The Link Between Borderline Personality Disorder and Trauma

Borderline personality disorder (BPD) is a stigmatized and misunderstood condition. Almost 70 percent of people who suffer from it were mistreated or abused in childhood. Today, we want to talk about the need for reformulation of this disorder.
The Link Between Borderline Personality Disorder and Trauma

Last update: 16 June, 2022

There’s a significant link between borderline personality disorder and trauma that needs highlighting. This disorder is a reviled and often stigmatized psychological condition. From a therapeutic point of view, sufferers have complex issues but socially, the negative way in which the condition is viewed is disproportionate.

In fact, the suffering that these men and, more frequently, women (its incidence is higher in females) deal with tends to be forgotten. Diagnoses take time to arrive and clinical care isn’t always the most accurate. However, change is in sight. There are attempts to reformulate and make this clinical reality far more visible.

One of the issues is that many doubt that borderline personality disorder (BPD) is a personality disorder. Moreover, the ‘label’ itself stigmatizes patients in a significant way. They perceive it as a defect in their personality causing their feelings of self-hatred and uselessness to rise to the surface even more. Many experts are of the opinion that BPD should be viewed as a complex response to trauma. Let’s take a look.

Coexistence and dealing with patients with BPD is usually complex. However, with an appropriate therapeutic approach, their symptoms can be reduced and they gain greater control over their emotions and impulses.

woman representing borderline personality disorder (BPD) and trauma
Viewing people with borderline personality disorder as patients with a trauma spectrum condition would improve their care.

What are people with borderline personality disorder (BPD) like?

Many of the patients seen as psychiatric emergencies exhibit borderline personality disorder. They’re often admitted due to suicide attempts or autolytic behavior. They’re people who are suffering and who show an almost stark emotional sensitivity. This leads them to impulsive and self-destructive behaviors.

For example, having a daughter with BPD means living with someone who hates herself and seeks our affection, but, at the same time, is full of contempt for us. In many cases, they also suffer from eating disorders. On the other hand, having a partner with this condition often means loving someone who’s attempted suicide on more than one occasion.

Life is really hard, both for those who suffer from this disorder and for the people around them. Therefore, it’s important not to get carried away by stigma or the idea that they’re problematic people. We need to see them for who they are – patients with a specific emotional reality.

The characteristics of BPD

To detect the presence of a BPD (borderline personality disorder) we must refer to the DSM 5 or Diagnostic and Statistical Manual of Mental Disorders. This publication claims that if patients show five of the following nine characteristics, they’re suffering from BPD.

  • Fear of abandonment.
  • A pattern of unstable interpersonal relationships.
  • Identity alteration.
  • Impulsivity in at least two areas that are potentially self-damaging. For instance, sex, money, binge eating, reckless driving, and substance abuse.
  • Suicidal attempts or self-injurious behavior.
  • Emotional instability.
  • Problems controlling anger.
  • Chronic feelings of emptiness.
  • Transient paranoid ideation that’s associated with stress or dissociative symptoms.

The Western Norway University of Applied Sciences (Norway) conducted research that claims the general incidence of BPD is one-two percent of the population, yet we tend to neglect one important aspect. This is the fact that when a patient receives the diagnosis, they experience it in a problematic way, recognize the stigma that it entails and, in many cases, avoid receiving specialized help.

Over the past 20 years, progress has been made in treating BPD. Specialized treatment programs, such as dialectical behavior therapy (DBT) and mentalization-based treatment (MBT), are extremely effective.

The need for reformulation

As we mentioned earlier, more voices are now calling for a change in the terminology of borderline personality disorder. They suggest that, instead of BPD, it should be named trauma spectrum disorder. This would make it a variant of chronic or complex post-traumatic stress disorder. The reasons for this are as follows:

Sexual abuse: a common condition

Dr. Mary Zanarini reviewed the empirical literature on this condition. She recognized that BPD and trauma are related. In fact, in a 2000 study, she pointed out that sexual abuse is present in between 40 and 70 percent of cases of BPD. More specifically, it tends to be due to the following circumstances:

  • Negligence by a caregiver.
  • Sexual abuse by a caregiver.
  • Witnessing sexual violence in childhood.
  • Suffering violations in adulthood.

Etiopathogenesis of borderline personality disorder (BPD) and trauma

In another more recent investigation, the presence of traumas in this mental condition was evidenced once again. Moreover, the genetic and biological aspect was also deepened. In fact, it was suggested that there may be an interaction between genes (FKBP5 polymorphisms and CRHR2 variants) and the environment (abuse, emotional neglect, etc).

A child with Borderline Personality Disorder (BPD) and trauma
The effects of a childhood of abuse are the trigger for some personality disorders.

Greater vulnerability to the psychological effects of stress

Not all people react in the same way to a traumatic situation. Although it’s true that suffering some type of abuse in childhood can completely alter a person’s psychosocial development, there are those who show more severe mental consequences.

It’s claimed that BPD and traumas are related because some people have a greater vulnerability to the psychological effects of stress. In these cases, it translates into an extremely complex artifact of emotional consequences, such as anger, impulsiveness, and dissociative symptoms.

This undoubtedly coincides with previous research, such as this study, conducted by Johnson, Cohen, Brown, et al. (1999). They claimed that the incidence of any personality disorder in people who suffered abuse or neglect in childhood was quadrupled in comparison to the rest of the population.

According to studies, BPD shows a suicide rate ten to 50 times higher than the rate in the general population.

The need for change

The simple fact that 75 percent of people with borderline personality disorder attempt suicide is enough of a problem for this condition to be viewed more seriously.  Regardless of whether they’re problematic, manipulative, and defined by obvious emotional dysregulation, these people are basically suffering from the unspeakable.

Indeed, behind the label lies the human being, one who needs a more accurate therapeutic approach and, above all, a more empathic society. Perhaps by removing the label of ‘personality disorder’ and replacing it with trauma spectrum disorder, the patient will feel less stigmatized and more motivated to initiate psychological treatment.

This would undoubtedly be a good start.

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