DeepSummary
The podcast episode discusses the differences and similarities between complex post-traumatic stress disorder (C-PTSD), post-traumatic stress disorder (PTSD), and borderline personality disorder (BPD). The hosts, David Puder and Adam Borecky, analyze two studies that use different statistical methods to examine the relationships between the symptoms of these conditions. The first study uses network analysis to show that the symptoms cluster into three distinct groups corresponding to the three diagnoses, indicating they are separate but related entities.
The second study uses factor analysis and finds that a three-factor model best explains the data, with the factors corresponding to PTSD, C-PTSD (described as "disorders of self-organization"), and BPD. The discussion highlights key differences, such as C-PTSD being more associated with an avoidant attachment style, negative self-concept, and emotional numbing, while BPD is more linked to externalizing behaviors like impulsivity and anger outbursts.
The hosts emphasize the importance of understanding these distinctions for appropriate diagnosis and treatment planning. They also touch on the role of childhood interpersonal trauma in the development of C-PTSD and BPD, as well as the potential impact of reflective functioning (the ability to understand one's own and others' mental states) on symptom severity and treatment outcomes.
Key Episodes Takeaways
- Complex PTSD (C-PTSD) is a distinct diagnostic entity from PTSD and borderline personality disorder (BPD), characterized by symptoms like avoidance, negative self-concept, and emotional numbing.
- BPD is more associated with externalizing behaviors such as impulsivity, anger outbursts, and self-harm.
- The types of trauma experienced, particularly prolonged childhood abuse or neglect, play a role in the development of C-PTSD versus other trauma-related disorders.
- Dissociative symptoms like depersonalization and derealization are highly prevalent in individuals with childhood trauma and C-PTSD.
- Accurate diagnosis of C-PTSD, PTSD, and BPD is important for appropriate treatment planning and interventions.
- Reflective functioning, or the ability to understand one's own and others' mental states, may impact symptom severity and treatment outcomes in these conditions.
- The diagnostic categories of C-PTSD, PTSD, and BPD are distinct but related, with some overlap in symptoms.
- Statistical methods like network analysis and factor analysis can help elucidate the relationships and distinctions between these diagnostic entities.
Top Episodes Quotes
- “Well, there's a construct. So when the ICD eleven was really codifying this, they have this thing called the trauma questionnaire, which is a pretty validated tool that really tries to capture the variety of traumatic experiences. And one construct that that questionnaire discusses is this thing called DSO, or disturbances in self organization. And that gets to exactly what you just said. It's this internal. It's affective dysregulation, which sounds like borderline, right? But it's more complex than that. There's hyperactivation, which is a little bit more of an externalizing thing, something that we tend to very much associate with borderline. There's also the deactivation, the dissociation, the depersonalization, the derealization, also symptoms of borderline. But we also. In complex PTSD, we have this negative self concept, this internalized sense of the world is an unsafe place, and I'm not going to engage with it.“ by Adam Borecky
- “So, behaviourally speaking, right, if you have a patient in front of you and you're trying. And they're talking about their trauma history, you're doing a good trauma history, right. And you're trying to figure out, okay, what symptoms am I seeing? Some things that can kind of shift you a little bit towards the complex PTSD. A couple clues. Right. So the kind of trauma that you're experiencing, is it long childhood, psychological, physical, sexual abuse or neglect? Is it prolonged domestic violence? Is it surviving a multi year war? Torture, kidnapping, imprisonment, captivity. A lot of patients have been forced into prostitution, even some kind of slavery as well. These are all things that point towards the kind of trauma that predisposes one to a complex PTSD picture.“ by Adam Borecky
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Episode Information
Psychiatry & Psychotherapy Podcast
David Puder, M.D.
6/14/24
The purpose of this episode is to provide a clear and simple guide for clinicians on the diagnosis of complex PTSD (C-PTSD) and how it differs from post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). It is intended to complement and add to recent episodes on attachment and trauma: 213: Reflective Functioning, 203 and 204 on adverse childhood experiences.
In today’s episode of the podcast, we are joined by Dr. Adam Borecky. Dr. Borecky is a psychiatrist and therapist who helped author the Connection Index and is part of Dr. Puder’s core team. His practice utilizes a holistic approach towards therapy and medication management.