BPD vs C-PTSD

Recent conversations with C regarding my experiences of child sex abuse have been highly suggestive that there’s a lot more to what happened than that which is recalled in my forefront, conscious memory. In recent sessions, and outside them at times too, I keep getting flashbacks of incidents of which I’d not previously been aware, and certainly a lot of my symptoms seem to imply that I am (or have been) afflicted by considerable dissociation. On Thursday (about which I must write soon) I accused myself of having false memory syndrome, but C defended me, advising that trauma memories are very often fragmented and dissociated in this way, and are recalled in random, disordered ways like those I was reporting.

Anyhow, if indeed the abuse was more sustained than I had previously supposed, I am wondering to what extent I am troubled by some version of post-traumatic stress disorder. C has bandied the term about a few times, but hitherto I’ve rejected any sense of it, as my ‘trauma’ was fuck all in comparison to that of many others of whom I’m aware. I still agree with this assessment of my experiences relative to others, but I can, in light of the apparent new memories, begin to accept that PTSD might apply. In particular, I believe I fit (at least some of) the criteria for complex-PTSD.

I have never disputed my BPD diagnosis, but I wonder to what extent the criteria for C-PTSD would also apply. Or perhaps one is more appropriate than the other? I am (rather pointlessly) going to examine the evidence.

Diagnostic Criteria for Borderline Personality Disorder (BPD)

Frantic efforts to avoid real or imagined abandonment.

I do fear abandonment considerably, that is undeniable. The mere thought of it upsets and terrifies me, though I’d have to admit that that doesn’t universally apply to all individuals in my life. I have made a concerted effort to fight the imminent abandonment from C; however, I would not say that any of my abandonment-avoidant issues have involved ‘frantic efforts’. It is a fear, but not something I am wont to actually do much about.

A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.

I certainly don’t have unstable relationships, and they’re not ‘intense’ by comparison to some. I am certainly known to swing between idealising and devaluing individuals with whom I have interpersonal relationships, but it’s usually quite episodic and would not be a consistent thing.

Identity disturbance: markedly and persistently unstable self-image or sense of self.

I’m conflicted about this. I do have a clear sense of who I am most of the time, but my self-image is certainly unstable, as I can go from despising myself to thinking I’m really quite alright within minutes (though admittedly the former position dominates).

Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).

I’m not at all guilty of the stereotypical borderline behaviour of promiscuous sex. However, in fairness to my ‘diagnoser’, I still do fit this criteria – I binge eat, I purge, I am known to drive recklessly, I am known to drink heavily, etc.

Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.

Can’t really deny any of this. I haven’t attempted suicide or seriously self-harmed since January, which I suppose is good, but I still think about such things all the time and engage in the picking / scar interference behaviour mentioned.

Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).

I don’t agree that it generally lasts less than ‘a few days’, but otherwise this is absolutely true.

Chronic feelings of emptiness.

Yes.

Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

I have very, very rarely been involved in physical altercations, but the rest is absolutely spot on.

Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.

Undeniable.

So, that gives a total of six symptoms out of nine, with one or two of the others being debatable. To meet the threshold for the diagnosis, one must exhibit at least five of the nine criteria (under the current incarnation of the DSM anyway). Ergo, I haz BPD innit. Fair enough. (Source for the above information: Wikipedia).

Proposed Criteria for Complex Post-Traumatic Stress Disorder (C-PTSD)

A history of subjection to totalitarian control over a prolonged period (months to years).

My instinct is to deny this…but I don’t think I really can anymore. Certainly, some of the more minor instances of the abuse were over many months, and quite probably years. The new memories suggest that more serious stuff may also have fitted this pattern, but I just cannot be sure. ‘Totalitarian control’ seems like a harsh term in my mind but, thinking (ostensibly) rationally, I suppose what else do you call it when some old cunt pushes a child forcibly to the ground or wall and sticks his fucking cock in her?

Alterations in affect regulation, including:

• persistent dysphoria
• chronic suicidal preoccupation
• self-injury
• explosive or extremely inhibited anger (may alternate)
• compulsive or extremely inhibited sexuality (may alternate)

Yes to all of these, in broad terms at least. The first three, as you know, are certainties. Furthermore, I am a very angry person and tend to ‘explode’ with certain individuals – but with others, I’m extremely submissive therefore hiding my raging anger. Consequently, I think it’s fair to say it alternates. Re: sexuality, I couldn’t say that ‘compulsive’ has ever been an especially accurate term, but it was for quite a while incredibly inhibited. It’s not so much the case now that I know sex – as in normal, consensual sex – is really not that much of a big deal (in the sense that it’s just one of many enjoyable things in which adults engage), but during my childhood and teenage years I had pretty conservative views on how I wanted to express my own sexuality.

Alterations in consciousness, including:

• amnesia or hyperamnesia for traumatic events
• transient dissociative episodes
• depersonalisation/derealisation
• reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

You see, my instinct is to absolutely refute any suggestion of amnesia – but then, if I’m ‘suffering’ from it, I’m not exactly going to know I’m suffering from it, am I? That’s kind of the point of amnesia. All one can do is look at the other evidence available. The new flashbacks and other symptoms I present do seem to hint strongly at it, so I will reluctantly accept it as at least a possibility.

The rest of these all absolutely apply. I can’t say that I experience flashbacks with considerable frequency, but they do happen and I do ruminate on events a lot.

Alterations in self-perception, including:

• sense of helplessness or paralysis of initiative
• shame, guilt, and self-blame
• sense of defilement or stigma
• sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

All of the first three apply absolutely, especially the shame / self-blame bit. I do feel different from other people in many ways, though in more nebulous terms than this criterion suggests. I’m not entirely sure how to describe it, but it applies in some inexplicable way.

Alterations in perception of perpetrator, including:

• preoccupation with relationship with perpetrator (includes preoccupation with revenge)
• unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s)
• idealisation or paradoxical gratitude
• sense of special or supernatural relationship
• acceptance of belief system or rationalisations of perpetrator

This is really the main area in which I feel that I deviate from this diagnosis. None of these strongly apply to me; I don’t think he’s that powerful, we don’t have a special relationship and I don’t idealise him at all. However, I don’t dislike him particularly, and have been known to defend him despite what he’s done. I also rationalise his behaviour towards me on the grounds that I’m a slag who led him on. Whilst ridiculous, this is of course a genuinely held belief.

Alterations in relations with others, including:

• isolation and withdrawal
• disruption in intimate relationships
• repeated search for rescuer (may alternate with isolation and withdrawal)
• persistent distrust
• repeated failures of self-protection

All of these apply, to varying degrees. I withdraw so considerably from society at times that I might as well be a hermit, and I trust absolutely no one until they have all but definitively proven themselves over a period of months. I wouldn’t say that I experience or cause disruption in my interpersonal relationships a lot – but I suppose in small ways it can be true (losing my rag with Mum or A, for example, some discussion of which has already been featured on this blog). I’ve been looking for a rescuer for years, and think my obsessive desire for C to protect and take care of me currently exemplifies this. And I can’t say that I’m especially successful in protecting myself, now can I?

Alterations in systems of meaning:

• loss of sustaining faith
• sense of hopelessness and despair

To be honest I’m not sure what the first one even means, but “yes, definitely” to the second one.

So, let’s say there are seven broad diagnostic criteria for this disorder. I’m not sure how many one would have to meet to be considered to be suffering from it, but I think I can say that six of the seven generally apply to me, which sounds like pretty categorical to me. (Source for the above information: Sasian. Oddly, C-PTSD doesn’t yet seem to be included in either the DSM or the ICD, though it is certainly recognised by the discipline of psychiatry, as this leaflet from the Royal College of Psychiatrists attests).

The more general syndrome of PTSD additionally includes traits such as hypervigilance, avoidance of anything that may trigger memories, distrust of authority, cynicism, sleep disturbances and psychic or emotional numbing – all things highly evident in the mentalness of yours truly. And, as stated, I sometimes have flashbacks too; in fact, Thursday’s session with C was almost characterised by them at points.

I’m not really sure why I’m writing this. If I were disputing the BPD diagnosis, it would make more sense – but I’m not. Part of me would love to get rid of it, given the unfair but deeply entrenched stigma attached to the illness; on the other hand, how can one meaningfully fight against that unreasonable stigma if one is not from within the bracket of people to whom it is applied?

I think what I’m trying to do is make clear to myself that there actually has been trauma in my life. Every time C (or anyone else) speaks the word I wince, because I find it difficult to accept on anything but an intellectual level that there actually was any trauma. If I fit the criteria for post-traumatic stress disorder, even if it’s only via a silly self-diagnosis, then perhaps somehow I can allow myself to actually believe that I am traumatised. Although often also (in part) caused by ‘trauma’, BPD doesn’t immediately convey that potential causation through its name in the way PTSD does.

At the end of the day it doesn’t really matter; it’s ultimately a semantic debate that doesn’t really mean anything, and psychiatric diagnoses are often a pile of old crap anyway. But I know that sooner or later I need to properly realise that I was not to blame for the sexual violence levied against me, and if I can advance that realisation in any way then I suppose that is to be welcomed. Alas, though, it is still a pipedream for now.

Related posts:

1. Psychiatrist Appointment Win?
2. Empty Voices and Empty Chairs – C: Week 44
3. Holiday Rage