Is BPD a Genuine Diagnosis or a Dismissive Label?
Curt and Katie chat about whether (or not) Borderline Personality Disorder is a useful diagnosis. We look at the difficulty in differential diagnosis, the huge overlaps with other diagnoses, and the harm caused by misdiagnosis and dismissal of these clients. We also explore whether BPD is just complex PTSD in disguise. We don’t come to total agreement, but we get a little bit closer on how we can move past the harmful elements of the BPD label.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we explore the diagnosis of Borderline Personality Disorder
After reading an article that suggests that there is no clinical utility to the BPD diagnosis, we decided to dig into whether or not BPD is a diagnosis worth using. We struggled to get this episode recorded as we started from a place of deep disagreement. We were able to get to a helpful conversation, we think.
Why is Borderline Personality Disorder controversial?
- It is heterogeneous
- There are a lot of rule outs and overlap with other diagnoses
- There may not be clinical utility in using this diagnosis
- There is bias and judgment related to having this diagnosis
- There is a lot of harm from misdiagnosis
What are the problems and challenges in diagnosing “BPD?”
“I think there’s that element of when we don’t have resources, and we have to get to a diagnosis very quickly, I think it is perfectly reasonable that we’re going to miss stuff. I think it’s when we stop looking, that we really…harm our clients.” – Katie Vernoy, LMFT
- Overlap with autism, psychosis, complex or chronic trauma and others
- Must look at the causes rather than solely the symptoms
- The ongoing complexity of how trauma interacts with other elements of a person’s experience and personality make it hard to tease out what is really going on
How is Borderline Personality Disorder distinct from Complex PTSD?
“Starting to differentiate between Complex PTSD and BPD is: Complex PTSD, when it comes to relationships, tends to show more avoidance of entering into relationships. BPD has a feature of an absence of self that complex PTSD does not…there is a desire to be in relationships, a desire to become…all invested into relationships, some of that great idealization, and then great…diminishment of the people that they enter into relationships with that is significantly different than…Complex PTSD.” – Curt Widhalm, LMFT
- First you must understand the relationship between PTSD and Chronic or Complex PTSD
- A theory is that Chronic PTSD has more relational avoidance than BPD
- Another theory is that BPD has an absence of sense of self, which CPTSD does not
- There is literature that shows that not all patients with BPD have trauma history
Should BPD remain as a recognized diagnosis in clinical practice?
- We’re still not sure and don’t completely agree
- At the very least, it needs to be renamed
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Mad in America – Borderline Personality Disorder “No Longer Has a Place in Clinical Practice”
The Wave Clinic – cPTSD vs. BPD
Psychology Today – Is It Borderline Personality Disorder or Is It Really Complex PTSD?
Mind – Complex post-traumatic stress disorder (complex PTSD)
Elephant Journal – Why I’m Setting Down the Label “Borderline Personality” Once & For All.
Elephant Journal – A Love Poem for Girls with Borderline.
Elephant Journal – Dear Mental Health Professionals: Stop Stigmatizing Us.
Elephant Journal – I Was Misdiagnosed with Borderline Personality Disorder.
American Psychological Association – Clinical Utility of the AMPD: A 10th Year Anniversary Review
Why borderline personality disorder is neither borderline nor a personality disorder
Mad in America – Addressing Cultural Bias in the Treatment of Personality Disorders
Cyr, G., Godbout, N., Cloitre, M., & Bélanger, C. (2022). Distinguishing among symptoms of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder in a community sample of women. Journal of Traumatic Stress, 35(1), 186-196.
Mulder R, Tyrer P. Borderline personality disorder: a spurious condition unsupported by science that should be abandoned. Journal of the Royal Society of Medicine. 2023;116(4):148-150. doi:10.1177/01410768231164780
Relevant Episodes of MTSG Podcast:
What’s New in the DSM-5-TR? An interview with Dr. Michael B. First
Rage and Client Self-Harm: An Interview with Angela Caldwell, LMFT
Are You Actually Neurodivergent Affirming? An Interview with Sonny Jane Wise
It’s NOT a Chemical Imbalance, An Interview with Dr. Kristen Syme
How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSW
Navigating the Social Media Self-Diagnosis Trend
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm, and Katie Vernoy.
Curt Widhalm 0:15
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. And this is the podcast for therapists where we discuss the things going on in our field, the ways that we have historically been as a field. And before we get to the content of this episode, we recommend that you go over to pitchforkemporium.com, and select amongst the finest pitch forks that you can get to because I’m feeling this one might bring up some feelings. And as always, we encourage people to share your thoughts about our episodes on our social media, or over in our Facebook group, the Modern Therapists Group. But we are starting this episode looking at an article from Mad in America about whether or not there’s clinical utility in the diagnosis of borderline personality disorder. And this article says, No. Katie and I are podcast hosts, and we apparently have enough time on our hands to dive into this inadequately. And…
Katie Vernoy 1:23
Extensively.
Curt Widhalm 1:24
Extensively.
Katie Vernoy 1:25
This is at least recording number two.
Curt Widhalm 1:28
We are putting an opportunity for a lot of community feedback on this as well. But Katie, you were the one who originally came across this article. You sent this over to me, said; Let’s make a podcast. So I’m gonna start this over with you.
Katie Vernoy 1:50
All right. So the premise behind this article is based in another article by…
Curt Widhalm 1:59
It’s articles all the way down and people it’s…
Katie Vernoy 2:01
Articles, just so many articles all the way down. Okay. This is from a this is a Mad in America article that basically is just summarizing an article from the Journal of Royal Society of medicine by Mulder and Tyrer. This is in 2023. And it talks about their big concerns about using the diagnosis borderline personality disorder, calling it a heterogeneous catch all that is not actually a personality disorder, because it talks about symptoms versus traits. One of the authors, Tryer, in 2009 had talked about maybe this is more of a recurrent unstable mood disorder and we should maybe call it fluxithymia. There’s been huge debates, including by Curt and me for hours trying to get to a place where we can actually have an episode here about whether or not BPD is just Complex PTSD, which we’re still probably going to have to sort through on this episode. But, but really, the reason that I wanted to bring this up is in the Mad in America article, as well as the source material, they they talk about how the differential diagnosis is, is pretty broad, looking through ADHD, bipolar, mood disorders, trauma, autism, psychosis, chronic sleep disturbance was one of the ones that was saying that some of this stuff can happen because of those things. And so there are saying it’s not diagnosed while there’s huge bias, which leads to a lot of clinician issues where they dismiss these these patients that come with with similar presentations. And that there really isn’t specific treatments for BPD that aren’t, you know, just kind of other things pulled together. And we’re not going to go into that element of it. But they went pretty far to basically say there’s no clinical utility to this diagnosis at all. And I’m still figuring out where I sit with that. Where do you sit with that, Curt?
Curt Widhalm 4:11
I’m gonna start with just kind of maybe a little bit of history in this. You and I were talking about this in many of our discussions leading into this episode. So the origination of borderline personality started out as you and I have discussed as being the borderline between neurosis and psychosis.
Katie Vernoy 4:37
Yes.
Curt Widhalm 4:38
And we are both very well aware of the historical ways both within the mental health treatment community as well as the greater society at large that has weaponized calling, particularly women, or female presenting people as being borderline when they’re having a emotional reactions to things or generally being perceived to be difficult.
Katie Vernoy 5:05
Yes.
Curt Widhalm 5:06
I was trained in when I was in grad school, we were still under the DSM-IV-TR. And one of the things that my professors at the time had really talked about is in the classification out of, at the time, the Axis II personality disorders and mental retardation, out of the things on Axis II, the one that was treatable, was borderline personality disorder. And so I’ve maybe not had always kind of the same bias that was taught to me that many other people have. I’m very well aware that it has been a huge bias, I see it very consistently. And currently, as far as, you know, some of the Facebook group posts that we see or some of the ways that I hear other clinicians talking about things as far as like, I think I have a borderline on my hands. That I generally try to create some some more positive space and understanding around. So, I’m not saying that I’m going to be the perfect representation on this at all. But I am going to say that there are definitely a lot of very bad people presenting, not bad people, there are people who are presenting very bad ideas about BPD historically. I think a lot of people who are perceived as being BPD have been misdiagnosed, when really things have started out as relational trauma. This is a way of expressing some of the big feelings that have been out there. Some people who probably have a true complex PTSD diagnosis have probably been misdiagnosed as borderline personality disorder. Ultimately, I’m going to make the case. Well, I’m going to attempt to. That I agree that BPD probably does not need to be a diagnosis. I’m not ready to jump in that it’s just cPTSD.
Katie Vernoy 7:10
Okay. I think the biggest pieces before we jump into, is it something different? Or is it a particular presentation of complex PTSD? I just want to comment on some of the stuff I was reading about the harm related to misdiagnosis were from some autistic folks who were not of a gender typically diagnosed with autism. And I think to me, you know, especially when we look at rejection sensitivity dysphoria, we look at autistic meltdowns, we look at a lot of things, I think we need to really talk through maybe maybe briefly, the differential diagnosis here. Because to me, it seems like when, when, usually a female client comes in, and they are pushing back, or they’re asking hard questions, or they’re doing things that maybe historically would have been dismissed as BPD, I think we are doing a huge disservice if we don’t dig deeper into causes, into where, you know, kind of the the makeup of of these symptoms. And for me, that’s why I get really hesitant about keeping a diagnosis that has this catch all, because it feels too easy to go to BPD when you have an annoying client, or when you have a client that’s challenging you. And I know for myself, and I may have talked about this in another episode, I don’t remember but I had a client who actually had psychosis, who was asking some questions that felt like BPD to me, and was like, I don’t know, should I kill myself, stuff like that. And it felt like it was pulling from a different place. But once I was able to get additional information and re-characterize this client as psychotic versus BPD, it completely changed how I was interacting with the symptoms. And so for me the bias that clinicians have and the difficulty they have moving past their own discomfort, with some hard symptoms, I think, really gets us off on the wrong foot.
Curt Widhalm 9:13
You get the sense that the rush to create a billable diagnosis often makes us overlook some of these things that ultimately gets us to a point where we just kind of ended up diagnosing things out of our own reactions, rather than taking a lot more pragmatic look at causes and history when it leads to presentations like this.
Katie Vernoy 9:39
I think that’s I think that’s fair to say. Especially I’m thinking about where really intense symptomatology might show up in inpatient units and places were usually under resourced staff, staff that are, you know, kind of familiar with gallows humor and it’s against them and those kinds of things. And I know that’s, that’s not every single inpatient place. And that’s, I don’t want to overstate that. But I think there’s that element of when we don’t have resources, and we have to get to a diagnosis very quickly, I think it is perfectly reasonable that we’re going to miss stuff. I think it’s when we stop looking, that we really, we really harm our clients.
Curt Widhalm 10:23
And I think, you know, in some of the things that you’re talking about, as far as you know, particularly assigned female at birth neurodivergent clients presenting with some of the features that fall under a BPD, as currently defined, and you’re gonna get annoyed…
Katie Vernoy 10:41
Sure.
Curt Widhalm 10:41
…hearing me say that during this episode, but as currently defined, some of the overlapping features of the two, one of the things that we have spent a long time discussing before the episode is kind of getting to this point that looking at some of the causes for why some of the perceived deficits or the skills that may be missing, whether it’s BPD, whether it’s complex PTSD, whether it’s ASD, whether it’s any other…
Katie Vernoy 11:16
A-B-C-D-E-F-G…
Curt Widhalm 11:17
…any other elephant alphabet sort of things here, yeah, is kind of the the cause of it. You know, there are specific, you know, relational skills that might be missing in that BPD presentation, that may be due to trauma, and that may have more in common with a complex PTSD thing than somebody who is neurodivergent, who has other reasons why those skills may be missing developmentally down the road. And I think that this is a necessary, important distinction to make. And due to the nature of this episode, we’re acknowledging it, but we’re not going to dive deeply within, like, Okay, we see it, maybe we’ll have a Patreon episode, or something else where we go deeper on this. But…
Katie Vernoy 12:04
I do want to address it for just a second, because I think there is some messiness here that I just want to illustrate why I have such a hard time getting to a clear call to action, or a clear response to: is this helpful? When someone has a lot of trauma throughout development, I want to just kind of go into this real quickly so that that I can express some of the things that gets me kind of that messes with my brain. As someone is growing up, and there’s a lot of trauma that’s happening to them and some might call that complex PTSD. That might be, you know, I’m not worried about that diagnosis for this this point. When you have trauma at important developmental milestones, you miss things, you learn how to be in relationships based on relational trauma, there’s a lot that happens there. And so for me, when someone has a really complex picture of trauma in their childhood, it’s going to impact who they are when they grow up. And it could be, you know, post traumatic growth in air quotes, it could be PTSD, it could be complex trauma, it could be a lot of things, right? I think the other challenge is when you are growing up as a neurodivergent person, when you grow up as a neurodivergent person, your brain works differently, and you interact with the world differently. And there’s also typically other types of relational trauma, other types of things that happen as well. And so there is trauma, and may impact how you develop as well. So you have both the neurodivergent picture and you have both trauma picture. If you have psychosis, if you have bipolar, if you have like if, if if if we keep going on to all these other differential diagnoses, and there is trauma, all of these things layer in to make a very difficult diagnostic picture. Because we can’t: is it neurodivergent? Is it trauma? Is it a personality disorder? Is it what is this? I think this is why differential diagnosis is so challenging. And oftentimes I go to who are you? What symptoms are you displaying that are problematic to you? And let’s start there, versus I’m going to label you with a particular diagnosis because that’s the easiest thing to do. And I don’t know how many people end up with the throwaway BPD diagnosis or the catch all, you know, BPD diagnosis, but that’s, that’s why I worry about it. Because I feel like it’s so complicated to try to sort through, tease out what is what.
Curt Widhalm 14:39
And that’s where one of the many conclusions and sweeping statements that we’re going to make is that why to clinicians are lazy and just kind of throw out a bad diagnosis on something that ends up being harmful to other people.
Katie Vernoy 14:56
Okay, I don’t know if I’d say a lot. But I’m worried about the ones who do .
Curt Widhalm 15:00
I would say it’s a significant amount enough that many of us are like, Yeah, we see that.
Katie Vernoy 15:08
All right. All right.
Curt Widhalm 15:09
I’m not saying it’s all I’m not saying it’s half. I’m not saying that it’s a quarter. I’m not.
Katie Vernoy 15:15
You’re not going to define it. You’re just saying: This is a problem. So stop doing it.
Curt Widhalm 15:20
There’s more than seven out there. That like…
Katie Vernoy 15:24
Sure, sure. It’s a less than non significant, or it’s a more than non significant amount.
Curt Widhalm 15:28
Yes.
Katie Vernoy 15:29
All right. Moving on.
… 15:30
(Advertisement Break)
Curt Widhalm 15:31
Let’s bring this back to: All right, let’s look at what is called BPD, as it currently stands. And maybe this is where I’m going to make the overture that I think that there’s a core enough group of symptoms that warrants maybe a refreshed diagnosis, a new name, one without the history that goes along with it, but one that is actually different from cPTSD.
Katie Vernoy 16:01
So what are the symptoms that you see are as distinctive, because I think this is where I get, this is where I’ve stumbled the most and trying to figure out what the real differences are. It just feels like there, you could explain a lot of these differences from trauma.
Curt Widhalm 16:16
Sure. So, within this combination of, I don’t know, a spectrum of looking things. Let’s first start with cPTSD, and PTSD.
Katie Vernoy 16:28
Okay.
Curt Widhalm 16:29
Because I think that this is where it’s not just like a natural spectrum, where it’s just like, oh, the more features that you show shows which severity of these diagnosis that there are. I think that there’s enough literature that defines what PTSD is, that’s pretty straightforward. I think that in the emergence of complex PTSD, and what makes it PTSD, is kind of the re-experiencing of trauma, and the sense of fear of threat to self and the oftentimes high levels of anxiety that go along with it. Now, this is a nuanced discussion where there is a lot still, there’s still a lot of overlap, that can happen between Complex PTSD and BPD. We’re not there yet.
Katie Vernoy 17:23
Okay, but just to clarify what you’re saying, complex PTSD, by nature has the symptomatology of PTSD?
Curt Widhalm 17:33
Yes.
Katie Vernoy 17:34
And if it doesn’t, it’s something else.
Curt Widhalm 17:37
Yeah.
Katie Vernoy 17:38
Okay.
Curt Widhalm 17:40
And I think that that’s really where getting into a little bit of the the nuanced picture helps us to say, you know, it’s PTSD with very complex, you know, origins, very complex presentations of things. That can also be in addition to what is currently called borderline personality disorder. I would love to come up with some sort of metaphor, or some sort of new name for like, what it should be called, instead of what I’m ultimately trying to land on here. But starting to differentiate between complex PTSD and BPD, is complex PTSD, when it comes to relationships, tends to show more avoidance of entering into relationships. There’s a sense of self that exists, but getting into relationships with other people can feel very threatening, and that can lead to avoidance aspects and isolative aspects that is not shared with some of the features of, I don’t know BPD 2.0 or that doesn’t even feel right in saying that. But like, and yet named a new, kind of still differently needed to be recognized for different treatment purposes, diagnostic label here.
Katie Vernoy 19:04
If anyone followed that, Curt still not renaming BPD, but we’re getting to the point of saying like, yes, we think it needs to be renamed, we just don’t have…
Curt Widhalm 19:14
It needs to be renamed. And the reason for it is the features that I think are very, very different is that what is currently called BPD has a feature of an absence of self that complex PTSD does not. I think what is currently called BPD has a different approach to relationships. I don’t see the things in the literature, the clients that I see in my practice, who are truly BPD as currently defined, avoiding entering into relationships, I see that there is a desire to be in relationships, a desire to become, you know, all invested into relationships, some of that great idealization, and then great, you know, kind of diminishment of the people that they enter into relationships with that is significantly different than kind of the avoidance that I see and the literature tends to show when it comes to complex PTSD, avoidance of those relationships.
Katie Vernoy 20:27
I see the distinction between the two relationship styles. And honestly, it kind of doesn’t matter to me. Like I get that this is a difference. So let me explain why it doesn’t mattered to me.
Curt Widhalm 20:37
Before, before you explain, can I tell you how I’m going to hear whatever you’re explaining first.
Katie Vernoy 20:42
Sure.
Curt Widhalm 20:44
I’m looking, I’m listening through this as far as different attachment styles.
Katie Vernoy 20:49
Yeah.
Curt Widhalm 20:49
And if that you would make the same arguments as far as different attachment styles. But I’m curious what you’re gonna say.
Katie Vernoy 20:58
Well, for me, the the distinction on attachment styles or relationship, the way someone interacts in their relationships, is, to me a, a distinction on a response, right? I think for me, I need to get past it being basing in complex trauma, because for me, I can see having a cPTSD with avoidant relationships and a cPTSD, with reactive relationships or whatever, I don’t know the right name. I mean, I can see it as being two different presentations with a similar background. And so for me saying like, well, well, there’s these things, but one person is, is running towards relationships, and one’s running away, like I’m like, okay, but we have, you know, agitated depression and can’t get out of bed depression, we have lots of different presentations that still fall under the same thing. Because in truth, even on treatment, helping someone to get to a place where they can trust people and have strong relationships with people is something you want for both of those presentations. So, I don’t know that even the distinction in relational style pushes me to like, Oh, yes, these are absolutely different things. And so for me, I would need to see how does BPD show up, or what is currently called BPD show up without trauma. Like, for me, that’s the trauma makeup and the thing that comes through, like there’s, there’s slightly different profiles, I get that, but they don’t seem like they’re so extremely different in how, when you’re actually talking about them with a client. You know, and they’re not mutually exclusive, I can avoid relationships, and then the relationships I have, I can have this high approach, and then also diminishment of the people around me. So I feel like they’re not necessarily mutually exclusive. And I don’t feel like they’re so different. It’s trouble with relationships because of what’s happened in the past.
… 22:57
(Advertisement Break)
Curt Widhalm 23:00
The literature that I’ve been looking at, we’ll include our our reference list in our show notes over at mtsgpodcast.com.
Katie Vernoy 23:08
In the huge rabbit holes that we went down, there’s going to be a lot in the show notes.
Curt Widhalm 23:14
The literature that I was looking at kind of consistently shows that the cluster of symptoms that I’m describing for as yet unnamed diagnostic category, that I’m hearing you describe as kind of like, these are, you know, a checklist of add on features that could be done with cPTSD. Am I correctly reflecting?
Katie Vernoy 23:39
A different presentation, like it’s giving, saying, like, this is the underlying and there’s this presentation, this presentation, and maybe a third presentation. Like it’s somebody has been extremely traumatized and they’re going to show up in one of a few ways. And this is how we, how we work with them is based on understanding that there’s huge amounts of underlying trauma that lead into these presentations.
Curt Widhalm 24:01
So the literature that I’ve been looking at says that in validating BPD, I’m not fully agreeing with this, but…
Katie Vernoy 24:11
Sure.
Curt Widhalm 24:11
BPD can exist without a trauma history.
Katie Vernoy 24:15
Okay, so where does it come from?
Curt Widhalm 24:18
This is why I like to look at it as the state versus trait idea. You know, I’m kind of sidestepping your direct question here and saying, it doesn’t necessarily matter where it comes from if there’s no trauma history, because it’s still treating the traits that show up. It’s teaching skills. It’s being able to have a better sense of self identity sorts of things. It’s better relational skills sorts of things. In the good differential diagnosis, all right, you don’t have a trauma histories, we don’t have to do the trauma experiences aspect of working through this. Literature kind of consistently shows that not all people who have correctly diagnosed BPD have trauma histories, a lot of them do. And those are needing to treat two different diagnoses.
Katie Vernoy 25:17
Can I, can I respond to that really quick before we move on? Because I would be very curious, especially in my history and the history and the folks I’ve supervised on that stuff. There are folks who come to us that have never told anyone else about their trauma history, they’ve never disclosed any of it. I’ve had people who’ve done intakes, and none of that was disclosed, came back to the second session told me their trauma history. So I, I feel like saying like, well, they don’t have trauma histories, like, how sure of that, are we? I guess it’s a real question.
Curt Widhalm 25:50
There’s a handful of meta analyses that we will keep in our references here that have at least several 100 participants in latent class analysis research, that go through trauma histories of people and consistently find a difference between cPTSD as currently defined, and BPD as currently defined. So have fun reading those references, we have just a few minutes getting to this point here. So, and once again, are available over mtsgpodcast.com. The big feature differences, though, is I think I’m hearing you describe it as there’s trauma, and there’s different presentations of it. I’m looking at it as in the absence of trauma, this is a standalone diagnosis, not warranted necessarily as a personality disorder. These are things where treatments and skills allow for people to move through these symptomologies that there is a: it’s not a life sentence, to you are forever going to be seen this way. There’s a lot of history that goes along with needing to throw out BPD that is badly handled in our fields. Yeah, there’s a lot of people with us that do have this as a trauma response and a relational trauma response. I acknowledge all of the points that you’re saying here. I think that it doesn’t necessarily mean that somebody has a trauma history. And that’s why it needs its own separate diagnosis, in order to be able to treat this cluster of symptoms that doesn’t have the reenactment or the the re-experiencing of feelings, that the, it’s not a threat to sense of self, because there’s not a sense of self in the same way. That’s why I see it as like, okay, there’s a place that it needs to land. But we kind of need to look at it as this is not just extra features on top of an already existing diagnosis.
Katie Vernoy 28:01
I think that’s as far as we can get with the time we have. And I think we’re pretty close together. I think it’s just, I still feel very strongly that there is such a huge relationship to trauma history or to underdiagnosed other things. And so I think, for me, I’m going to just come back to differential diagnosis, see the human in front of you. Just because someone is challenging don’t go to I can’t work with this person, they must be BPD.
Curt Widhalm 28:28
Are we signing up for a part two of this episode?
Katie Vernoy 28:32
Maybe. I’m bet we’re gonna get some responses. So probably we’ll have a part two, whether we like it or not.
Curt Widhalm 28:38
Once again, we’d love to hear your input on this. Yyou can let us know through our social media or send us a message and you can join our Facebook group, the Modern Therapists Group. If you want to support us become a patreon member and…
Katie Vernoy 28:55
And then if you do that, you can actually come and talk with us in like a coffee hour or q&a and, and have this conversation with you.
Curt Widhalm 29:04
And depending on the level of Patreon that you want to join at, we might create a level where you can see our poorly recorded earlier versions of this.
Katie Vernoy 29:13
I don’t know if I feel comfortable with that.
Curt Widhalm 29:16
And until next time, I’m Curt Widhalm with Katie Vernoy.
… 29:19
(Advertisement Break)
Announcer 29:21
Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don’t forget to subscribe so you don’t miss any of our episodes.
SPEAK YOUR MIND