Question: If You've Been Told You Have Complex Trauma Does That Mean Bpd?

[ms spock]

Even if it was true @Lizio, which I don't think that it is, but even if it was - well doesn't the research say that DBT can heal/manage BPD? I thought it was 18 months or two years of DBT to fix BPD?

 

[ms spock]

And I would be interested to know what the overlap from say Reactive Attachment Disorder to BPD as well? I don't understand it all.

 

[Chava]

I'm in therapy for complex trauma (multiple traumas but probably worst of it in early years). Even with the early trauma, I've never been diagnosed with a personality disorder. I've taken the MMPI and a whole load of assessments. I do have some attachment-related issues that share features with both borderline and avoidant personality disorder at times (also dissociative, but not quite enough to designate a dissociative disorder). My therapist is working with me on trauma but also with understanding that my ability to connect to others is all rolled into this most of the time.

 

[Queen Boudica]

He is still saying complex trauma is classified as BPD in the DSM even though he doesn't agree with that label or the DSM. And he said there is a spectrum so I am not at the level that my sister and mother were. But I don't understand that. I look at the criteria for BPD and I don't come anywhere near that or tick enough boxes. And if complex trauma is covered by PTSD plus subtypes then why isn't he aware of that? I couldn't challenge him on it, because then it feels like I am questioning his competence. I just kept quiet. But everytime I think about it or see the symptoms for BPD, and remember what my mother and sister were like, and I have tried to not behave like that and I don't think I have.

 

[anthony]

It sounds to me like a lot of interpretation on his behalf, to be honest. The DSM V is quite clear in these things.

The only reference to BPD and trauma, under the BPD DSM V diagnosis, is, Physical and sexual abuse, neglect, hostile conflict, and early parental loss are more common in the childhood histories of those with BPD.

There is nothing else in the BPD diagnosis about trauma, than the above. Taking the above and claiming that is complex trauma diagnosis, is a far far reach and personal opinion, not specifically factually based on the science and practice of mental health diagnosis.

 

[Chava]

I couldn't challenge him on it, because then it feels like I am questioning his competence. I just kept quiet.

If you are confused and really don't agree, it's completely reasonable to keep asking questions. I always have several questions for my doctor...and I've stuck with her because she is willing to answer, if she can, or have a conversation about stuff.

Does he feel like he needs to nail a diagnosis for treatment and/or insurance purposes? Like this might be more descriptive of the approach he wants to use in therapy? Does he not feel like sticking with just "PTSD" from the DSM will cover it? What is his driving force for giving you the diagnosis of BPD, even if he doesn't agree with the DSM? There must be something.

You deserve to have confidence in your therapist. It sounds like he wants to give you a diagnosis he doesn't entirely believe himself. So, I'd keep asking questions. It's your treatment. Personally, a DBT or other BPD approach would have been a far cry from the trauma therapy I am doing, and likely not as deeply relevant and helpful. Is he going to work with your traumas? And how? You are the customer/recipient of this uncertain diagnosis and what it might mean for your treatment.

You don't have to question his competence, but you can question his own uncertainty (as well as your own), and ask questions about why the diagnosis matters (especially since he doesn't agree with the DSM) and how this will relate to your treatment. It's helped me so much to be more active in my healthcare and therapy this way. You're not telling him what to do or how. You can just ask more questions and get more information so you are more empowered in your own therapy and healing choices. If he's determined to diagnose BPD but can't well explain how it fits for you, or explain a mode of therapy that you believe in, you have the option of finding another therapist who might have a very different interpretation of early trauma and diagnosis.

ETA a sidenote: I think this is where the Judith Herman work on trying to re-label BPD as CPTSD has not been very helpful. For one, we don't have a DSM diagnosis for CPTSD yet. Also, while many BPD patients might likely not be BPD but more some version of complex trauma (so deserve a more descriptive diagnosis and treatment), many others with BPD have no trauma history. So now sometimes people with obvious trauma histories can be diagnosed BPD because we've learned there might be a connection but we have no other diagnosis. So, a sort of back-fire effect while it all gets sorted out?

I think many therapists do see the separation here, that they probably can't be one-in-the-same, but it got muddied when the concept of CPTSD arrived. I've had a highly self-destructive history, but not the relational problems that are quite hallmark in BPD. In all my ins-and-outs of psych wards and therapists and hospitalizations for suicide attempts, I have not been diagnosed with a personality disorder. The skills work for the true BPD diagnosis would make little sense for me. Work on body-level regulation for the trauma has helped. I've moved beyond self-destruction but still have chronic pain, feelings of numbness, and avoidance of relationships. This relates well to my trauma, not so much my personality.

 

[Queen Boudica]

What is his driving force for giving you the diagnosis of BPD, even if he doesn't agree with the DSM? There must be something.

That is what I want to know. I emailed him yesterday. Saying I don't understand why he is saying complex trauma is BPD in the DSM and asking him how I could come under BPD in the DSM as he must be thinking I match the criteria even if it is low on the spectrum. So what symptoms does he think I match other than I have complex trauma? I have an appointment with him tomorrow and I am really edgy.

In all my ins-and-outs of psych wards and therapists and hospitalizations for suicide attempts, I have not been diagnosed with a personality disorder.

See I haven't even been that serious to be hospitalised on made a suicide attempt. I have thoughts I want to die. I just don't see how I can be so serious to be BPD??

 

[Chava]

That is what I want to know. I emailed him yesterday. Saying I don't understand why he is saying complex trauma is BPD in the DSM and asking him how I could come under BPD in the DSM as he must be thinking I match the criteria even if it is low on the spectrum. So what symptoms does he think I match other than I have complex trauma?

Those are really good questions...and good to empower yourself through wanting to understand your (proposed) diagnosis better. I had some weird stuff come up on an MRI that might have meant nothing. I maybe bored my doctor to tears with my questions, but it's my body and my life. It's not saying you don't trust the professional, it's that as an adult in charge of your life, you deserve to understand murky diagnosis, especially if you are being treated by this person.

I hope it goes well tomorrow. Maybe keep writing down more questions. Complex trauma is NOT "BPD" in the DSM. Complex trauma might be PTSD + DDNOS, PTSD alone (but from child abuse), PTSD + depression, personality disorder, panic disorder, etc.... So I do think he is wrong in that statement. But good to ask why he thinks you have BPD, or symptoms worthy of that diagnosis. Is this for insurance??? Or is this how he will model his treatment?

Let us know how it goes. I know you're edgy but you're doing really well asking these questions vs just being passive and perhaps losing trust in your therapist/therapy as a result of not communicating your concerns and questions.

 

[Queen Boudica]

PTSD + DDNOS, PTSD alone (but from child abuse), PTSD + depression, personality disorder, panic disorder

Yes that is exactly it. I did say to him before I am PTSD from child abuse plus GAD, maybe and depression yes I have panic attacks.

What did DDNOS mean again?
No it's not for insurance, fat chance I'd insurance on this. Or disability. But what I am worried about is being wrongly labelled and it affecting jobs, and any custody battles.

He is treating me for complex trauma. He just seems to think that complex trauma comes under BPD in the DSM. And keeps saying that. I know he doesn't like the DSM, but then he talks about BPD to me as being complex trauma. So he shouldn't be doing that. I've been seeing him for 4 years and the thing is I asked him before and he said I wasn't BPD, so now to be saying complex trauma is BPD. But he also tells me I have PTSD and BPD is not PTSD is it?

 

[Chava]

but then he talks about BPD to me as being complex trauma. So he shouldn't be doing that. I've been seeing him for 4 years and the thing is I asked him before and he said I wasn't BPD, so now to be saying complex trauma is BPD.

This would all be very confusing, especially the need for this diagnosis after seeing him for four years. So hopefully he can spell out why he feels the need to label it now under the DSM, after all this time, or why he maybe thinks you have BPD for real but doesn't want to freak you out. Yes, with the stigma attached, it might not be helpful in custody issues. My therapist is treating me for complex trauma as well, and sees no need for further diagnosis I've had depression, anorexia, and PTSD diagnosed in the past, but complex trauma, or even "developmental trauma" probably fits better with my stuff, even if not in the DSM...these are then lenses through which my therapist is helping me, and the root of the other issues like eating, self harm, suicidal behavior, and substance abuse...

I've had all of these destructive symptoms, but no pattern of intense or unstable or rapidly changing relationships. It would make little sense to have diagnosed BPD without the relational symptoms. But does your therapist see some of those patterns? I've been through and survived some panic around fearing my therapist would forget about me, be angry at me, or dump me...only specific to therapy relationship. I actually get along with pretty much anyone but am highly avoidant of close relationships (not Avoidant Personality Disorder either, but definitely an avoidant attachment style related to my early traumas and my home).

What changed for him to seek out a BPD diagnosis? Why didn't he try to do this initially? Does he see something different in you or did the system in how he works changes? How would treatment change, or what difference does labeling your issues now matter? (maybe you can't answer, just examples of questions for him)

DDNOS is Dissociative Disorder Not Otherwise Specified.

 

[Queen Boudica]

Well see that is it. See he doesn't like the DSM, said he disagrees with them calling complex trauma BPD. But yet he refers to it sometimes as BPD.

I'm not getting an official diagnosis. He originally told me I had complex trauma. But my sister was diagnosed with BPD and I am pretty sure my mother was BPD.

But then he started talking and saying complex trauma is BPD. And that freaked me out. I really freaked after I left the session out as it triggered me really badly. My sister was originally misdiagnosed as schizophrenic. And she wasn't. And I have always been afraid of being like my sister and my mother. My mother was so tick all those boxes in BPD and by the time the mental health care system and years with my mother, my sister was ticking all those boxes too.

So I had to phone him up because I was in a state. And he said that there were spectrums and that he doesn't like the DSM, uses it as a doorstop but he still was saying that the DSM calls complex trauma BPD. And he was going on about many psychologists don't believe it should be called BPD, because of the name, and politics etc.
I couldn't question him after that I was in a state.

So he hasn't changed diagnosis he is saying complex trauma comes under BPD in the DSM. He says I am complex trauma. But he also is saying complex trauma is BPD and that has really freaked me out, because I know what the symptoms are for BPD and I don't match them. And it feels like when my mother and my ex, were trying to label me as things I never was. I've been called so many things and told I was evil and a slut and selfish and a monster and my ex calling me lazy and selfish and useless and paranoid and psychotic. None of which I was. They were the ones who were violent and abusive and got into angry rages. So to think I could be put under the BPD category when I have strived to not be anything like they were. I just don't understand.

And I asked him before and he said I was complex trauma but not BPD, So why is he calling complex trauma BPD now? I just don't understand unless he thinks I am BPD. And I don't understand how he can think that.

 

[Chava]

So to think I could be put under the BPD category when I have strived to not be anything like they were.

First, we can't strive not to have something like BPD, if we do have it. I hear your fear of not being like your mom. My was likely BPD plus her own trauma history. She was abusive and raging. I'm not like that. But I have inflicted a lot of rage and fear onto myself (vs others). Anyway, I'm not like her, but I have my own set of issues. If you could set aside your fear of being associated with your mom (or others), would it make a big difference?

But again, I don't know where the DSM would consider "complex trauma" to be the same thing as BPD. Maybe others can answer this. Your therapist seems to be of the mindset that they are one-in-the same. So either he really believes that, or he also thinks you have BPD but doesn't want to scare you (which is legit, with your family history). I hope you get some more clarification. Complex trauma is not defined or attached to any one diagnosis in the DSM, as far as I know. It's more a philosophical thing. The DSM doesn't yet have any one diagnosis for "complex trauma."