any source patrick walker does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment. australians with bpd face considerable barriers to accessing high-quality and affordable care, according to new research published today. at least part of this stems from the way we frame the condition, and from the name itself. rather than as a personality disorder, bpd is better thought of as a complex response to trauma. most people who suffer from bpd have a history of major trauma, often sustained in childhood. people with bpd who have a history of serious abuse have poorer outcomes than the few who don’t, and are more likely to self-harm and attempt suicide.
the diagnostic and statistical manual of mental disorders (dsm-v) does not mention trauma as a diagnostic factor in bpd, despite the inextricable link between bpd and trauma. labelling people with bpd as having a personality disorder can exacerbate their poor self-esteem. “personality disorder” translates in many people’s minds as a personality flaw, and this can lead to or exacerbate an ingrained sense of worthlessness and self-loathing. explicitly linking bpd to trauma could alleviate some of the stigma and associated harm that goes with the diagnosis, leading to better treatment engagement, and better outcomes. eventually, this may lead to what us psychiatric researcher ron aviram and colleagues call a “self-fulfilling prophecy and a cycle of stigmatisation to which both patient and therapist contribute”. bpd is a difficult condition to treat, and the last thing we need to do is to make it harder for patients and their families.
in clinical settings, dissociation is a core symptom of various disorders, including dissociative disorders (e.g., dissociative identity disorder, did), (complex) post-traumatic stress disorder (cptsd, ptsd), and borderline personality disorder (bpd) . trauma models consider psychological trauma a crucial risk factor in the development of dissociation [17,18,19,20,21]. in bpd, stress-related dissociation is a core symptom, closely linked to other features of the disorder [1, 49]. in a recent study, female patients with bpd reported significantly lower levels of body awareness and significantly higher levels of body dissociation compared to healthy women. a multilevel meta-analysis of different psychotherapies for bpd suggests that changes in dissociative symptomatology may be harder to achieve, as compared to symptoms of affective instability and overall bpd severity . overall, the understanding of dissociation and its link to trauma and bpd is steadily increasing. types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder. an update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the dsm-5. evaluation of the evidence for the trauma and fantasy models of dissociation. paret c, hoesterey s, kleindienst n, schmahl c. associations of emotional arousal, dissociation and symptom severity with operant conditioning in borderline personality disorder. the trauma model of dissociation: inconvenient truths and stubborn fictions. the link between dissociative tendencies and hyperassociativity.
dissociation and emotion regulation in borderline personality disorder. 2021;12(1):1987686. scalabrini a, cavicchioli m, fossati a, maffei c. the extent of dissociation in borderline personality disorder: a meta-analytic review. etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children. dissociative symptoms are positively related to stress in borderline personality disorder. specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. lower self-positivity and its association with self-esteem in women with borderline personality disorder. the temporal interplay of self-esteem instability and affective instability in borderline personality disorder patients’ everyday lives. the rupture and repair of cooperation in borderline personality disorder. ludäscher p. pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study. cyr g, godbout n, cloitre m, bélanger c. distinguishing among symptoms of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder in a community sample of women. state dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. treating adults with a dual diagnosis of borderline personality disorder and posttraumatic stress disorder related to childhood abuse: results from a randomized clinical trial. krause-utz, a. dissociation, trauma, and borderline personality disorder.
bpd as a sequela of childhood traumas often occurs with multiple comorbidities (e.g. mood, anxiety, obsessive-compulsive, eating, dissociative, prolonged and severe trauma, particularly trauma that occurs early in the life cycle, tends to result in a chronic inability to modulate emotions. overall, these studies support the hypothesis that childhood trauma could be associated with changes in bdnf epigenetic signature, that in turn, .
a key difference, however, is that complex ptsd explicitly frames an individual’s condition as a response to trauma, whereas bpd does not. stressful or traumatic life events often feeling afraid, upset, unsupported or invalidated family difficulties or instability, such as living with a parent most people who suffer from bpd have a history of major trauma, often sustained in childhood. this includes sexual and physical abuse, extreme, .
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