“Borderline Personality Disorder” vs “Borderline States” vs “Complex Psychological Trauma”
PCH Treatment Center avoids the term ‘Borderline Personality Disorder’. We have a better and more empathic way to think about this issue.
Borderline Personality Disorder is a psychiatric label developed for the Diagnostic and Statistical Manual of Mental Disorders many years ago. The term was thought to describe individuals who had “persistent maladaptive character traits” that were “enduring” and “long standing.” In particular, dysregulation and poor relationships were at the center of this “disorder.” The term “borderline” was derived from a belief that a person manifesting these symptoms and behaviors was on the border between psychosis and neurosis, a concept that we now know is inaccurate. In recent years, many clinicians have changed their thinking, finding the term to be misleading, unreliable diagnostically and pejorative and stigmatizing. Furthermore, the idea that this is a “lifelong disorder” is damaging and untrue.
At PCH Treatment Center, we avoid this diagnosis as we do not believe in the construct of Borderline Personality Disorder. Furthermore, we find the entire diagnostic category of Personality Disorders to be an inadequate way to describe complex personality traits and issues. We see dysregulation and attachment difficulties, which are at the center of what is called Borderline Personality Disorder, to actually be the result of complex psychological trauma. This trauma manifests as instability of mood (issues with regulating thoughts and emotions), behavior (recklessness and impulsivity), and relationships (intense relationships that cycle between idealization and devaluation). When people find themselves triggered and become dysregulated and highly reactive, we see that as a “Borderline State”, which reflects the contextual nature in which we view all psychological issues. We do not believe in the concept of personality disorder as a persistent and consistent trait (which is inferred in the term “Personality Disorder”). Rather, we find that by treating dysregulation and attachment from a trauma perspective, and recognizing the context of relational triggers, we are able to improve insight as well as emotional regulation. By using multiple treatment modalities, we provide tools to help our clients better regulate and navigate the attachment issues that cause such difficulties. Because anxiety, depression and stress exacerbate these symptoms and behaviors, we teach our clients to identify and manage these issues so they can maximize their well-being.
In short, we are less interested in what is “wrong” with you and more in what happened to you to trigger these difficult relational states.
Complex Psychological Trauma and its relation to “Borderline Personality Disorder” and Personality Disorders in general.
Letter from Dr. Jeff Ball
PCH Treatment Center was designed to fill a gap between outpatient treatment and psychiatric hospitalization. The population that needs this type of service includes many bipolar and mood-disordered clients, anxious clients, and clients that have been labeled with “AXIS II Disorders” or “Personality Disorders.” But what does that mean? So many of our younger clients, who range between 18-30 years of age, tend to have emotional regulation problems and would fit the criteria, as written, of “Borderline Personality Disorder.” But they also have significant trauma histories and would also fit a definition of Complex Post-Traumatic Stress Disorder (PTSD). Over the years, I have questioned the meaning of “Borderline.” Is the term really useful anymore? Is it now a pejorative term for difficult people? Is it even useful to use that label? At PCH Treatment Center, we have reevaluated the concept, asking a lot of questions about the utility of the personality disorder concept. We have instead chosen to focus on the causes of the person’s symptoms and behaviors in the context of psychological and emotional trauma. Over the past seven years of PCH’s existence, we have treated hundreds of clients who would be diagnosed with “Borderline Personality Disorder” in other programs. We have had tremendous success in addressing underlying trauma and attachment issues while avoiding this label and all of its negative connotations.
Complex or Developmental PTSD*
Defined as multiple social and/or interpersonal traumatic episodes, usually beginning in early development, and spanning multiple developmental stages.
With complex trauma, the patient presents additional symptoms and dimensional problems beyond the basic symptoms of PTSD.
- Self-destructive and suicidal behaviors
- Mood and affect dysregulation
- Identity problems
- Eating disorders
- Substance abuse
*Note that the symptoms of Complex PTSD are virtually identical to what is referred to in DSM-V as “Borderline Personality Disorder”