Why is C-PTSD Misdiagnosed as BPD?
By Dr. Betsy Usher
It is my professional and personal opinion that 80% of those diagnosed with BPD have CPTSD and do not have a true personality disorder. Yes, 80% of those of you who have been diagnosed with BPD are actually suffering from C-PTSD, issues with attachment, and are survivor’s narcissist abuse. Now stay with me as we define these disorders so we can compare and explore why being misdiagnosed is happening and why it is extremely damaging.
Let’s start with personality disorders. It is important to start here because it is within this definition that creates a problem why so many individuals diagnosed with BPD do not actually have a true personality disorder. According to the DSM-5, personality disorders are pervasive, inflexible, and they are stable over time. Research has shown that treatment for personality disorders such as narcissistic personality disorder (NPD) and antisocial personality disorder, has little to know affect in changing symptomology. However, Borderline personality disorder (BPD) is fundamentally different then all the other personality disorders in that it is not fixed, pervasive, and inflexible over time. Approximately 80% of individuals with bpd and who are in therapy no longer have symptoms after 6-10 years, only 11% of those in “remission” have a recurrent episode after those 6-10 years. BPD is the only personality disorder that has positive outcomes of change in symptomology and complete remission. So, an individual diagnosed with BPD who gets better over time, changes in their rigidity, and in all different domains of their life are not true a personality disorder. This can be confusing since these individuals are meeting criteria for BPD. So what is happening?
We are missing a different diagnosis. Someone that meets criteria for BPD, however, they do not meet the definition of the personality disorder part (pervasive, inflexible, stable over time). C-PTSD is more of an accurate diagnosis until a new disorder has been created.
Why is this important; these tiny details of definitions?
Some people do have true BPD. They meet criteria which is pervasive, they are inflexible, and the personality disorder doesn’t get better (stable over time). Those individuals do not look the same as the 80% of those diagnosed with BPD that change and grow over time through therapy, medications, and life experience. This confusion leads many individuals who do not have BPD to believe that the stigmatized version of BPD (true personality disorder) is them and the belief that they will not get better.
C-PTSD, BPD, & Abandonment
Although it is true abandonment is not part of the criteria (symptoms for diagnosis) for C-PTSD, it is a misconception that abandonment is not part of C-PTSD. According to Pete Walker, author of Complex PTSD: From Surviving to Thriving, abandonment is the heart and deep experience of C-PTSD. C-PTSD is surviving childhood abuse and adult abuse. Childhood abuse is abandonment from self and from caretakers. The abuse that was either neglect, emotional, verbal, physical, sexual or all of them created a profound experience of abandonment, which then created a reaction from abandon of self as well. The experience of abandonment resurfacing is what creates the borderline dysregulation. It is a flashback that resurfaces and triggers the emotional chaos and suffering which expresses itself to look like BPD. However, therapists do not use C-PTSD as a diagnosis since it is not yet recognized in our diagnostic statistical manual that we use to code diagnoses. PTSD doesn’t quit fit what we are talking about here, so that diagnosis doesn’t get used for these individuals. Moreover, there is little education on C-PTSD and abuse in general for therapists and therefore many therapists don’t have the training or understanding to know what appears to be BPD is actually C-PTSD.
Why is this problematic?
The danger here is that these individuals already feel worthless, hopeless, unlovable, and hateful towards themselves from childhood and adult abuse. Receiving a diagnosis of BPD can make the toxic shame even worse, creating more hate and worthlessness for themselves. BPD negatively stigmatized more so than any other disorder. When an individual get diagnosed with BPD and go down the rabbit hole of the web looking for support, what they find is hateful and hurtful messages that they are terrible people and deserve more pain and suffering. There is little compassion out there for BPD due to the stigmatized version being seen as the truth for all of those with BPD. Most likely the stigmatized version that is plastered all over the web is the 20% that have true personality disorders like BPD coupled with NPD. Moreover, they usually are unaware they have a personality disorder and that they are creating chaos in their wake. It is also unfortunate even the individuals with true BPD are being stigmatized. However, being labeled incorrectly for the other 80% makes it more challenging for them to find self-compassion and thus “getting better.” C-PTSD that looks like borderline is an attachment issue that needs specific modalities of therapy, a healthy attachment with their therapist, self-compassion, patience, time, and a deep education and understanding of the abuse they endured. Unfortunately, an incorrect label of BPD can create the opposite experience for many on an already difficult journey.