Ptsd - Page 3

Have a question about PTSD: is it common to see BPD in the same patient?

Assuming you mean borderline personality d/o, the answer is a resounding "yes" for those patients who's PTSD is due to childhood sexual abuse. In adult survivors of profound abuse in childhood, usually sexual, and by parents, the common axis I diagnoses are:PTSD, Major Dep d/o, dissociative disorders, Eating disorders, OCD, Substance abuse. The most common axis II dx would be BPD. All of the above follow from the common substrata of an abuse hx.
Kissy: Bipolar is an Axis I dx, borderline is an Axis II.

The double edge of the sword is that it can become too easy for a clinician to overgeneralize...yes...it does happen and frequently. Overgeneralize... in that PTSD with childhood abuse, especially sexual, includes the diagnosis of BPD as an automatic. .

I found this very interesting. Do you find that the PTSD pt with more "insight" is less likely to manifest BPD? Is the severity of the abuse a factor, or possibly genetics? Timely intervention in early adulthood?

Insight is very helpful but only half of the coin. Half of most counseling or therapy is trying to gain it in order to really understand the disorder and how it impacts self. The other half of the coin is how does it sit with the person...that is coming to acceptance, which persons often struggle the most with. Even with insight, positive/healthy change is often self sabotaged if acceptance is not truly gained. Why? Effort and energy towards change often becomes half hearted. So insight and acceptance is the work of therapy. Behavioral change is what the person does on the outside when not in therapy or in the therapist's office...what the person does in the real world. When speaking of BPD...we are talking a life long pattern of perception and behavior that the person has come to rely on, which can often be difficult to change or give up. It requires learning new patterns of behavior and new ways to perceive one's world, others, and self. Not easy. But, it can be done, but it takes time. Often, persons with BPD mellow out with age, but we are often looking at in a person's 40's typically. So, you see why insight and acceptance work in therapy is important. New role models for healthy behavior make it more possible and also provides hope for change as well. Therapists/counselors are supposed to be one of those role models. Severity of the BPD illness is another factor. Not all BPDs are alike, although some/many clinicians may believe they are...again, this is often the case for clinicians who may be burned out or simply naive. So, even treatment for a person with BPD really needs to be individualized. You mention severity of prior abuse...sure, it is a factor to consider in one's assessment and knowledge base for that patient...but, again...don't lump all person with BPD this way. Believe it or not, many persons who have had significant and terrible childhood abuse do NOT have BPD. This is something to keep in mind. Don't equate childhood abuse with an automatic BPD. You really short change the patient that way and can commit a real bad therapeutic sin towards the patient. You mention genetics...Hmmm. More data is needed on that; however, I might tend to believe more that "dysfunctional patterns of behavior" by family members that are "passed on" and "learned by the patient" while young may have more a significant impact. If you live in a paranoid family, you tend to learn paranoia...get my meaning. Often personality disorders are seen budding while the person is in their teens...intervention really needs to begin there if diagnosed as causing difficulty in that teen's life. Again, we are talking patterns which are often growing root then. However, don't be tempted to assume all acting out teens are BPD. Many teens may demonstrate BPD behavioral "traits" which they soon or later outgrow (ie..such as acting and dressing Goth/Gothic, which comes to mind...also, drug abuse really needs ruled out here), while teens with genuine BPD tend to snowball and get worse. Lastly, another thing to consider also is that some folks with BPD may come from "healthy" families...if you want to use healthy as a term. In this, other things that may need to be considered is just individualized, poor self development of self, for what ever reason...drug abuse, physical illnesses, neonatal trauma/difficulty when born, other mental/emotional disorders being present, life events outside of family. In saying this, there may be MANY risk factors...not JUST child abuse. A naive clinician will tend to say/believe a disorder (any for that matter, not just BPD) is caused by ONE thing. Often what is MORE true is that a disorder develops as a result of many factors being present for that person which puts that person at risk to develop a disorder. A more seasoned or wise counselor/therapist acknowledges this. In saying ALL of this, I hope I make the point that "assessment really needs to be a thorough process" and "treatment needs to be very individualized" to be fair to the patient. I know, it is alot to think about and consider. I hope I did not throw too much at you or make it more confusing. But, I hope I was able to answer some of your questions.

Thank you for taking so much time to answer my questions. What you said about teens manifesting BPD traits, yet growing out of them caused me to wonder if personality disorders are partly a case of arrested development: a person just gets stuck at some immature level of perception and response.
Your insights are very helpful.