![]() ![]() ![]() PTSD prevalence estimates worldwide among adults in the general population are 3.0–4.4%, with a wider range of 2–39% in primary care samples. The estimated prevalence of BPD in the adult general population is 0.7–3.5%, and 9–18% among adults in mental health treatment. Prevalence and comorbidity of BPD, PTSD, and cPTSD Therefore, this review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity (2) clinical phenomenology (3) traumatic antecedents (4) psychobiology (5) emotion dysregulation (6) dissociation and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment. These refinements in the conceptualization and measurement of cPTSD have spurred new research on the relationship of PTSD, cPTSD/DSO and BPD in adulthood, including their traumatic antecedents in childhood and across developmental epochs. The cPTSD/DSO symptoms represent post-traumatic: (1) emotional numbing and dysregulation, (2) self-perceptions as a failure or worthless, and (3) emotional detachment in relationships. Based on confirmatory factor analysis studies with adults, the ICD-11 diagnosis of cPTSD is defined operationally as requiring one of the two symptoms from each of three DSM-IV criteria for PTSD (i.e., intrusive re-experiencing, avoidance of trauma reminders, hyperarousal) and one of the two symptoms from each of three domains of Disturbances of Self-Organization (DSO). However, empirical evidence showing that the core features of cPTSD are distinct clinically and conceptually from PTSD has resulted in a revised formulation of cPTSD that has been adopted as a diagnosis in the 11th Revision of the World Health Organization’s International Classification of Diseases. Instead, the DSM-5 opted for a broader conceptualization of PTSD with some symptoms similar to those in cPTSD. Although research with adults and children accumulated over the next two decades, many of the initially proposed symptoms of cPTSD were not included in a separate diagnosis) in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ). ![]() Seven years after a foundational review on cPTSD and BPD, the relationship of cPTSD to BPD remains an open question.ĬPTSD was originally defined as a disorder of extreme stress not otherwise specified (DESNOS) following traumatic victimization with symptoms in seven domains: emotion dysregulation, altered schemas of self, altered relationships, trauma-related sustaining beliefs (morality, spirituality), somatization, and altered perceptions of perpetrators. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.įour decades after complex posttraumatic stress disorder (cPTSD) was first defined and proposed as an alternative diagnosis to borderline personality disorder (BPD) for conceptualizing and treating the symptoms of adults who had suffered prolonged and severe interpersonal trauma,, the validity and utility of cPTSD continues to be debated by mental health researchers however, it is accepted by many clinical practitioners who view it as a less stigmatizing and possibly more accurate diagnosis than BPD. The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity (2) clinical phenomenology (3) traumatic antecedents (4) psychobiology (5) emotion dysregulation (6) dissociation and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. ![]() Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. ![]()
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