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

Threaded | Flat

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:

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:

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:

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:

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:

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:

sasha_feather

That's so interesting, thanks for posting.

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.

From:

runpunkrun

I've been thinking about this since you posted it. Thanks for the summary.

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adventures with Jesse the K

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

Communicating and Framing Diagnosis and Difference

Adaptive Tech Resources

Disability Culture

Dreamwidth Tools

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