Decoding Distress – BPD, PTSD, and the Fine Line Between

Available with English captions.

Borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are two very distinct mental health conditions—each marked by specific diagnostic criteria and treatment approaches. But BPD and PTSD symptoms often overlap, and it’s not uncommon for someone to struggle with both challenges.

Far too frequently, the resulting confusion leads to misdiagnoses and delays to the start of effective treatment. So what should mental health care providers and concerned loved ones know about recognizing the key signs of BPD and PTSD? How does trauma factor into each diagnosis? And what does treatment look like for someone with one or both of the disorders?

Audience Questions

Gillian C. Galen, PsyD, provides an overview of borderline personality disorder and post-traumatic stress disorder, shares tips for understanding what sets them apart, and answers audience questions about the conditions’ shared symptoms, such as emotional dysregulation.

  • How would you define borderline personality disorder (BPD)?
  • What do we know about the prevalence of BPD?
  • What do we know about what causes BPD, and is there a genetic component?
  • How difficult is it to diagnose BPD?
  • What are some basic signs that someone might be dealing with BPD?
  • Can anger, blaming others (like parents), and refusing to take responsibility for actions be signs of BPD?
  • Does BPD exist on a spectrum?
  • Can you talk about dialectical behavior therapy (DBT) and other approaches to treating BPD?
  • When might someone with BPD need to consider a level of care beyond outpatient treatment?
  • How long does treatment for BPD typically take?
  • Does treatment for BPD become more difficult as a person gets older?
  • What tools or methods can clinicians use to diagnose BPD accurately?
  • What other treatments should be considered alongside DBT?
  • What’s the difference between post-traumatic stress and post-traumatic stress disorder (PTSD)?
  • Does PTSD affect a broader population than just those directly impacted by combat?
  • How would you define complex PTSD (C-PTSD), and how is it different from PTSD?
  • What are the diagnostic criteria for PTSD and C-PTSD?
  • What does treatment for PTSD look like?
  • How often do BPD and PTSD co-occur?
  • How does having both BPD and PTSD make diagnosis more challenging?
  • Can PTSD trigger symptoms of BPD?
  • What does treatment look like for someone who has both BPD and PTSD?
  • What guidance do you have for clinicians about treating BPD and PTSD?
  • How can we reduce stigma around BPD and PTSD, including among health care professionals?
  • Does BPD go away with time, or is it something people struggle with long-term?
  • Can C-PTSD develop from long-term medical conditions in childhood, such as diabetes or frequent surgeries?
  • How does dissociation or derealization show up in people with BPD?
  • What are some strategies for individuals looking to support a loved one who has PTSD or BPD?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.

Resources

You may also find this information useful:

About Dr. Galen

Gillian C. Galen, PsyD, is a senior child and adolescent psychologist specializing in dialectical behavior therapy (DBT). She is the director of training for McLean’s 3East continuum, an array of programs for teens that use DBT to target self-endangering behaviors and symptoms of borderline personality disorder.

Dr. Galen has extensive experience diagnosing and treating adolescents and young adults who struggle with emotion dysregulation, anxiety, depression, trauma, and self-endangering behaviors, such as self-injury and suicidal behaviors.

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