), hyperactivation of the HPA axis (hypercortisolism), suppression of reproductive, growth, thyroid and immune functions, and changes in pain perception. These changes may be accompanied by abnormal childhood, adolescent and adult behaviors, including excessive fear ('inhibited child syndrome') and addictive behaviors, dysthymia and/or depression, and gradual development of components of the metabolic syndrome X, including visceral obesity and essential hypertension.

Prenatal stress exerted during the period of sexual differentiation may be accompanied by impairment of this process with behavioral and/or somatic sequelae. The vulnerability of individuals to develop varying degrees and/or components of the above life-long syndrome is defined by as yet unidentified genetic factors, which account for up to 60% of the variance. CRH has marked kindling and glucocorticoids have strong consolidating properties, hence both of these hormones are crucial in development and can alone produce the above syndrome. CRH and glucocorticoids may act in synergy, as in acoustic startle, while glucocorticoids may suppress or stimulate CRH, as in the hypothalamus and amygdala, respectively. A CRH type 1 receptor antagonist, antalarmin, inhibits both the development and expression of conditioned fear in rats, and has anxiolytic properties in monkeys.

Profound stressors, such as those from sexual abuse, may elicit the syndrome in older children, adolescents and adults. Most frequently, chronic dysthymia and/or depression may develop in association with gastrointestinal complaints and/or the premenstrual tension syndrome. A lesser proportion of individuals may develop the classic posttraumatic stress disorder, which is characterized by hypocortisolism and intrusive and avoidance symptoms; in younger individuals it may present as dissociative personality disorder.
Copyright 2003 S. Karger AG, Basel Charmandari E, Kino T, Souvatzoglou E, Chrousos GP., Hormone Research, 2003;59:161-179.

Why do those with BPD seem to almost deliberately seek out chaos in their lives?

Much of the research on PTSD has focused on the compulsive tendency of sufferers to "re-enact" inadequately resolved early traumatic experience. The documented tendency of those with BPD to appear to seek out abusive intimate relationships and risky situations in adulthood, for example, illustrates this principle of "re-victimization."

This phenomenon has been read in psychiatric circles in various ways:
1) as the unconscious wish to 'replay' an original traumatic relationship in order to bring about a better conclusion this time around,
2) as the power early trauma has over an individual's self-image, leaving a person subjectively 'helpless' to change that accustomed role,
3) as the weakness of the cognitive executive functions of the brain under higher levels of stress perception, and, related to this,
4) as a purely neurological, inheritable dysfunction of those parts of the brain that regulate stress perception and actively "addict" the sufferer's body to higher levels of stress-related, self-produced biochemicals.

Regardless of one's take on their etiology, once they are set in place during an individual's developmental years, the coping mechanisms that developed in order to combat the everpresent subjective sense of being under attack are extremely difficult (although not impossible) to "re-wire" -- thus, also, the label Personality Disorder: these cognitive mechanisms become ingrained so early on as to form a constitutive portion of the individual's personality, or identity.

What's up with the strange selective memory of those with BPD?

One of the most puzzling aspects of severe PTSD as well as BPD, for observers, is the effect these disorders can have on a person's overall cognitive functioning. Paranoia about current events, sudden mood shifts, situationally-inappropriate outbursts of aggression or grief, enduring depression, and the inability to recall past events correctly, are all classic chronic PTSD symptoms.

In severe cases, PTSD sufferers can dissociate, mentally placing themselves back into the original traumatic scenario during a current adult interaction. This process is known as "triggering." (Think of a war veteran flinging himself to the ground to seek cover at the sound of a car backfiring.) The Borderline's tendency to perceive abuse when none is present is a hallmark of the disorder wearily familiar to NonBP loved ones. The default position of a trauma survivor's brain chemistry is defensive -- the behaviors and thought patterns so destructive in BPD have developed over a lifetime of learning to cope with the enormous stress of a constant physiological state of perceived attack. This may be one reason that those suffering from BPD have a strong chance of also developing addictive disorders, as a method of numbing/escaping from their subjective pain.

For resources and articles on the puzzling relationship between memory and BPD, please see my entire page on Memory, Traumatic Amnesia, and BPD.

Most trauma therapy today focuses on allowing the sufferer to integrate the memories of traumatic experiences into a more coherent life narrative. Once the trauma is identified and articulated, the task of changing the ingrained reflexive behaviors will become more conscious and less insurmountable for the patient. This is why psychotherapy (talk therapy) of some kind is almost always necessary for treating BPD -- medication alone will help reduce the current stress level, but cannot address the root causes and learned nature of the symptoms.

Trauma researchers such as Dr, Judith Herman, Dr. John Briere, and Dr. Jennifer Freyd have proposed a convincing model of trauma that explains the two sets of apparently contradictory memory behaviors found in PTSD (and BPD): hyperarousal and intrusive memories versus numbness and forgetting. These and other researchers distinguish between Type I Trauma, caused by a single devastating event, and Type II Trauma, which results from chronic instances of abuse over time, the severity of the abuse, and multiple perpetrators.

Dr. Freyd clarifies this paradigm in the familial context; she characterizes traumatic experience as belonging to two categories (which may and do overlap in severe cases such as BPD): threat to life and social betrayal. Her work explores the betrayal trauma that occurs when caregivers treat an infant or child abusively. Her research proposes that survivors of such caregiver abuse (a large percentage of those with BPD) tend towards the amnesiac/dissociative end of the spectrum.

What about the traumatic effects of Complex PTSD/BPD on loved ones?

Untreated trauma is, in many ways, the 'gift that just keeps on giving': children who are sufficiently traumatized can develop the maladaptive behavioral coping mechanisms (addictions or raging) and distorted thought patterns (splitting, projection, dissociation or attachment disorders) typical of BPD that unfortunately can continue to traumatize those around them in adulthood. Because of the interpersonally abusive nature of many of these mechanisms (whatever their origin), over time, family members, partners/former partners, and children of those with BPD can themselves develop symptoms of PTSD. Children of untreated Borderlines are statistically more likely to develop symptoms or traits of the disorder, whether this is due to environmental or genetic factors, or both. (For research studies on this, see my page on: Etiology of BPD.)

It is not uncommon -- but by no means a rule -- for intimate partners of Borderlines (or close friends or co-workers) who develop PTSD symptoms, to have experienced emotionally invalidating or even abusive childhood histories themselves. Some of the worst emotional aftermath of a chosen relationship with a Borderline occurs in those non-Borderline partners who may have already been exposed to emotional trauma of some sort much earlier in life.
Current PTSD research is finding significant correlations between the development of adult PTSD symptoms and a personal history of some form of earlier trauma in, for example, war veterans following combat experience or rape victims.

There is a large body of research relating to this intergenerational transmission of trauma in families with a history of domestic violence, communities with a culturally ingrained tolerance of violence, or the experience of extremely traumatic events such as political internment or the Holocaust.

As yet, there is little research being funded on the profound effects of BPD on the community of non-Borderline friends and families -- see National Mental Health Organizations to find out how you can become an advocate to change this situation!

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Basics of PTSD

What is Psychological Trauma?

Reliving Trauma: Post-Traumatic Stress Disorder
Fact Sheet from the National Institutes of Mental Health

Post Traumatic Stress Disorder
Excellent, clear and informative talk given by Dr. Dennis Charney of the National Institutes of Mental Health, 2000.

Dr. Frank Ochsberger answers 10 Common Questions about PTSD

Defining Trauma
A fabulous detailed page by Deb Martinson, who runs web sites on self-injurious behaviors.

PTSD: What It Is and How to Recover
by Patience Mason, 1995
Really lovely detailed and compassionate piece written by the wife of a VietNam veteran; excellent tips!

Expert Consensus Treatment Guidelines For Posttraumatic Stress Disorder: A Guide For Patients and Families
Excellent comprehensive free publication. (Pdf file; requires Adobe Acrobat to read)

Research-Based Treatment For Posttraumatic Stress Disorder (PTSD)
Very helpful lecture notes from Dr. David Lilly of Sonnet Psychological, LLC, Maine.

Posttraumatic Stress Disorder (PTSD)
by Lauren Berman, PhD, 2001
Excellent clear overview of the symptoms of PTSD.

PTSD 101 for Journalists
by Frank Ochberg, MD

What Are Traumatic Memories?
A great online brochure from the Sidran Foundation.

Stress and Your Shrinking Brain (post traumatic stress disorder's effect on the brain)
Fabulous, funny article introducing basic neuropsychological concepts, by Robert Sapolsky, Discover Magazine, March, 1999

Development of the Cerebral Cortex: Stress and Brain Development
by Paul J. Lombroso, M.D. and Robert Sapolsky, Ph.D, 1998
Excellent summary of the physiological damages of long-term stress on brain development (including atrophy of the hippocampus/memory storage) -- technical language, but pretty clear. Great diagrams!

The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category
Great history of the term, the disorder and its controversies, by Derek Summerfield, 2001

Problems with PTSD and Alcohol Use

Post Traumatic Stress Disorder
by Greg Shannon
This is an excellent exploration into the causes of lifelong PTSD, by a VietNam veteran. Great, clear overview of the various theories explaining PTSD!

How Does PTSD Affect Families?
Recommended! Has very good specific tips for family members/loved ones for coping.

How does Trauma Affect Relationships?

PTSD and Holidays
Excellent coping tips and suggestions for all family members.

Posttraumatic Stress Disorder Handbook
by Glen R. Schiraldi, 2000
Describes the coping mechanisms of those with PTSD.
Also available online to download as a PDF file (requires Adobe Acrobat).

Children of Child Survivors of the Holocaust: Can Trauma be Transmitted Across the Generations?
by Dr George Halasz

Phenomenology and Psychobiology of the Intergenerational Response to Trauma
by Rachel Yehuda, Ph.D., Jim Schmeidler, Ph.D. Abbie Elkin, et al. 1997
Great detailed article and studies of the effects of the Holocaust on children of survivors.

Through the Eyes of Deception
Personal account of the development of BPD in a child of a family of Holocaust survivors.

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Organizations and Sites offering Post-Traumatic Stress Disorder Resources, Support & Information

The Post-Traumatic Stress Disorder Gateway
Excellent new site from the Dart Foundation

National Center for PTSD

MedLine's Collection of PTSD Research Articles
Maintained by the National Library of Medicine, this excellent collection is continually updated to bring you the very latest medical research on PTSD.

David Baldwin's Trauma Pages
Excellent site with lots of book recommendations, overview of PTSD and an extensive full-text collection of the most influential research on trauma.

The SIDRAN Traumatic Stress Foundation
Extensive book list, readings and updated information for both loved ones and the afflicted.

The PTSD Alliance
New organization that offers excellent overview readings, links, and information for everyone.
Order their excellent free booklet and video: Hope for Recovery: Understanding Posttraumatic Stress Disorder.

Gift From Within
"An International Organization for Survivors of Trauma and Victimization"

The International Society for Traumatic Stress Studies

American Academy of Experts in Traumatic Stress

The Trauma Center
Offers treatment programs (located in Massachusetts), readings and introductions to the latest research.

The National Center for Victims of Crime

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PTSD in Survivors of Abusive Relationships

Please also take a look at the many important resources on the BPD, Relationships & Abuse page.

A new survey on 'Physical and mental health effects of intimate partner violence for men and women' by Coker, Davis, et al, in the November 2002 issue of the American Journal of Preventive Medicine found that "A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV [intimate partner violence] during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV and abuse of power and control, but less likely than men to report verbal abuse alone. For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores."

Do I have symptoms of PTSD?
A very useful self-test.

Understanding the Victims of Spousal Abuse
by Frank Ochberg, MD, 1998
Great article, explains among other things the concept of the "Stockholm Syndrome", an examination of the term "victim", and pointers for therapeutic treatment.

Helplessly Overwhelmed
by Monika R. Smith, Ph.D., B.C.E.T.S.
Fabulous article that empowers one to redefine the notion of "helplessness" in the face of terrible stress.

Helping Battered Women
by Michael K. Gilbertson, Ph.D., B.C.E.T.S. , 1999
Examines the development of PTSD in light of environment and attachment.

Trauma: The Vortex of Violence
by Peter Levine, Ph.D.
Examines the origins of the aggressive coping mechanisms in chronic PTSD.

Toxic Nourishment
by PMichael Eigen, Ph.D.
A lovely, articulate look at folks who appear to seek out relationships that are "on the edge."

>Post Traumatic Stress Disorder (PTSD), Complex PTSD and trauma caused by bullying, harassment and abuse
A really excellent review of PTSD caused by stress at the workplace (as well as other sources), from the ever-excellent BullyOnline UK website.
Offers a nice clear description of PTSD, too.

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PTSD in Children & Adolescents

What does PTSD look like in Children and Adolescents?

Effects of Domestic Violence on Children and Adolescents: An Overview
by Joseph S. Volpe, Ph.D., B.C.E.T.S.

Why Does Trauma Leave Such Lasting Effects? The Effect of Childhood Trauma on Brain Development

Trauma and Terror in Childhood: The Neuropsychiatric Impact of Childhood Trauma
by Bruce D. Perry, M.D., Ph.D. 2000
Excellent overview of how the brain responds to trauma with mechanisms like hyperarousal, dissociation, etc.
A very good introduction to these "biochemical reaction" ideas.

Overcoming and Healing from Intergenerational Trauma
Excellent write-up of the effects of long-term PTSD on family relations.
by Gregory Phillips, 1999

Toward an Empirical Definition of Pediatric PTSD: The phenomenology of PTSD symptoms in youth
by Victor G. Carrion, Journal of the American Academy of Child and Adolescent Psychiatry, Feb 2002.

Posttraumatic Stress Disorder in Childhood & Adolescence
Great article on prevalence and medication.

>Posttraumatic Stress Disorder in Children
by Roy Lubit, MD, PhD, October 2001
Provides an excellent overview, as well as a detailed summary of the medications used in treating PTSD in children. Article may require registration (it's free) to read.

Post-Traumatic Stress Disorders in Children and Adolescents
by Bruce D. Perry, M.D., Ph.D.
Excellent overview article on neurophysiology, intervention and therapies.

Posttraumatic Stress Disorder in Adolescents
Great article for parents.

Posttraumatic stress disorder in hospitalized adolescents: psychiatric comorbidity and clinical correlates
by Deborah S. Lipschitz, 1999

Developmental Traumatology: Neurobiological Development in Maltreated Children With PTSD
by Michael D. DeBellis, M.D., 1999

The Neuropsychological Basis of Potential Co-occurrence of Mild Traumatic Brain Injury With Posttraumatic Stress Disorder
by Robert B. Sica, Ph.D., B.C.E.T.S.

Cultivating Resiliency in Youth
by Carl C. Bell, M.D.
Excellent article on trauma in children, the neurophysiology of PTSD, and raising healthy, stress-resistant children.

Frightened No Longer: Finding Safety After Sexual Child Abuse
By Lana R. Lawrence
Offers some great tips for parenting kids with PTSD.

Something Bad Happened: A Series of 6 Books for Children dealing with aftermath of stress or violence.
geared for 4-10 year-olds

The Way I Feel: A Series of 6 Books for Teens dealing with the aftermath of stress or violence
Geared for teenagers.

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"Complex" or "Chronic" Post-Traumatic Stress Disorder: Conceptualizing BPD as a Traumatic Disorder

A New Diagnosis: Complex Post-Traumatic Stress Disorder
Text from Chapter 6 of Judith Herman's excellent book, Trauma and Recovery. Herman's proposal provides an alternative to the definition of BPD and other dissociative, posttraumatic disorders. ~Recommended reading!

Psychophysiological reactivity to traumatic and abandonment scripts in borderline personality and posttraumatic stress disorders: a preliminary report
Schmahl CG, Elzinga BM, Ebner UW, Simms T, Sanislow C, Vermetten E, McGlashan TH, Bremner JD., April 2004
This study found that the major distinguishing factor between the two diagnoses is the physiological response to abandonment in patients diagnosed with BPD.

Is Comorbidity of Posttraumatic Stress Disorder and Borderline Personality Disorder Related to Greater Pathology and Impairment?
Abstract of a study by Caron Zlotnick, Ph.D., C. Laurel Franklin, Ph.D., and Mark Zimmerman, M.D., Nov. 2002, which concludes that: "The additional diagnosis of PTSD or borderline personality disorder does little to augment the pathology or dysfunction of patients who have either disorder without the other."

Posttraumatic stress disorder and fMRI activation patterns of traumatic memory in patients with borderline personality disorder
Driessen M, Beblo T, Mertens M, Piefke M, et al, March 2004
This study details some differences observed in the activation of neural networks in patients with BPD with and without PTSD.

PTSD: A Biological Response Gone Awry?
by Anne B. Brown
Excellent overview of how PTSD can turn into Chronic PTSD, or BPD.

The Trauma Model: A Solution to the Problem of Comorbidity in Psychiatry
by Colin A. Ross, M.D.
Article overview of Ross' book by the same name. Describes some of the diagnostician's frustration with the current classification system of mental disorders.

As the Pendulum Swings: The Etiology of PTSD, Complex PTSD, and Revictimization
by Anne M. Dietrich, M.A., CT
Excellent article exploring the history of the term and asking whether PTSD may have a genetic component.

The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism
Excellent full-text article by Bessel A. van der Kolk, examining Freud's old notion of "repetition compulsion" and why people with Borderline and other personality disorders seem to seek out re-enactments of their original traumatic experiences (such as abusive romantic relationships).

Memories of Fear: How the Brain Stores and Retrieves Physiologic States, Feelings, Behaviors and Thoughts from Traumatic Events
by Bruce D. Perry, M.D., Ph.D., 1999
Perry is another of the leading U.S. researchers in trauma theory.

Treating Complex Posttraumatic Stress Disorder with EMDR and Ego State Therapy
by Carol Forgash, LCSW, BCD, summer 2004.
Fabulous detailed article about the methodology of EMDR treatment.

Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study
Abstract of study findings by Yen S, Shea MT, Battle CL, Johnson DM, Zlotnick C, Dolan-Sewell R, Skodol AE, Grilo CM, Gunderson JG, Sanislow CA, Zanarini MC, Bender DS, Rettew JB, McGlashan TH., 2002
"Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events."

Posttraumatic stress disorder, dissociation and self-destructive behavior in borderline patients
This study by Spitzer C, Effler K, Freyberger HJ., 2000, found that:
"Of the borderline patients, 67% met criteria for PTSD and only 13% of the control group. Dissociative symptoms were significantly more frequent in borderline patients and predicted in combination with PTSD symptoms and self-destructive behavior."

The phenomenological and conceptual interface between borderline personality disorder and PTSD
Abstract of an article by JG Gunderson and AN Sabo.

Personality disorders, history of trauma, and posttraumatic stress disorder in subjects with anxiety disorders
Abstract of an article by M. Tracie Shea, et al

BPD and PTSD
An essay comparing the diagnoses, by A.J. Mahari, in recovery from both.

BPD and PTSD in Survivors of Sexual Abuse
An article by S. Michael.

Recent developments in research of trauma and personality disorders
by S. Yen and M. Shea
"Although the association between trauma and personality disorders, particularly borderline personality disorder (BPD), has been well established, the etiologic role of trauma in the development of personality disorders has been a topic of debate. Numerous mediation models have been put forth to explain how trauma can serve as a risk factor for the subsequent development of BPD. The symptomatic overlap between the proposed complex post-traumatic stress disorder diagnosis and BPD has fueled research efforts aimed at determining whether these are distinct disorders or should both be considered as trauma spectrum disorders. Treatment implications of this diagnostic differentiation are discussed."

Integrating Dialectical Behavior Therapy Into Exposure Therapy for Complex Posttraumatic Stress Disorder
by By Carolyn Black Becker, PhD, and Claudia Zayfert, PhD, March 2002

Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: a preliminary examination
Abstract of a study by Feeny NC, Zoellner LA, Foa EB., 2002

Multivariate prediction of posttraumatic symptoms in psychiatric inpatients
Carlson EB, Dalenberg C, Armstrong J, Daniels JW, Loewenstein R, Roth D., 2001

"Based on a conceptual framework for the long-term effects of childhood abuse, this study examined the capacity of childhood family environment (caretaker dysfunction, neglect, perceived social support), violent abuse (physical and sexual), and individual variables (other abuse) to predict adult psychiatric symptoms of PTSD, dissociation, and depression. Complete interview data were obtained from 178 psychiatric in patients who varied greatly on abuse status and severity. Results of multiple regressions of predictor variables onto the three outcome variables showed that the predictor variables accounted for 15% (for depression) to 42% (for PTSD) of the variance in these symptoms and that violent abuse uniquely accounted for a significant proportion of the variance in outcomes for all three of the symptom groups studied."

Personality Profiles of Trauma Survivors
by Dean Lauterbach. Ph.D
Full-text study of the comorbidity of PTSD and Personality Disorders.

A comparison of posttraumatic stress disorder with and without borderline personality disorder among women with a history of childhood sexual abuse: etiological and clinical characteristics
Abstract of a study by Heffernan K, Cloitre M., 2000

Complexities in complex posttraumatic stress disorder in inpatient women: evidence from cluster analysis of MCMI-III Personality Disorder Scales
Abstract of a study by Allen JG, Huntoon J, Evans RB., 1999
This article examines

"the sheer breadth of symptoms and personality disturbance encompassed by complex PTSD limits its descriptive usefulness. This study employed cluster analysis of the MCMI-III (Millon, 1994) personality disorder scales to determine whether there is meaningful heterogeneity within a group of 227 severely traumatized women who were treated in a specialized inpatient program. The analysis distinguishes 5 clinically meaningful clusters, which we label alienated, withdrawn, aggressive, suffering, and adaptive."

Neuro-Endocrine Scars of Early Traumatization in Borderline Patients
by T. Rinne
Compares PTSD, Depression and BPD in neurological terms.

�Development of the Cerebral Cortex: Stress and Brain Development
by Bruce McEwen, Ph.D., 1998
Fabulous description (with charts!) of how cortisol and its appropriate/inappropriate use by the body curing extreme stress might be genetic or learned.

Early Childhood Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder
by Julian D. Ford and Phyllis Kidd
Very interesting if a bit technical, this article explores the interrelationship of PTSD and what the authors call "Disorders of Extreme Stress Not Otherwise Specified" (DESNOS), or chronic PTSD, which is another term for BPD in the authors' understanding. Authors find that war veterans with the worst cases of PTSD are also child abuse survivors. The authors explore the efficacy of various kinds of treatment in these cases.

PSYCHOTRAUMATOLOGY: A Two-Factor Formulation of Posttraumatic Stress
A really clear and excellent article detailing a model of the infinite negative "feedback loop" of neurological hypersensitivity and psychological hypersensitivity, by George S. Everey, Jr.
The site is in Portuguese, scroll down a bit to find the full-text English article.

Predictors of chronic post-traumatic stress disorder: A prospective study
Freedman, Sara A.; Brandes, Dalia; Peri, Tuvia; Shalev, Arieh, British Journal of Psychiatry, Vol 174. 353-359. April 1999
ABSTRACT:

"Most individuals who, shortly after trauma, express symptoms of posttraumatic stress disorder (PTSD) recover within 1 year of their traumatic experiences. In contrast, those who remain ill for 1 year rarely recover completely. This study prospectively evaluated predictors of PTSD at 4 months and 1 year. The authors followed 236 trauma survivors (aged 16-65 yrs) recruited from admissions to a general hospital's emergency room for 4 months, at which point 41 (17.4%) met diagnostic criteria for PTSD. 23 of these individuals, and 39 individuals without PTSD at 4 months, were assessed again at 1 year. Depressive symptoms were the best predictors of PTSD at both time points. Intrusive symptoms and peritraumatic dissociation were better at predicting 4-month PTSD than 1-year PTSD. It is concluded that the occurrence of depression during the months that follow a traumatic event is an important mediator of chronicity in PTSD."

Risk Factors in PTSD and Related Disorders: Theoretical, Treatment, and Research Implications
by Anne M. Dietrich, in Traumatology Issue 7, Number 1.
Explains and analyzes the differences between the "EP," or Emotional Personality and the "ANP," or Apparently Normal Personality. Great stuff, very applicable to BPD, with good suggestions for the implications for treatment.
[This excerpt is from the "beta version" (pre-publication version) of the article.]

Delayed Posttraumatic Stress Disorder Mechanism and the Unification Model for Mental Illness
A very intriguing study by Clancy D. McKenzie, M.D, 1998

Posttraumatic Spectrum Disorder: A Radical Revision
Great article by K. Elan Jung, M.D. 2001
"The term posttraumatic stress disorder was introduced in an attempt to classify psychiatric sequelae that arise from the experience of severe trauma. However, the magnitude and complexity of the psychiatric disorders caused by trauma are such that current classification systems (including DSM-III, DSM-III-R, DSM-IV and ICD-10) are grossly inadequate to be of use scientifically. My hope is that the reorganization suggested here will lead to further research, more accurate diagnosis and more appropriate treatment for our traumatized patients."

Traumatic Stress and Human Behavior
by Andrei Novac, M.D., Psychiatric Times, April 2001

Understanding PTSD takes on urgency: expecting a spike in cases after Sept. 11, researchers puzzle out the biology of the disorder
by Douglas Steinberg, The Scientist, Nov. 2001

Evidence for genetic influences common and specific to symptoms of generalized anxiety and panic
by Scherrer JF, True WR, 2000
"Our data suggest a distinction in liability for Generalized Anxiety Disorder versus Panic Disorder. The common genetic influence to GAD and PD may partially account for the risk of the co-occurrence of these disorders in a lifetime."

A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms
by True, Rice, et al, 1993

A twin study of generalized anxiety disorder symptoms, panic disorder symptoms and post-traumatic stress disorder in men
Abstract of research by Chantarujikapong SI, Scherrer JF, et al, 2001

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PTSD Treatment and Support: What do I do Now?

Current Government-Sponsored Clinical Trials for PTSD Treatment
Current Industry-Sponsored Clinical Trials for PTSD Treatment
Those diagnosed with PTSD may apply for participation in the research.

Recommended Lifestyle Changes for PTSD Patients

Emotional Memory Management: Positive Control Over Your Memory
by Joe Carver, PhD.
Great summary of the effects of trauma on memory loss and some cognitive-behavioral techniques for addressing the problems.

Therapy for Post-Traumatic Stress and Dissociative Conditions: What to Look for and How to Choose a Therapist

Psychological Therapies for Post-traumatic Stress Disorder
Review of the different forms of therapy for PTSD, based on recent medical research results, by Gwen Adshead, 2000

Expert Consensus Treatment Guidelines For Posttraumatic Stress Disorder: A Guide For Patients and Families
Excellent comprehensive free publication. (Pdf file; requires Adobe Acrobat to read)

Treating Patients with Post-Traumatic Stress Disorder
Fabulous discussion on treating PTSD in terms of a "narrative perspective."

Integrating Dialectical Behavior Therapy Into Exposure Therapy for Complex Posttraumatic Stress Disorder
by By Carolyn Black Becker, PhD, and Claudia Zayfert, PhD, March 2002

Posttraumatic Stress Disorder (PTSD) and the Consciousness Restructuring Process
by Iona Miller and Graywolf Swinney, Asklepia Foundation, 2000
I found this to be a very enlightening article; ~recommended!

Hypnotic Psychotherapy in the Identification of Core Emotional Issues
by Constance Spencer, 2000
Discusses the value of hypnotic therapy in treating PTSD and related disorders.

How Effective are Cognitive-Behavioral Techniques for Early Intervention?
Fact sheet from the National Center for PTSD

The Assessment and Treatment of Complex PTSD
by Bessel van der Kolk, 2001
(pdf file: requires Adobe Acrobat to read)

Cognitive-behavioral psychotherapy for children and adolescents with posttraumatic stress disorder after a single-incident stressor
by John S. March, June 1998

Anniversary Reactions: A Survivor's Guide on How to Cope
by Angie Panos, Ph.D.

Escaping the Prison of a Past Trauma: New Treatment for Post-Traumatic Stress Disorder
Great, informative article discussing the symptoms, treatment with Zoloft, and a checklist for distinguishing between regular stress and PTSD. June 2000

Posttraumatic Therapy
Excellent long article detailing how treatment works for PTSD sufferers (applies to BPs as well)
by Frank M. Ochberg, 1991

A Narrative Constructivist Perspective of Treatment of Post-Traumatic Stress Disorders with Ericksonian Hypnosis and Eye Movement Desensitization and Reprocessing
by Rosemarie Amendolia, Ph.D., 1998
Excellent evaluation of the treatment options for PTSD by combining treatment of the patient's belief system with evidence from neurophysiology.

Abreaction: The Baby or the Bathwater?
by Leonard Holmes, PhD
Essay analyzing the practice of 'exposure therapy' for trauma and PTSD

EMDR Therapy (Eye Movement Desensitization And Reprocessing)
Gaining in clinical popularity for treating traumatic memories.
Dr. Francine Shapiro, developer of this method, runs an EMDR Forum for professionals & enthusiasts.

--->Also see my EMDR therapy descriptions & links

The Counting Method for Ameliorating Traumatic Memories
Frank M. Ochberg, M . D.
Another approach with clinical results similar to EMDR

Efficacy of Sertraline [Zoloft] in the Treatment of PTSD

Paxil approved for PTSD treatment
Mental Health Weekly, Dec 24, 2001

Studies Report Paroxetine [Paxil] Effective in Treatment of PTSD
by C.D. Pitts, American Family Physician, June 15, 2001

FDA reported to approve ecstasy [MDMA] for PTSD clinical trial
Mental Health Weekly, Nov 12, 2001

PTSD Mental Health Sanctuary
A nice collection of resources, with research, tips, chat rooms and bulletin boards.

PTSD and the 12 Steps
Details a sceptic's use of the 12 steps for PTSD, and outlines her progress.

The Stages of Grief

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PTSD Books for Sufferers & Understanding and Supporting Survivors of Traumatic Stress

Trauma and Recovery
by Judith Lewis Herman, M.D.
Excellent book; highly recommended! (This is a theoretical rather than self-help book: see below for self-help.) Read excerpts and order at this link.

Post Traumatic Stress Disorder: the invisible injury
2001 edition, by David Kinchin
"The only book in the world, we believe, written by a former PTSD sufferer for PTSD sufferers (and their families, carers and professionals)."
Read reviews and excerpts at this link, too.

Heartwounds: The Impact of Unresolved Grief and Trauma on Relationships
Thoughtful, beautifully written and wise stuff by Tian Dayton. Definitely read the online excerpt of this excellent book (click on the title and follow the link)!

Coping With Trauma: A Guide to Self-Understanding
by Jon G. Allen
Another very good read for survivors.

Growing Beyond Survival : A Self-Help Toolkit for Traumatic Stress
by Elizabeth G. Vermilyea
From the review:

"Growing Beyond Survival is a self-management workbook which teaches skills that empower survivors to take control of and de-escalate their most distressing trauma related symptoms... this self-help toolkit is both comprehensive and flexible. This versatile workbook can be used as an independent self-help program, in the context of individual therapy, or in a group setting. It teaches trauma survivors to recognize, contextualize, and understand distressing dissociative and posttraumatic reactions... Rather than simply offering "band aid"-type crisis intervention, this self-paced program empowers survivors with an understanding of where the symptoms come from and why. By learning a variety of interventions, skills, and techniques, survivors are able to select and make use of different "tools" for different self-regulation purposes."

Trust After Trauma: A Guide to Relationships for Survivors and Those Who Love Them
by Aphrodite Matsakis
Read an excerpt at this link, too.

Healing the Shame That Binds You
by John Bradshaw

Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society
by Bessel von der Kolk, et al
Collection of academic articles by one of the country's leading trauma researchers. Read the preface to the book here.

Dissociative Children: Bridging the Inner and Outer Worlds
by Lynda Shirar
"Beyond teaching how to recognize and diagnose dissociation, the author also provides treatment plans and techniques useful in helping to work with dissociative children."
From the book: "The penalty of childhood trauma and the necessary dissociative coping become increasingly costly for the child growing up, even after the trauma itself has stopped. Any child who has dissociative symptoms, whether, mild or severe, can benefit from identification and treatment of those symptoms. Given the opportunity, children can heal while they are still children." Read a review at this link.

Betrayal Trauma : The Logic of Forgetting Childhood Abuse
by Jennifer J. Freyd
Dr. Freyd is not only an academic psychologist, she is a survivor of childhood abuse whose parents founded a high-profile but very controversial national organization (False Memory Syndrome Foundation) to fight what they saw as her "false allegations." From the book: "The more the victim is dependent on the perpetrator, the more power the perpetrator has over the victim in a trusted and intimate relationship, the more the crime is one of betrayal. This betrayal by a trusted caregiver is the core factor in determining amnesia for a trauma." Great validation for survivors. Read a detailed review of the book.

Military Brats: Legacies of Childhood Inside the Fortress
by Mary Edwards Wertsch
"Gives the experience of a military childhood a weight many of us have never fully admitted, allowing our pain, finally, to be saluted alongside our pride." -- The Atlantic

Waking the Tiger: Healing Trauma : The Innate Capacity to Transform Overwhelming Experiences
by Peter A. Levine, Ann Frederick
The premise rests on the ability of the body to store and release traumatic memories: not a self-help book for BPs, but quite good at detailing Eastern methods of meditation, mindfulness, etc., to use in conjunction with therapy.

More Alike than Different: Treating Severely Dissociative Trauma Survivors
By Margo Rivera, Ph.D.
"Rivera makes a unique contribution to the treatment of lesbian and gay survivors of abuse. She theorizes that all sexuality is a social construct, subject to change over an individual's lifetime, a reality that is nowhere more clear than in highly dissociative individuals, who may identify themselves as alternately heterosexual female, gay male, lesbian and heterosexual male."

Sibling Abuse : Hidden Physical, Emotional, and Sexual Trauma
by Vernon R. Wiehe

Find a zillion more specific annotated titles about Trauma at these locations:

Sidran Foundation's Excellent Traumatic Stress Book Offerings
Dozens of titles for every conceivable interest group

David Baldwin's Trauma Pages: Book Recommendations

Dr. Jim Hopper's Book Recommendations for male survivors of sexual abuse

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This Page Last Updated: May 24, 2004

Helen's World of BPD Resources

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helenbpd@yahoo.com

This site is entirely personal and not-for-profit, and I am not professionally affiliated with any other site or product on the web. I am a researcher, not a practicing psychotherapist, and cannot guarantee the accuracy of any material located off-site, nor be responsible for any third-party interpretation of my material. For specifics on your situation, I encourage you to consult your mental health professional. The information provided on this site is provided for complementary reasons only, and is not intended to replace in any way the relationship that exists between a site visitor and his/her medical professional. At no time is information about visitors to this site (or any email communication) shared wih any advertiser or other third party, except via personal request and verification by the correspondent.