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Gift From Within - PTSD Questions & Answers with Frank Ochberg, M.D.
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|It is important to distinguish PTSD from BPD.
Q: Dear Frank, Why do so many professionals still misdiagnose PTSD for BPD?
A: Dear Joyce, Dear Joyce, PTSD includes feeling numb, having pent-up emotion, and, at times, being aloof or angry. BPD (borderline personality disorder) includes those feelings, too. But a person with BPD can also feel dead inside, and can have volatile, out of control emotion, and can be very difficult to live with --at times being extremely loving, and then, rather suddenly, becoming rejecting and insulting. This pattern does appear more frequently with women and when it occurs on an in-patient mental health unit, the diagnosis pf BPD serves as a warning to staff - "Be careful! Don't be too friendly!" I recall being told as a psychiatric resident, "These people have a knack for playing one staff person off against another and causing morale problems on the unit." BPD may be over-diagnosed on a psych unit. The label gets used for any difficult patient. The difficulty could stem from legitimate physical pain, and legitimate anger when pain medication is withheld. The difficulty could have to do with personality clashes (we can't all like one-another) but the staff gets to give the diagnoses and the patient ends up with a permanent record that may have some serious consequences.
I don't know how often someone with PTSD is mis-diagnosed as having BPD. But I do know it happens. It has happened with a patient I see now. She has complex PTSD resulting from a childhood trauma (near strangulation by a psychotic mother). She gets angry. She gets overwhelmed. But she is NOT borderline. Previous therapists who, in my opinion, failed to understand and appreciate her condition and her true personality got angry with her and gave her that BPD label.
I did help a friend, many years ago, get his wife's medical record amended to reverse a mis-diagnosis. It isn't easy. You can't pull a page out or erase an entry. You can have an evaluation placed in the record that notes a change in diagnosis or a "second opinion" about a previous diagnosis.
Now that BPD has been well researched, particularly by Dr. Linehan (http://www.linehaninstitute.org), some of the stigma is reduced. BPD responds to a form of treatment that modulates emotion, appreciates "mindfulness," and attracts therapists who can work with a person who, sooner or later, subjects them to withering verbal abuse.
PTSD and BPD may co-exist. This is most frequently seen when the trauma occurred during formative years in the family of origin. I've written about that
When the conditions do co-exist, it helps to have a therapist skilled in treating both patterns.
I'm glad, Joyce, that a GFW correspondent raised these issues. It is important to distinguish PTSD from BPD, to know that both diagnoses may apply and, most of all, to realize that labels do not make the person. You are not a borderline. You are not a disordered person who has PTSD. You are you and you deserve respect, self-respect, and well-informed care.
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