CPTSD VS. BPD: The Key Difference

Complex PTSD (CPTSD) and borderline personality disorder (BPD) are conditions that affect the mind and influence a person’s ability to regulate their emotions. While the conditions have some common symptoms, the key clinical characteristics differ.

What is CPTSD?

Complex PTSD¹ is a type of PTSD characterized by persistent feelings of worthlessness, shame, or guilt that negatively affect a person's relationships and daily life. 

In a CPTSD diagnosis, all criteria for a PTSD diagnosis are met, but the person has additional symptoms that are not normally associated with PTSD. The characteristic self-perception and relationship issues related to CPTSD typically last longer than in PTSD. 

What is BPD?

Borderline personality disorder² is a type of personality disorder that influences how a person perceives themselves and relates to others. 

Personality disorders are long-term, recurring dysfunctional thoughts and emotions that affect a person's behaviors and relationships. Personality disorders like BPD can lead to various social and interpersonal issues while causing acute distress to the individual with the condition. 

Because BPD is characterized by a range of symptoms and affects everyone differently, a person may struggle to recognize that their behavior stems from a personality disorder or that there are ways to treat and manage their condition for a better quality of life.  

Is it CPTSD or BPD?

BPD and CPTSD are both mental health disorders that can significantly affect a person’s life. While there are many similarities between the two conditions, and a person can be diagnosed with both, there are some notable differences with respect to the causes, symptoms, treatments, and prognosis of the disorders.

Most notably:

• In CPTSD, emotional issues stem from an impaired ability to self-soothe when upset and a tendency toward emotional numbing. In BPD, the problems are linked to uncontrolled anger and a profound inability to regulate one’s emotions.

• In CPTSD, self-perception is hampered by feelings of worthlessness, shame, and guilt. In BPD, self-perception is variable and can change drastically and quickly from one moment to the next.

• In CPTSD, relationship issues are linked to a fear of closeness and involve feelings of detachment toward others. In BPD, there’s an alternating pattern of over-attachment and disengagement. 

Causes of CPTSD vs BPD

Causes of CPTSD 

CPTSD can develop when a person is exposed to long-term trauma. While CPTSD is a type of PTSD, it has additional unique symptoms. 

There does not need to be a single traumatic event associated with trauma — people develop CPTSD from long-term traumatic situations. Generally, PTSD in adulthood can stem from short- or long-term abuse or neglect in childhood. Shame from childhood abuse can persist for a person’s lifetime and affect their self-perception and perception of others.

A person may be more likely to develop CPTSD if they:

• Experienced trauma at an early age

• Were hurt by someone they trusted

• Couldn’t escape the harm they endured

• There’s substantial evidence³ that some families are genetically predisposed to PTSD, indicating that the presence of one or more genes may make a person susceptible to developing the condition. 

Causes of BPD

A variety of factors contribute to the development of BPD. While there’s no known “BPD gene,” it’s worth noting that there does seem to be some (poorly understood) genetic basis for the disorder.

A review⁴ of relevant scientific literature reported that 11.5% of people diagnosed with BPD have a first-degree relative who also has the condition. That said, the majority of people with family histories of BPD don’t go on to develop it themselves. BPD typically results from a combination of factors, including:

• Neurotransmitter (messenger chemical) malfunctioning leading to improper signaling within the brain

• Abnormally small or unusually active parts of the brain, specifically the amygdala (emotion regulator), hippocampus (behavior control center), and orbitofrontal cortex (decision processor) 

Environmental factors, including abuse, neglect, long-term distress, or growing up with a family member who was struggling with mental illness, can sometimes contribute to the development of BPD.

Symptoms of CPTSD vs BPD

Symptoms of CPTSD

Many people with CPTSD experience recurring flashbacks. These are characterized by a surge of feelings experienced during the time of trauma, which may include intense fear, shame, or sadness.  Flashbacks can be persistent.

Other symptoms of CPTSD may include symptoms of general PTSD, such as:

• Nightmares

• Physical panic responses, like trembling or sweating

• Avoidance of  feeling strong emotions (or emotional numbing)

• Isolating

• Irritability

• Insomnia

• Depression

• Anxiety

• Headaches

As well as symptoms that are unique to CPTSD, including:

• Difficulty controlling or understanding emotions

• Feeling worthless, shameful, or guilty

• Struggling to connect with others

• Relationship problems (romantic relationships, friendships, and work relationships)

Symptoms of BPD

BPD is characterized by emotional issues, relationship instability, and impulsivity. 

In particular, people with BPD may struggle with:

• Intense negative emotions, including fear, sadness, panic, or rage

• Mood swings

• Suicidal thoughts (if you’re in crisis, call 911 immediately)

• Upsetting thoughts relating to self-perception

• Strange experiences, like hearing voices while alone

• Impulses to self-harm or engage in activities that are likely to result in harm

• Frantic behaviors in relationships stemming from fears of abandonment, or the opposite, feeling smothered

What are the treatment options for CPTSD vs BPD?

Treatment options for CPTSD and BPD are different, but both require therapy. 

Treatments for CPTSD

Healthcare professionals typically recommend psychotherapy to treat CPTSD.

Cognitive behavior therapy

Cognitive behavior therapy,⁵ or CBT, is a type of talk therapy.⁶ In CBT, a therapist guides the patient through the complex mesh of thoughts and emotions that guides their behavior.

CBT aims to help people develop the skills necessary to recognize negative thoughts and cognitive distortions and cope more effectively with these thoughts so they can improve their relationships and ability to function. 

Eye movement desensitization and reprocessing (EMDR)

Eye movement desensitization and reprocessing,⁷ or EMDR, is a form of therapy that aids in dealing with traumatic memories to reduce the emotional response to these memories. While focusing on past trauma, patients are asked to make repeated eye movements. EMDR has a reputation for being an effective CPTSD treatment.

Treatments for BPD

Healthcare providers may recommend combining medication and psychotherapy to treat BPD. A treatment plan for BPD may include:  

Dialectical behavior therapy (DBT)

Dialectical behavior therapy,⁸ or DBT, is designed to help people overcome difficult emotions by teaching them skills to improve mindfulness, control their emotions, handle distress, and successfully navigate interpersonal relationships.  

Mentalization-based therapy (MBT)

Mentalization-based therapy,⁹ or MBT, aims to increase a person’s ability to focus on and distinguish between their own emotions and that of others. It helps clients gain insight to how their state of mind impacts their behavior. MBT  helps in improving social skills and quality of life. 

Transference-focused therapy (TFP)

Transference-focused psychotherapy,¹⁰ or TFP, is a type of psychoanalysis that aims to identify the underlying causes of BPD and use that knowledge to change negative thoughts and behaviors. The concept of TFP centers around the unconscious mind and its influence on behavior.

Medication

Anticonvulsants, antidepressants, and antipsychotics are all classes of medication doctors may prescribe for people with BPD. However, it’s essential to note that medication alone is rarely recommended, and it’s considered a supplement to, not a replacement for, psychotherapy.

Medications may be used to manage symptoms of BPD, but there are currently no drugs labeled by the FDA for treating BPD.

Medications that may be used alongside psychotherapy for BPD include:

• Anticonvulsants, including lamotrigine and topiramate

• Antidepressants, such as fluoxetine and phenelzine

With the proper therapy and medication, symptoms of BPD become manageable for most people. However, people with the condition should routinely monitor changes in symptoms, as the path to recovery may not be straightforward. 

How does the prognosis differ for people with CPTSD vs BPD?

CPTSD prognosis

People diagnosed with CPTSD may live with the condition for life. About 30% of people¹¹ recover entirely from PTSD, while 40% respond well to treatment. There’s no solid data on recovery rates for CPTSD in particular.

People with CPTSD can live happily, fulfilled lives with the right therapy and medication. Therapy can help people cope with their symptoms, understand their triggers, and overcome social withdrawal tendencies. 

BPD prognosis

BPD tends to develop at an early age. Symptoms may come and go, and the condition can improve with time. In the past, researchers believed that a person who had BPD would have it forever, but recent research indicates that it’s not necessarily a lifetime disorder. 

Therapy and medication can help patients reclaim a sense of normality, strengthen their interpersonal relations and social skills, and deepen their awareness of their feelings. 

The lowdown

While there are many similarities between CPTSD and BPD, they are ultimately very different conditions. 

People with CPTSD have emotional issues that stem from the inability to self-soothe effectively. They may feel worthless, guilty, or ashamed, and they’re typically hesitant to get emotionally close to someone.

People with BPD, on the other hand, have emotional struggles linked to uncontrolled anger and an inability to regulate their negative emotions. Their feelings can change drastically and in a short time. A person with BPD may be irrationally angry one moment and calm the next.

While people with CPTSD avoid close relationships, BPD is marked by alternating periods of feeling underloved and smothered, even if the attention and affection they’re receiving from a loved one hasn’t changed.

Both conditions are treatable, and with the appropriate therapies, people with CPTSD or BPD can live healthy, satisfying lives.