The Many Faces of Trauma
Complex Trauma versus PTSD
Beginning in the late 1990s, Complex Trauma—aka Chronic PTSD or Complex PTSD—was first identified by researchers. Complex Trauma came as a long-overdue recognition of the cumulative effects of multiple childhood traumas and as a nod to the fact that most people suffering from PTSD did not fully recover within the six-month time frame initially set down by the Diagnostic and Statistical Manual (DSM)—the “Bible” of psychological disorders.
Complex PTSD has now been struck from the DSM but remains in the ICD-10, the international usurper formulary of medical conditions utilized by insurers and behavioral health providers in the US. This has led to a lot of confusion. In reality, most people’s psychological symptoms rarely fit into neat boxes, but the overlap between symptoms of PTSD, Borderline Personality Disorder, and Complex Trauma is especially blurry.
Borderline Personality and Attachment Disorders
Living with intense, unmanageable feelings, poor emotional support, and unrefined coping skills leads many sufferers of PTSD to behave in a manner that’s sometimes categorized as borderline. Borderline Personality Disorder (BPD) is the experiential manifestation of unprocessed trauma and a particular style of communication that virtually guarantees the sufferer will be shunned, avoided, and blamed for their erratic and extreme behaviors. Since its inception, BPD has been a controversial disorder with a reputation for being largely untreatable. Historically, clinicians and other mental health professionals have viewed BPD as an intractable personality flaw, stigmatizing sufferers as manipulative and self-indulgent.
Childhood trauma has been found to be the single biggest risk factor for BPD, but it is by no means a precondition for the occurrence of the disorder. Though BPD continues to be categorized as a personality disorder, many researchers now conceptualize this affliction as a part of a larger spectrum of disorders associated with trauma. Recent studies have found the co-occurrence rate between PTSD and BPD to be as high as 76%.
The biological and genetic markers of BPD are now well established, with the effects of these in-born traits being multiplied by detrimental environmental factors like childhood attachment disorders and PTSD. The shift to viewing BPD as a trauma-spectrum disorder rather than an enduring personality defect has fostered a long overdue reduction in the overall stigma associated with this affliction. Over the past twenty-five years, Dialectical Behavioral Therapy (DBT), has, at long last, brought relief to people suffering from BPD.
How are Borderline Response and Childhood Attachment Issues Related?
For children, a healthy attachment to their key caregivers is paramount. From the moment of birth, an infant must reliably sense that their inner states are well-intuited by their caregivers. This feat is accomplished first through eye contact, touch, facial expression, and the experience of having one’s basic needs—food, shelter, and emotional comfort—dependably met. It is only then that the infant will have the confidence to explore the world without being overwhelmed with the fear that their caregivers—their sole source of nurturance and protection—will simply disappear if they look away.
Occupying these protected zones of physical and interpersonal safety, the securely attached infant is able to comfortably interact with the wider world, spurring vital cognitive growth and emotional development. By contrast, BPD is often the result of an insecure childhood attachment pattern predicated on poor parenting, physical/emotional/sexual abuse, disrupted connections, and/or forced separation from key caregivers.
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