What is the Link Between Borderline Personality Disorder and Trauma?

These days, it seems like the term borderline personality is thrown around loosely, highly stigmatized, and not well understood. Historically, patients with borderline personality disorder (BPD) have been misunderstood, treated poorly, and dismissed by mental health institutions. The symptoms of BPD can make forming positive relationships with others feel difficult and sometimes impossible. Luckily, we now understand more about this diagnosis. As a result, we have found effective and compassionate treatment methods drawn from a deeper understanding of BPD’s origins. Many wonder if there is a link between borderline personality disorder and trauma. Let’s explore what makes up a personality, and how early trauma can deeply impact the formation of who we become. Additionally, we will explore what therapies can be most effective for treating BPD, specifically focusing on trauma-informed practice. 

What is personality?

To break down what is happening with BPD, let’s first look at what makes up a personality. Personality is a big piece of who we are as individuals. At its core, personality is how we think, feel, and behave. While parts of our personality may stay consistent over time, personality can also dynamically shift throughout our life course. For example, as we age, we may learn better coping skills to be less reactive. We gain perspective to become more understanding, and we take in positive reassurance to feel more confident.

In the same way that we can grow through positive experiences in our lives, our negative experiences can also impact our personality. Borderline personality disorder can be defined as “a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity.”  Along with these personality traits, people with BPD may often fear abandonment, struggle with suicidal ideation, show intense anger, or experience a distressing sense of emptiness.

The link between borderline personality disorder and trauma

Complex PTSD or cPTSD refers to symptoms experienced as a result of trauma which occurs over long term exposure to extreme stress. Examples include experiencing ongoing domestic violence, childhood abuse or neglect, or being a prisoner of war. Borderline personality disorder and trauma may appear to have similar symptoms. These overlapping symptoms can include emotional reactivity, unstable interpersonal relationships, drastic changes in personality and self image, and self-destructive behavior.

While cPTSD can happen at any point in the life span, findings show that anywhere from 30-80% of those diagnosed with BPD experienced complex trauma in their childhood. This may seem like a loose correlation, but researchers have found that not all BPD cases start with “large T traumas” (e.g. life threatening accidents, sexual assault, witnessing a traumatic death). Many individuals who go on to develop BPD do experience long term “small t trauma”. Although “small t” trauma might not warrant an official PTSD diagnosis, these smaller traumas occurring at early developmental stages can still have a huge impact on the development of our worldview, and therefore, our personality.

Read more about cPTSD

Small “t” traumas

Small t traumas are “events that exceed our capacity to cope and cause a disruption in emotional functioning.” These distressing events are not inherently life or bodily-integrity threatening, but perhaps better described as ego-threatening due to the individual left feeling notable helplessness.

In the context of BPD, living in an environment that invalidates or devalues could count as a small ‘t’ trauma. Within these invalidating environments, caretakers may not show compassion or sympathy in times of need.  Peers can also create a hostile environment through bullying. Over time, these small scars calcify the child’s ability to internally validate themselves. This can impact their resilience and create challenges in learning how to cooperate and form relationships with others.

It is important to understand how trauma, whether it be big or small, impacts the formation of BPD. Having this information can shed some light on why this disorder can be so destabilizing. It can also help us reframe the stigma against it. When we acknowledge the hurt that creates the behaviors, we can shift the narrative from “something is wrong with you” to “something happened to you.” In treatment, this allows us to frame our goals around resolving trauma, as well as learning to cope with the burdens of the diagnosis.

Treatment of BPD

Dialectical Behavior Therapy, an adaptation of Cognitive Behavioral Therapy, is the main treatment of BPD. It focuses on learning to tolerate the distress by being mindful and present, learning healthy coping skills to regulate stress and emotions, and improve interpersonal relationships. In addition to the present-focused DBT, trauma therapy can be an important addition to address the past hurt. Research has shown EMDR, a form of trauma therapy, has been successful in significantly reducing symptoms of BPD alongside depression and anxiety.

In conclusion, BPD is a complex diagnosis. BPD presents in many different ways and affects not only the person diagnosed, but also those around them. By understanding the suffering that comes from trauma, we can stay in tune with feelings of compassion and understanding. We can address traumas and work to reframe feelings about the past to heal in the present.

Are you seeking support in managing BPD? Working with a trauma therapist can help. Reach out to myTherapyNYC today to find out more about our therapists!

How has learning about the link between BPD and trauma impacted your thoughts and perspectives about this diagnosis? Join the conversation in the comments below!