Borderline Personality Disorder (BPD) as the name suggests is a serious mental illness that is marked by unstable moods, behaviours and relationships. Although as the name suggests BPD is largely accepted as a disorder of personality, some experts have for a long time queried whether BPD is in fact more of disorder of trauma. The reason being for this is that many individuals who develop BPD tend to have experienced some form of childhood trauma (often Child Sexual Abuse; CSA) and thus some researchers in the area have argued that a direct causal relationship exists between the two. This relationship has yielded significant research support and has been largely accepted as a likely contributor to the development of BPD. The reasoning behind this relationship is that incidences of childhood trauma, particularly when they lead to a significant loss in trust in a loved one, can impact on how a person learns to self-regulate their emotions.
Although this association has been widely accepted, the relative importance of this factor within the diagnostic criteria of BPD is what is still causing some concern. For instance, some experts have been influenced by the symptom overlap with trauma disorders such as Post-Traumatic Stress Disorder (PTSD) as well as the lack of support in the literature regarding the reliability and validity of BPD as a diagnostic entity and have called for further examination into the diagnostic suitability of the term BPD suggesting a complex PTSD may be more suitable.
While these issues provide reasonable support to the argument that BPD should be considered to be a disorder of trauma, there are several unavoidable holes to this debate. Firstly, although there is considerable overlap in their symptomology, research has demonstrated that PTSD and BPD also exhibit significant differences. For instance, BPD is often presents as a far more pervasive a condition. Secondly, significant evidence exists to support a biopsychosocial theory of BPD. This means that while the traumatic history element of diagnosis is clear, so too at least to some extent are the biological and behavioural correlates of the disorder. As well as this, there are the obvious examples of when BPD occurs without the presence of significant trauma. Further a recent review published in the Journal of Canadian Psychology highlighted that many of the studies arguing for an alternative trauma diagnosis suffer from a number of methodological concerns, namely that they struggle to conceptualise trauma in an adequately measurable way.
These issues demonstrate that many factors appear to contribute to the development of BPD and that though BPD and trauma disorders do indeed share several similarities, they are undeniably distinct in several ways. Perhaps the question of whether BPD should be categorised as a trauma or personality disorder is actually irrelevant. Perhaps the issue lies in how such complex disorders are approached diagnostically. Perhaps, efforts should be directed at moving away from a categorical diagnostic approach to a more transdiagnostic approach. Transdiagnostic theory accepts that there are a number of commonalities between the psychological disorders and therefore advises approaching mental illnesses from a broad symptom level. In light of this and with reference to the earlier question, by adopting a transdiagnostic approach BPD could be considered a disorder of both trauma and personality.
Ms. Niamh Allen, M.A. B.Sc.