jesse_the_k | Online Con Report 2: SDS@OSU -- BPD vs CPTSD

Second of several posts about the SDS@OSU Virtual Conference held the first weekend in April.

Communicating and Framing Diagnosis and Difference

Rachel Larrowe, a DePaul University MA student, presented a fascinating paper on "BPD, CPTSD, and Identity: the Discursive Construction of Diagnostic Possibilities." She deployed a very close reading of how the two conditions are defined which raised the following issues:

There’s significant overlap in diagnostic criteria for Borderline Personality Disorder and Complex Post-Traumatic Stress Disorder. C-PTSD was considered and excluded from the most recent US diagnostic/billing/research tool, the DSM-5, while it is part of the rest-of-the-world tool ICD-10.
People DXed with BPD often have terrible, traumatic childhoods.
Quoting her presentation: ‌What if so-called disordered personalities are the psychological consequences of childhood abuse? What if trauma doesn’t always look how the medical establishment and the media have taught us to expect? How can a disorder be post-traumatic if a child never experiences a time pre-trauma?
There’s gender trouble here: CPTSD is more commonly DXed in men, BPD in women. CPTSD is partly defined by events people experience, while BPD is defined by how people are. Some of the behaviors unique to BPD, such as ‌Individuals with borderline personality disorder make frantic efforts to avoid real or imagined abandonment overlap with how women are defined as needy and "too much."
What if we could accommodate these needs? Her example: if I’m doubting my place in a relationship, could it be okay for me to text someone "I’m afraid you’re hating me right now" and they could reply with "🧡👍 all clear" and we’d all be good?

ETA: 23 Apr 2020, correct researcher's name and degree

Flat | Top-Level Comments Only

From:

peoriapeoriawhereart

I seem to recall there was a term for the PTSD where it's chronic as opposed to 'localized' to an event.

But, yeah. That "avoid real or imagined abandonment" is an interesting phrasing for a disorder.

From:

tarasacon

You are right. There’s PTSD, and there’s c-PTSD, or complex ptsd. The latter is a result of repeated/chronic experiences such as childhood abuse, and poverty. It has a slightly different presentation.

From:

sovay

if I’m doubting my place in a relationship, could it be okay for me to text someone "I’m afraid you’re hating me right now" and they could reply with "all clear" and we’d all be good?

I honestly feel it is very useful to be able to do this sort of check-in with people. Even if it's just, "Hello, I suspect I am being eaten by brainweasels, would you mind confirming objective reality?" I made one of those phone calls last week. (I do not have CPTSD or BPD, but for a variety of reasons acquired in adulthood it is far too easy for me to believe that I am barely tolerated by just about everyone I know.)

From:

azurelunatic

It's so useful. I eventually learned that I could spare my BFF the recitation of the reasons I was afraid he hated me, and just ask for a reassuring confirmation that he didn't.

From:

jesse_the_k

Hooray! for finding ways to communicate that acknowledge we're human and sometimes just need to get the ugly thoughts out of our brains.

From:

tarasacon

I so wish this were a thing - I would have used it with a friend recently. (Problem is that he’s avoidant, so I don’t know if he would respond honestly. But most of my friends would.)

From:

jesse_the_k

It might be worth a try?

From:

jesse_the_k

I am so glad you are able to communicate honestly! I spent way too many years afraid to speak out about what I needed, thinking that a check-in was a scarlet marker of childish dependence.

From:

j00j

Being able to do that check in with a friend or partner is so good.
Also, anecdotal info not from a professional but no one I know with a BPD diagnosis is without childhood trauma. I think a lot about how some of my pals didn't grow up with those models of "this is what a relatively healthy relationship looks like" or "this is what stability and security look like" and it looks like *incredibly fucking hard work* to get to a place of feeling secure and confident; it's been hard (if very different) work for my relatively untraumatized ass.

From:

jesse_the_k

Indeed. It's been enlightening to witness the parents I've met through fandom provide love and guidance to their offspring. That's possible?!

From:

tarasacon

The information here overlaps with &/or compliments information in
The Body Keeps The Score, by van der Kolk. (Caveat that while the author is a major pioneer of and an important figure in trauma research, he is also problematic.)

In the chapter on recurring childhood trauma (abuse, poverty, addiction, etc.) he talks extensively about how many children trying to cope with trauma are given what are likely inaccurate diagnoses of various mental/behavioral issues, which stick with them and shape future treatment. It’s really frustrating to see how we (as a society) refuse to deal with the issues which make the poverty/abuse/homelessness/addiction far more likely and cause this generational trauma.

He also talks about the work to have c-PTSD included in the DSM IV, the incredible frustration of it being kept out, and the consequences this has for patients who can’t be accurately diagnosed to insurance companies. I believe it was also excluded from the DSM V, despite an abundance of evidence that it is a separate beast from the PTSD caused by a single traumatic event.

From:

peoriapeoriawhereart

Keeping in mind that I did not make a concerted study of Freud, and history of science scholarship may have been trying to rehabilitate him contrary to evidence, at first Freud was very agitated to find help for the first patients reporting sexual abuse only to later disbelieve incest was rampant in "good Viennese homes"--and bent his practice to explaining why so many false reports were being made.

It strikes me that c-PTSD not being recognized is similar, and sadly reminiscent of how PTSD was treated back in WWI. The officers' battle fatigue was 'worked around' and the enlisted were "severely held to account".

From:

tarasacon

Yes!

The denial by government and institutions with “power over” on the frequency and severity of trauma (whether childhood and wartime) seems essential to maintaining a plentiful lower class as both cheap labor and cannon fodder. All hail, Capitalism! Plus the insistence that We Are Nice People, no matter the evidence.

From:

tarasacon

(I’m tired enough that the above might not be coherent. Please tell me if I am unclear.)

From:

peoriapeoriawhereart

I don't have a reference on this one, but it has been reported (thus is should be falsifiable if it's being over interpreted.) that boot camp sergeants awhile back figured out they couldn't use their normal methods because increasingly recruits were too brittle to rebuild.

For an interesting historical note, ACD frequently had Holmes point out that remote country houses were dangerous in ways the urban dweller would not stomach/would render summary 'redress'.

From:

jesse_the_k

Oh, that WWI practice is indeed a good mirror of the current dynamic.

From:

jesse_the_k

Yes! Yes! Yes! Reading The Body Keeps the Score was transformative for me.

(Do I want to know the problematic bits? I'm secure enough now that I can handle some complexity.)

From:

tarasacon

If you want to know, a google search for his full name should bring up results. If not, add “clinic” and “allegations.” Nothing was proven or charged, but people working with trauma patients need to be above reproach.

From:

mlravenwrites

Thanks for posting about this-- the conference sounds amazing and I'm definitely curious about going in future years.

And I'm glad someone is taking this stuff in this direction-- I've read several CPTSD books/articles that discuss overlap/similarities with BPD, so this seems like the next logical place to go.

citations: Janina Fisher, "The Treatment of Structural Dissociation in Chronically Traumatized Patients", in Trauma treatment in practice: complex trauma and dissociation. Article PDF here, book here, in Norwegian (?).

In her chapter, she cites Korzekwa, Dell, and Pain, "Dissociation and Borderline Perosnality Disorder: An Update for Clinicians" Korzekwa, Dell, and Pain PDF here, which I haven't read but seems potentially relevant, as well.

Also, definitely interested in your final bullet point! I feel like that's a thing that I can do with some close friends/my partner who Gets It, but it's still something that causes additional anxiety-- on top of the "I have an irrational fear that they hate me", the "oh no I'm being too needy asking them to confirm they don't hate me". Gotta say, being Autistic doesn't help with that, esp i/r/t body language/tone. ugh, humans!!

From:

jesse_the_k

Thanks for those links.

I hear you on the anxiety -- and I learned "my needs don't matter" growing up.

Attending Society for Disability Studies events has demonstrated how we can create a world that does accommodate our needs. At my first one (2000) 90% of the accommodations were physical: interpreters, alternate formats, level spaces. Now the expectation is that most impairments aren't written on the body; that neuroqueer people are everywhere; that communicating through voice and text and sign (and space and time) is the way we want to go.

From:

mlravenwrites

That's amazing, and so hopeful-sounding. Thanks for sharing all of this!

From:

firecat

I'm in a relationship with someone who was diagnosed with BPD at one point and believes her condition derives from childhood abuse, so CPTSD could certainly be an alternative to describe it. We have an agreement that she can ask me for reassurance; sometimes the way that works is as simple as what your bullet point describes; sometimes it's a lot more difficult.

I have other friends who also fit the criteria and have had multiple diagnoses over the years—BPD, bipolar, etc.

From:

jesse_the_k

Indeed. Nobody is average! the DSM tidy-boxes approach may make sense for corralling research subjects and billing insurance. Not as helpful for helping any one person understand their place in the world.

From:

firecat

Right! My point is that those diagnoses seem to have huge overlaps and I suspect many people get cycled through them depending on whatever's on the psychiatric community's mind that decade.

From:

sasha_feather

That's so interesting, thanks for posting.

From:

jesse_the_k

From:

starshipfox

How can a disorder be post-traumatic if a child never experiences a time pre-trauma?

I have never directly asked myself this question before, and I find it very enlightening and powerful.

Thank you for writing this up.