The Adverse Childhood Experience study (CDC)

Under my post Adult Poverty and Scapegoat-hood: A Connection?,  one of my commenters (katiesdream2004) mentioned a study conducted by the Centers for Disease Control (CDC) in the mid-late 90’s that researched the connection between adverse childhood experiences (which includes emotional abuse by parents and early caregivers) and ill health and general low quality of life in adulthood.  I decided to Google it and here’s what I found.

From their webpage:

ace_study

The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego.

More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.

The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. It is critical to understand how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery.

A correlation was found:

Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood experiences (ACE) are common. Almost two-thirds of our study participants reported at least one ACE, and more than one of five reported three or more ACE. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems.

The ACE Study uses the ACE Score, which is a total count of the number of ACEs reported by respondents. The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion:

Alcoholism and alcohol abuse
Chronic obstructive pulmonary disease (COPD)
Depression
Fetal death
Health-related quality of life
Illicit drug use
Ischemic heart disease (IHD)
Liver disease
Risk for intimate partner violence
Multiple sexual partners
Sexually transmitted diseases (STDs)
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual activity
Adolescent pregnancy

None of this should be surprising. Abuse early in life, whether emotional or physical, takes a huge toll on a person’s sense of self-worth and these people tend to enter adulthood lacking the emotional, financial and practical tools others have to create a healthy and successful life. They also lack the support systems others do, and I would guess the enormous stress of facing challenges that others get help with also has ill effects on health and wellbeing.

I did notice the list mainly includes unhealthy life “choices” such as smoking, illicit drug taking, and early pregnancy. However, I also see depression and general health problems on the list too. I’d include other mental illnesses such as PTSD, Complex PTSD, Borderline Personality Disorder, Avoidant Personality Disorder, and Social Anxiety, all which interfere with a person’s ability to function well in the working world and in interpersonal relationships. These mental disorders could also cause a person to make “bad choices” such as smoking or sexual promiscuity.  Some, like Social Anxiety or Avoidant Personality Disorder, could cause a person who doesn’t engage in unhealthy behaviors, to be afraid to take any risks in life, limiting their opportunities and setting them up for failure.

More research needs to be done, particularly on the connection between emotional/narcissistic abuse during childhood and poverty later in life.

You can read more on their website:
http://www.cdc.gov/violenceprevention/acestudy/

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My fractured memory.

FracturedMemory2
“Fractured Memory,” by Hanna Trussler, 2012

I’ve been doing a lot of thinking about my early years–childhood and adolescence. As many of you know, my parents were active alcoholics, narcissists (my dad more likely covert NPD or maybe Borderline), and that I spent almost all of that time miserable and lonely due to emotional (and sometimes physical) abuse both at home and at school (because I was already trained to be a good little victim and had no self esteem or the ability to defend myself, I was bullied a lot).

The problem is, most of these early memories are fractured, hazy, or both. I remember snippets of traumatic events, but in most cases I can’t remember the entire event, or it’s spotty. Some of my memories seem more like dreams than reality and therefore I can’t remember the specifics of what happened. The same is true of my abusive marriage. I can only remember fractured pieces of that time. The two and a half decades I spent with him don’t seem like a cohesive whole, but more like a photo album with many of the photos missing. But this post isn’t about my early adult years.

I think something happened when I was 12 that was significant and a kind of turning point for me–it was when I stopped trusting anyone, I think. It was the moment when I realized how truly alone I really was and that no one cared and anyone who said they cared was probably lying. I’m not 100% sure, but I think this is when I stopped reaching out to others and began my avoidant pattern of behavior. Of course, this coincided with puberty, so maybe that had something to do with it too.

Here’s what I do remember. My parents and I had taken a two week trip to the beach. Another couple and their two children came along with us and rented the cottage next door. That couple was friends with my parents. I didn’t know my father was sleeping with the wife at the time, and my mother probably didn’t either, but I remember how jealous she was of that other woman because she was younger and blonder than she was and my father paid a lot of attention to her. Their daughter was a year older than me and was adopted. She was from India and was a close friend of mine at the time.  I envied her beautiful long, glossy black hair, permanent tan, and huge soft brown eyes.  Her little brother (her parent’s natural child) was an adorable little blond-headed boy of about 5 or 6. To me, they seemed like the perfect family. It may have been an illusion (for all I know, they were putting on appearances too), but to my 12 year mind, they seemed like they were in love with each other and their kids were both well loved and well-adjusted. My friend always seemed happier, more focused on a future (she eventually became a doctor) and much more emotionally stable than I was. I loved her and envied her.

My parents at the time were drinking heavily and fighting almost daily. Some of their arguments became physical, and I remember lying silently in my bed at night listening to these arguments as they escalated. I was both fascinated and terrified. What if they divorced? What if they abandoned me?  What if they killed each other?  What if I became an orphan?  I seemed to be the cause of an awful lot of their problems (and they did fight over me a lot).

This beach vacation didn’t put a stop to their constant fighting, and one night, my father left. I don’t know where he went, but my mother and I were left alone. My mother didn’t speak to me about this and her demeanor toward me was cold, as if I was an annoyance to her. I was terrified my father was never coming back, and I remember crying myself to sleep the next night. I don’t think my mother ever came in to comfort me. She was probably getting drunk, but I don’t remember.

Desperate for someone to talk to, I pulled the father of my friend aside, and asked him if I could talk to him in private. He always seemed like a warm and sympathetic person to me, someone who loved kids. We sat down outside on a bench near the parking lot, with the sound of the waves crashing behind us on the beach,  and I spilled out all my worries, all my pain, and all my fears.  I talked for about an hour.  He just held my hand and listened. I started to cry and he held me.  He told me everything would be alright. He didn’t say he was going to talk to my parents.

sad_child_beach

He must have talked to them, because that night I was told by my mother that my father was returning to talk to me. She said he was not happy and was in fact enraged.
He came back as promised, and that’s where my memory gets all hazy and fractured. I remember snippets, like quick-flashing frames from a movie: getting beaten severely (but I was always beaten in a way that bruises didn’t show), being told I was a troublemaker and was the reason the family was falling apart. That I was nothing but a problem to them and never knew when to keep my mouth shut. I don’t remember the rest but I know there’s even more. I just can’t access it.

I also don’t know if my friend’s father had told my parents what I’d said to him because he was concerned about me and thought they might listen to him, or if he was just another participant in the abuse against me.

I realized even then my parents were drunk and probably not fully in control of what they said and did, but I think behind their alcoholism was narcissism. I think a lot of narcissists become alcoholics or addicted to drugs, and even after they become sober or clean, refuse to look any deeper into the core issues that caused them to drink or use in the first place. But that’s a subject for a later post. One thing that did occur to me, was that the only time my parents seemed to come together as a team and weren’t attacking each other, was when they joined forces to attack me. Only then were they the unified couple I dreamed of, unified in their abuse of their only child.

I don’t remember much of what happened after that beating and berating. I’m pretty sure our vacation ended at that point. I might have been sent to stay with relatives for a week or two, or left with a babysitter, so they didn’t have to deal with me. I feel like something important got blacked out, but I can’t remember what it was. But it was around this time that I stopped being able to confide in anyone at all. I remember one of the nuns who taught me in 8th grade, a woman who seemed to favor me for some reason, once called me aside and asked me if I was abused at home. I thought to myself, how can she tell? Of course I told her I wasn’t, that everything was fine. But nothing was fine in my life anymore.  I think my emotional growth stopped that summer.  At age 12.  But it might have stopped even earlier than that.  How in the name of God was I ever supposed to grow into a happy successful adult, able to form healthy attachments to others, when I never grew beyond the age of 12?

The next summer I was sent to sleep-away camp for the entire summer, and while I did enjoy it for the most part, I couldn’t help but feel that it was a rejection, a way for my parents to get rid of ‘the problem child’ so they didn’t have to deal with my “issues.”

Wow. Suddenly I feel like crying. The pain is getting real.

I’m asking the little girl who still lives somewhere inside me to tell me everything she knows.

Guest Post #1: When My World Shattered

Favim.com-26101
Credit: Unknown artist, Favim.com

I’m thrilled to introduce my first guest blogger, Tessa from Advocate for Mental Illness.   Her blog is about her daily struggles with Bipolar disorder, told from a Christian perspective.  She has recently given her life to Jesus Christ.  Here is her bio from her About page:

ABOUT TESSA

Teresa (Tessa) Smeigh is over 55 and still going strong despite her disabilities affecting both physical and mental abilities. She has bipolar disorder (mental), Fibromyalgia (nerves), degenerative disc disease (spine), and arthritis (joints). Despite that she is active in Mental Health Advocating, writing for http://www.IBPF.org (volunteer for non-profit) and has 5 blog posts already published by them. She is also working on 2 fiction books (mysteries). She keeps her blog filled with useful content, daily devotionals (She is a Christian), stories and poems. Plenty to keep you busy. She has also been interviewed by blogs and had other posts published on many different blogs. She has 2 blogs so far http://www.tessacandoit.com and http://www.finallyawriter.com She is from Deptford, NJ. Her family and blogs keep her busy.
Although she doesn’t focus on it in her blog, Tessa also has Borderline Personality Disorder (BPD) and complex PTSD.  I have asked her to write a guest post about having BPD, because none of my other guest bloggers are writing about BPD but I already have several who will be writing about Bipolar and complex PTSD.
Here is her guest post.
When My World Shattered!
I am a 59 year old female who has suffered mental health conditions since birth. Since I was born in the 50’s people didn’t talk about mental health. Even with a suicide in the family it was not talked about.
As an infant I took anxiety medication in order to keep food in my stomach. I was considered to have a “nervous stomach.” My mother kept a supply of anxiety medicine at hand all through my childhood because anything could set me off into an “anxiety episode” and hysteria. This was common throughout my childhood. My self-soothing unfortunately was considered self-harm by today’s standards.
At a very young age I developed signs of bipolar disorder which at the time we did not know. I got an official diagnosis in my early 30’s after a breakdown. Also by the same procedure, a hospital stay almost 4 years ago picked up on the Borderline Personality Disorder (BPD) and I followed the symptoms back to when I was a child as well, but a little bit later than the bipolar.
Bipolar disorder and BPD are similar in symptoms and are often misdiagnosed. I have officially now been diagnosed with both. The biggest difference between the two is the length between the mood swings. Since my mood swings as a very young child were months apart it is most likely the bipolar disorder started first. Then later when the BPD developed they became rapid even changing during a single day or even hour.
It is difficult to break the symptoms down and say this belongs to bipolar disorder and this belongs to BPD. I will just go into the symptoms I suffer as one. Which is the direct cause, is not really necessary to know at this point.
How about a little history on BPD?
Symptoms usually manifest in childhood, but don’t become serious until a person becomes a young adult. This fits close to my time-line. Only I figure mine started in my teens after a traumatic experience of having been almost raped twice by the time I was 15 years old. I was then emotionally raped at 17 years old where I was told by the young man that either we had sex at that point or he was leaving me (abandonment considered to play a role in BPD) and we had just gotten back together. I couldn’t let him go. I gave in and that was also traumatic. I wasn’t ready. During that time I also suffered a miscarriage although I really didn’t know it at the time. I was totally naive even though my low self-esteem led me to wear sexy clothing and flaunt my body to every man. I didn’t know why I did it. I craved that attention though (promiscuity).
The exact cause of BPD is not know though they suspect brain chemistry plays a role, also genetics and environmental factors, along with the possibility of childhood trauma.
To add to the trauma, the 17 year old played the “I am going to kill myself if you don’t marry me” game when I tried to break up our relationship. I felt stuck, my emotions caused me to give in and marry him. I didn’t love him, but I was married at 19 years old. At 21 I had my first child, 22 I had my second and by 30 I had three children.  By then my weight was out of control due to binge eating.
My self-harm became more severe although I did resist cutting after I tried it and felt it didn’t give me the feelings I needed to soothe myself.
My anger intensified, but I kept it inside. I did not explode into rages unless you really pushed me but those rages were severe. People didn’t listen to my warnings and I flew into rages, shocking people with their intensity.
Paranoia became a constant state of my life. I am always sure people are talking about me. Even today.
Dissociation has been a constant since childhood. I always daydreamed and put myself into my books. I loved to read and my parents would force me outside. That triggered my anxiety and panic.
Severe depression for months on end would cause suicidal thoughts and several attempts and the last one landed me in the hospital for treatment and intense therapy. Luckily I didn’t succeed. The last one was the most serious.
I am currently in severe financial poverty due to low disability payments and reckless spending while I was manic.  Manic episodes are currently considered a symptom of both bipolar disorder and BPD.
I also have had a lot of unsafe sex due to my promiscuity, which is another shared trait.
BPD is difficult to treat. Usually a therapist, especially one trained in DBT (Dialectical Behavior Therapy) or CBT (Cognitive Behavior Therapy), combined with medications such as anti-psychotics, anti-depressants and mood stabilizers will help tone down the symptoms.
***
Please visit Tessa’s blog here. 
My apologies about the wonky spacing.  WP isn’t letting me change the coding and I don’t know CSS.  I hope that doesn’t affect anyone’s reading experience!

Self-sabotage.

self_sabotage1
I think I had an interesting therapy session last night. I was talking to my therapist about the way my father stole the little illustrated stories I wrote when I was about 7 (which I wrote about in this article). This long ago incident seems to have set the tone for my entire life, because after I’d realized my intensely personal little creations (that were intended for no eyes but my own) were stolen, I felt overcome with shame and I felt as violated as if I’d been raped (and I have been raped so I can vouch for the similar feeling of violation). I remember what I did with those little books after I stole them back: I destroyed them.

This has been a refrain throughout my entire life.  It’s like that song you hate that keeps playing in your head until you’re ready to shoot yourself in the head to make it go away.  During my session last night, I made this connection: whenever I felt there was a threat of something that came from my true self (usually related to my creativity which meant being vulnerable) being violated or taken away, I sought to destroy it. Sometimes this “destruction” simply meant losing interest in whatever it was or giving it up. When I was 19, I had some expensive camera equipment and loved to take pictures as a hobby. When my 35mm camera (which I’d saved for months for) got stolen one day, I gave up photography. Only recently, have I been taking pictures again (on a crappy Smartphone).

self-sabotage2

But there are other examples where something wasn’t literally stolen from me as my camera was or my illustrated books were, but where my boundaries were violated (or I perceived them to be violated, or believed they were about to be violated). I’ve never stuck with anything I loved doing for too long, because sooner or later it wasn’t just “mine” anymore and it was either held up for judgment, or criticized (to me, these feel like boundary violations and make me feel too vulnerable). For several months I’ve been struggling with trying to figure out why I’ve been losing interest in blogging, which has been so life-changing for me and has brought me so much happiness. I realized it was because “running naked in public,” while incredibly liberating and having many rewards, also means you’re vulnerable to judgment and criticism. I don’t know how to handle judgment and criticism. I take everything too personally; any sort of criticism is a personal assault–again, like being raped. Even worse is having to deal with trolls and bullies, which feels like gang rape (and reminds me of my childhood at the hands of bullies both at school and at home).

A person with a healthy sense of self and normal self esteem might feel somewhat offended by a hurtful comment, but would be able to move on from that and wouldn’t give up or find themselves losing interest in something they’re passionate about. They might even fight back or take a stand. But when I’m attacked, or even criticized, I get triggered and become the defenseless and helpless child I used to be (and that I rejected a long time ago). I can’t handle reality, which means confronting both the good and the bad. And so to avoid being “raped” again, I’ve turned off my ability to be interested by much of anything at all (and then resent the hell out of whoever I feel violated me). That way, I don’t put myself at risk of being judged, which in my mind always leads to being rejected. Tied in with this is the fear of failure: I was raised to believe I was incompetent, so if I don’t attempt anything, I can’t really fail at it. Right? But the bottom line is, hiding behind my fear of failure is a absolute terror of being found defective, and hence rejected.

I don’t know whether this unfortunate tendency of mine is indicative of BPD, C-PTSD, or Covert NPD or something else (I do not know what my therapist has diagnosed me with and I’m afraid to ask), but I think writing about this is a step in the right direction. I want to explore this further when I see my therapist again and am going to show him this post (he knows I have a blog and write about psychology and NPD, but I haven’t shared the link with him yet).

I think age of NPD onset correlates with malignancy and curability.

kids_different_ages

Because of a recent conversation I was having on Psychforums about age of onset and prognosis for a cure for different levels of narcissism, I’ve been doing a lot of thinking about this.

I do think how old a narcissist was when Ground Zero occurred–that would be the primary traumatic event that forced the child to create a False Self–determines the difficulty/ease of healing, and also how low or high the narcissist falls on the spectrum.

Here’s what I came up with.

Age of onset of Trauma/stage of child development (Piaget, Freud):

0-2 (Piaget’s Sensorimotor stage; establishing boundaries, physical and comfort needs met; Freudian Oral/Anal stage):

toddler_bear

High spectrum, malignant narcissism and/or psychopathy/sociopathy (if as an infant)– not curable except under extreme circumstances in very rare cases. May be self aware but has no incentive to change.

3-6 (Piaget’s Concrete Operations; Freudian Anal–Oedipal/Electra stage )

childabuse

Mid-high spectrum narcissist who may or may not be malignant. May become self aware but will be resistant to a cure. In unusual circumstances (total loss of supply or primary supply), a narcissist this high on the spectrum might seek therapy. They are unlikely to be willing to do all the work required for healing due to its difficulty for someone this high, but there might be a few exceptions.

7-11 (Piaget’s Formal Operational stage; abstract learning, competence; Freudian “latency” period)

sad_girl2

Mid-spectrum narcissist. Could become self aware and if so, there’s a good chance of them seeking therapy or treatment. They’re more likely to be cured, but it’s not a guarantee.
Therapy would be difficult at the higher end (onset before 8-9), moderately easy at lower end (onset between 9-11).

12-21 (adolescence)

sadness

sadness

Low-mid spectrum narcissist. Likely to become self aware and good chance of being cured.
Low spectrum at the higher ages (onset after 15/16), mid spectrum at the lower ages (younger than 15).
Good prognosis for a cure and self awareness. If very low, may be able to heal him or herself without outside help

21 +

How's my hair?

How’s my hair?

A person cannot become a true narcissist after age 21 or so. They may instead have a lot of narcissistic traits, have DNP (Destructive Narcissistic Pattern disorder–just below NPD on the spectrum), or in rare cases they could develop “acquired narcissism” (this is something a lot of celebrities and famous people get) which is temporary and lasts only as long as the adulation or fame lasts.

ETA: I got a rebuttal to this on Psychforums. I think this poster’s argument may be valid too, so I’m going to post it:

I believe the PD occurs in the first 5-6 years due to abuse/trauma, the critical level of which differs for each person depending on genetics (temperament, sensitivity).

I think NPD-like traits resulting from abuse/trauma after age 6 would be cPTSD to a normally developed personality.

I suspect traits from coddling/overvaluation after age 6 would be easier to “return to earth” from than something like sexual abuse and humiliation (say, having to testify in court) after age 6. I think the former might be unwind’able to a level of stable narcissism. I think the latter could be a more permanent scar/condition.

left-out_child

But, I don’t know much about. That’s just the way I think of it. It doesn’t seem feasible that PD could occur after the P(personality) is developed. I thought the whole point of a PD was that the P stopped developing, became a defective structure. Not merely unresolved trauma (like PTSD is?) but structural and permanent.

Basically his argument is that after age 6, true narcissism won’t develop but complex PTSD (C-PTSD) could. This could mean a child acquires a lot of narcissistic traits (what ACONs call “fleas”) that could resemble NPD in many ways but is more treatable/curable. I think this would be the same thing as the spectrum condition called the Destructive Narcissistic Pattern (DNP)
This would also take into account type of abuse inflicted and level of severity.

Are BPD and complex PTSD the same disorder?

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Me at age 3 in the zone. Was the template for my BPD already laid down?

Ruji, a new commenter on this blog, made an interesting observation–that BPD should be divided into at least two subtypes: Empathy Challenged/Character Disordered (closer to NPD/ASPD) and Highly Sensitive Person with Emotional Dysregulation (closer to the type I have, although at different times in my life or when extremely stressed I have displayed the more character-disordered subtype). I agree with her. Ruji’s idea is remarkably similar to The World Health Organization’s two subtypes of BPD:

1. F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):

–marked tendency to act unexpectedly and without consideration of the consequences;
–marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
–liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
–difficulty in maintaining any course of action that offers no immediate reward;
–unstable and capricious (impulsive, whimsical) mood.

2. F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

–disturbances in and uncertainty about self-image, aims, and internal preferences;
–liability to become involved in intense and unstable relationships, often leading to emotional crisis;
–excessive efforts to avoid abandonment;
–recurrent threats or acts of self-harm;
–chronic feelings of emptiness.
–demonstrates impulsive behavior, e.g., speeding, substance abuse

Psychologist Theodore Millon has gone even further, proposing that BPD should be divided into four subtypes:

1. Discouraged (including avoidant features): Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.

2. Petulant (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.

3. Impulsive (including histrionic or antisocial features) Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.

4. Self-destructive (including depressive or masochistic features) Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.

Millon’s Types 1 and 4 would correspond to the Highly Sensitive Person/Emotional Dysregulation type mentioned above (and therefore closer to the Avoidant/Dependent PDs); Type 2 sounds very much like NPD; and Type 3 seems closer to ASPD or Histrionic PD.

complex_ptsd
BPD symptoms are almost identical to those of Complex PTSD.

There are so many diverse–almost opposite–symptoms that can appear with this disorder that one person with BPD can be very different from the next. In fact, you can take 10 borderlines and they will all seem very different from each other, with barely any similarities in their behavior at all. One will be shy, fearful and retiring, never making waves, acting almost like an Aspie or an Avoidant; while another may break the law, lie constantly, and act obnoxious and rage whenever things don’t go their way. A borderline could be your raging boss who drinks too much and ends every annual Christmas party with one of his infamous rages, or it could be the sweet and pretty schoolteacher who goes home every night and cuts herself. She could be the come-hither seductress or the nerdy computer programmer. He may have few or no friends or a great many.

This diversity is not the case with the other personality disorders, which have more cohesiveness in the symptoms their sufferers display. So I wonder–is BPD really a personality disorder at all? Does it even exist, or is it really just a group of trauma-caused symptoms the experts in their ivory towers stuck in a single box called “BPD” because they didn’t know how else to classify them?

In fact, all these diverse subtypes have one thing in common–they are all very similar or identical to the symptoms of someone with complex PTSD (C-PTSD). People with C-PTSD are often misdiagnosed as Borderlines because their behaviors can be just as baffling and manipulative, and both disorders also include dissociative, almost psychotic episodes. Extrapolating from that, I wonder if ALL borderlines actually have C-PTSD.

Earlier today I posted an article outlining 20 signs of unresolved trauma, and I was struck by how similar these were to the symptoms of BPD. And there is also this article that Ruji just brought to my attention that also describes how remarkably similar the two disorders are, but that the idea of fear of abandonment (which is recognized as the root cause of BPD) is not recognized as a factor in causing PTSD and that may be part of why they have been kept separate.

The BPD label, like any Cluster B label, is very damaging to its victims because of the “evil and character-disordered” stigma it carries. One psychologist has even included us, along with narcissists, among the “People of the Lie”!

Yes, it’s true some borderlines do act a lot like people with NPD or even Malignant Narcissism or ASPD, but most probably do not, and are really much more similar to people with Avoidant or even Dependent personality disorders, which hurt the sufferer more than anyone else. But if you have a BPD label, people start backing away from you slowly due to the stigma. Therapists are reluctant to treat you because they assume you will be either difficult and hateful in therapy sessions, or will never get better. Insurance companies won’t pay claims where there is a BPD diagnosis, because it’s assumed there is no hope for you. I’ve had this problem when I’ve tried to get therapy. I remember one therapist who I had seen for the intake session, who told me he needed to obtain my psychiatric records before we could proceed. The session had gone smoothly and I felt comfortable with him. A few days later I received a phone call and was told he did not treat “borderline patients” and wished me luck. So that’s the kind of thing we’re up against if we’ve had the BPD label slapped on us.

Also, as an ACON blogger who works with a lot of victims of narcissistic abuse, my BPD label sometimes makes people wary of me and they begin to doubt that my motives here are honest. At first I was reluctant to talk about my “Cluster B disorder” here, because I knew it might be a problem for some ACONs, who think borderlines are no better than narcissists. But I eventually decided that to hide it away like an embarrassing family secret would be misleading so I “came out” about having BPD (I never actually lied about it, but played it down in the beginning and rarely mentioned it). I’m glad I fessed up, but there have been a few people who left this blog after I came out about it or began to doubt my motives. So there’s that stigma and it’s very damaging.

Both C-PTSD and Borderline PD are caused by trauma. Both are complex defensive reactions against future abuse and both involve things like splitting, dissociation, psychotic episodes, self-destructiveness, wild mood swings, and behavior that appears to be narcissistic and manipulative.

The way I see it, the only real difference between C-PTSD and BPD is that the traumatic event or abuse happened at an earlier age for someone with BPD, perhaps during toddlerhood or infancy, while all forms of PTSD can happen at a later age, even adulthood. But the symptoms and defense mechanisms used to avoid further trauma are the same for both.