PTSD vs. Complex PTSD vs. Borderline Personality Disorder: What’s the Difference
Comparing PTSD, Complex PTSD (C-PTSD), and Borderline Personality Disorder (BPD)
A common question I’ve been asked is, “Dr. J, what’s the difference between PTSD, Complex PTSD, and Borderline Personality Disorder?”. So today let’s talk about it. These are all mental health conditions that share many overlapping symptoms, but have some slight differences in characteristics to keep in mind. Understanding the differences and similarities between them can be the key to an accurate diagnosis and finding the most effective treatment.
So how are BPD, PTSD, and C-PTSD similar?
Traditionally, PTSD, Complex PTSD (C-PTSD), and Borderline Personality Disorder (BPD) have been considered separate conditions with their own distinct diagnostic criteria. PTSD is classified as a trauma-related disorder in the DSM-5, while BPD is categorized under personality disorders. C-PTSD, though widely recognized by many experts, is not officially listed in the DSM-5. Many mental health professionals have found it helpful to view these conditions as existing on a spectrum of trauma-related disorders. Understanding them as part of a broader trauma spectrum can often lead to more effective, compassionate, and targeted treatment approaches.
Understanding Trauma Disorders as a Spectrum
At MindfulMD Psychiatry, we agree with the approach of PTSD, Complex PTSD (C-PTSD), and Borderline Personality Disorder (BPD) being treated as part of a spectrum of trauma-related disorders. Understanding that trauma can manifest differently in individuals is extremely important. Realizing that factors such as the duration, intensity, and developmental stage during which the trauma occurred likely play a role. As well as understanding that genetic, environmental, psychological, and social factors can all contribute to the complexity of how symptoms of a trauma disorder manifest.
Even when thinking about the subtle differences between BPD, PTSD, and C-PTSD, it can also be helpful to recognize that there are even more trauma-related conditions than just these three. In the DSM-5, the conditions specifically listed under Trauma- and Stressor-Related Disorders include:
Post-Traumatic Stress Disorder (PTSD)
Acute Stress Disorder (ASD) – Symptoms very similar to PTSD, with shorter duration lasting from 3 days to 1 month following trauma exposure. Studies have shown that that acute stress disorder often develops into PTSD, this is not 100% of the time, but it is common to see ASD persist and the diagnosis changes to PTSD.
Adjustment Disorders – Emotional or behavioral symptoms in response to a stressor, occurring within three months of the stressor.
Reactive Attachment Disorder (RAD) – A condition occurring in children characterized by emotionally withdrawn behavior towards caregivers due to severe neglect or inconsistent caregiving.
Disinhibited Social Engagement Disorder (DSED) – A condition in children marked by overly familiar behavior with unfamiliar adults, often related to neglect or inconsistent caregiving.
Other Specified Trauma- and Stressor-Related Disorder – Conditions that cause trauma-related symptoms but do not meet the full criteria for any of the specific disorders above.
Unspecified Trauma- and Stressor-Related Disorder – Diagnoses given when symptoms are present but do not fit specific criteria for the named disorders and further clarification is not possible or necessary.
Complex PTSD is not listed as a separate disorder in the DSM-5. However, it is officially recognized in the ICD-11 (International Classification of Diseases, 11th Revision) and is increasingly accepted by many clinicians as a distinct trauma-related condition.
Borderline Personality Disorder is listed under the category of Personality Disorders in the DSM-5. There is ongoing debate regarding if it should be moved into the trauma-related disorders section of the DSM. Research has shown that a very large percentage of individuals with BPD have a history of trauma, and some researchers have suggested that BPD very likely could be a manifestation of trauma. There are some experts who believe that C-PTSD is the condition that arises from BPD mixed with a history of trauma, while others believe PTSD, BPD, and C-PTSD to be three district diagnoses.
What BPD, PTSD, and C-PTSD Have in Common
While Borderline Personality Disorder (BPD), Post-Traumatic Stress Disorder (PTSD), and Complex PTSD (C-PTSD) are traditionally seen as separate diagnoses, it is clear that they have several overlapping features, especially when viewed through a trauma-informed lens. Understanding these commonalities can help demystify these conditions and guide effective treatment.
PTSD, C-PTSD, and BPD share overlapping symptoms—but not everyone experiences them the same way. This infographic highlights some commonalities, but not every symptom is exclusive to a single diagnosis. Think of this as a broad overview, not a definitive guide.
Shared Symptoms and Features:
Emotional Dysregulation:
All three conditions can involve intense, rapidly shifting emotions that feel overwhelming or out of control. Sometimes this can be confused with bipolar disorder because emotions can go up and down rapidly. Individuals with C-PTSD and BPD, as sometimes PTSD as well, often experience heightened emotional sensitivity and difficulty returning to a baseline of calm.
Interpersonal Difficulties:
Challenges in forming and maintaining healthy relationships are common. Those with BPD may struggle with fear of abandonment and unstable relationships, while individuals with PTSD or C-PTSD may experience emotional numbing or difficulty trusting others.
Trauma-Related Symptoms:
While PTSD and C-PTSD are often directly trauma-related diagnoses, many experts believe BPD is often rooted in childhood trauma or attachment disruptions. However, the exact mechanism of what type of trauma leads to which diagnosis, isn’t always a clear link. Flashbacks, intrusive thoughts, and heightened sensitivity to rejection can be traced back to traumatic experiences.
Identity Disturbance:
A fragmented or unstable sense of self is common across all three conditions. In BPD and C-PTSD, this often presents as a shifting sense of identity, see below on examples of what this can look like. In PTSD, sometimes this can look like individuals feeling detached from themselves or experience a loss of previously stable identity structures.
Impulsivity and Risky Behaviors:
To cope with overwhelming emotions or dissociative states, individuals with these conditions sometimes engage in impulsive behaviors. A few examples of impulsive behaviors can look like substance use, self-harm, reckless spending, impulsively quitting their job, or risky sexual behavior.
Dissociation:
Particularly common in C-PTSD and BPD, dissociation involves feeling detached from one’s thoughts, feelings, or surroundings. This can be the body’s coping mechanism for trying to deal with traumatic memories or intense emotions.
Hypervigilance:
Increased sensitivity to perceived threats or rejection can be seen in all three conditions. In all three conditions, the individual may feel constantly on edge. People with BPD may be hypersensitive to signs of abandonment. C-PTSD and BPD often have sensitivity to rejection, this can come out in various ways, sometimes looking like leaving a relationship at the first sign of potential rejection or abandonment, or potentially having intense emotional experiences when they see a sign that they interpret might be rejection.
Understanding the Overlap:
Despite being classified differently in diagnostic manuals, BPD, PTSD, and C-PTSD share core features that often relate back to trauma and its impact on emotional regulation, relationships, and self-concept. Viewing these conditions as existing on a spectrum of trauma-related disorders, is where compassionate, trauma-informed care can make all the difference.
What Is PTSD?
PTSD is classified by the DSM-5 as when an individual has been exposed to a traumatic event and experiences specific symptoms in the following categories: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. These symptoms must last for more than one month, cause significant distress or impairment, and not be due to substances or another medical condition. According to the DSM-5, the diagnostic criteria for PTSD include the following:
Criterion A: Trauma Exposure (At least one)
Exposure to actual or threatened death, serious injury, or sexual violence through:
Direct experience, witnessing, or learning of it happening to a close person.
Repeated exposure to distressing details (e.g., first responders).
Criterion B: Intrusion Symptoms (At least one)
Distressing memories, nightmares, or flashbacks.
Emotional or physical distress to trauma-related cues.
Criterion C: Avoidance (At least one)
Avoiding distressing thoughts, feelings, or external reminders of the trauma.
Criterion D: Negative Changes in Cognition & Mood (At least two)
Memory gaps about the trauma.
Persistent negative beliefs or distorted blame.
Ongoing negative emotions, detachment, or loss of interest.
Criterion E: Arousal & Reactivity Changes (At least two)
Irritability, aggression, or reckless behavior.
Hypervigilance, exaggerated startle, concentration issues, or sleep disturbances.
Specifiers (Not required but can occur)
With dissociation: Depersonalization (feeling detached) or derealization (feeling the world is unreal). Some experts think that C-PTSD this diagnosis, a manifestation of PTSD with dissociative features.
With delayed expression: Symptoms appear 6+ months post-trauma.
What Is Complex PTSD (C-PTSD)?
C-PTSD is recognized in the International Classification of Diseases (ICD-11) as a condition similar to PTSD but with additional symptoms related to emotional dysregulation, self-identity, and interpersonal difficulties. It is thought to typically results from prolonged, repeated trauma (examples: childhood abuse, domestic violence, war captivity). This is how the ICD-II classifies C-PTSD, although this is still being clarified so different experts classify C-PTSD in different ways:
Core PTSD Symptoms (With ICD-11 Criteria All Must Be Present):
Re-experiencing the Trauma – This could look like flashbacks, nightmares, or intrusive memories causing distress.
Avoidance – Actively avoiding thoughts, feelings, or reminders of the trauma.
Hyperarousal & Reactivity – Increased irritability, hypervigilance, sleep disturbances, or exaggerated startle response.
Additional C-PTSD Symptoms (With ICD-11 Criteria All Must Be Present):
Affective Dysregulation – Difficulty managing emotions, including extreme anger, sadness, or emotional numbness.
Negative Self-Concept – Persistent feelings of worthlessness, guilt, shame, or seeing oneself as damaged.
Interpersonal Difficulties – Struggles with forming or maintaining relationships, feeling disconnected from others, or avoiding closeness due to fear of betrayal or harm.
Additional Criteria:
Symptoms must cause significant distress or impairment in daily life.
Symptoms must persist for an extended period after trauma exposure.
Not explained by another mental health disorder, substance use, or medical condition.
What Is Borderline Personality Disorder (BPD)?
BPD is a personality disorder characterized by the DSM-5 as having instability in emotions, self-image, behavior, and relationships. The diagnostic criteria for BPD includes a pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity, beginning by early adulthood and present in various contexts.
Some may describe it like feeling like all your emotions on a rollercoaster—going from extreme highs to deep lows very quickly, sometimes over things that might not seem like a big deal to others. This can often be confused with bipolar disorder, although these are two different conditions. Bipolar Disorder and BPD can look similar because both involve intense mood changes and impulsivity, but they are fundamentally different in their causes, symptom patterns, and treatments. With BPD moods often can change rapidly, often within a few days, hours, or even minutes, usually in response to triggers and even potentially very small triggers. These two conditions can be difficult to tease out, so it is very important to have a physician who is skilled in differentiating between these two conditions so that the correct treatments are recommended.
For BPD at least five of the following symptoms must be present according the DSM-5, the examples column is included to show some different examples of what this symptom might look like however this does not include every single presentation:
Keep in mind these presentation can vary person to person. There can be significant overlap between BPD, PTSD, and C-PTSD, this is one of the reasons why talking to a trained professional such as your psychiatrist or your therapist is important.
Why work with us?
At MindfulMD Psychiatry, we specialize in clarifying diagnoses for patients. If you are interested in learning more about if you may have PTSD, C-PTSD, or BPD, we offer comprehensive assessments that look at the whole person. Taking a holistic approach, through a trauma-informed lens, is how we provide patients with compassionate care, with expert assessment and personalized treatment plans to help individuals navigate their healing journey. If you are someone who would rather not have any diagnosis labels, that is absolutely okay too. At MindfulMD Psychiatry, we understand that your symptoms do not define you.
Conclusion
Having a better grasp on the nuances between PTSD, C-PTSD, and BPD can empower those experiencing symptoms to have access to treatments that actually work and target the root causes. Recognizing these conditions as existing on a continuum rather than entirely separate entities can also be a powerful tool to better understand how these conditions arise and what treatments may work best for them. If you're looking for trauma-informed psychiatrist in the Tampa area or virtually all over the state of Florida, MindfulMD Psychiatry is here to help you reach your mental health goals.
Keep a look out for our next post where we will talk about treatment for PTSD, C-PTSD, and BPD.
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