For decades, the diagnosis of borderline personality has been used to disparage abuse survivors as “difficult to treat,” often minimizing their experience of trauma, as noted in Herman’s classic Trauma and Recovery. In contrast, from 1989 to the present, studies have repeatedly shown the high co-occurrence of BPD and severe dissociative symptoms. Nevertheless, within the dissociative disorders field, BPD is often characterized as separate and apart from trauma-related dissociative disorders. Although the DSM-5 criteria show a high concordance between the symptoms of BPD and Post-traumatic Stress Disorder, they’re understood very differently. PTSD is conceptualized as the sequelae of a history of discrete incidents of trauma. BPD is often diagnosed based on the clinician’s experience of the patient - a disorder of the capacity for relationship – and has always been described as a disorder of alternating, dissociated, idealizing and devaluing self-states, BPD can be better understood as a disorder of chronic relational trauma, usually beginning in childhood. The characteristic alternating states may develop from the alternating approach and avoidance strategies needed to manage attachment to a frightening or abusive caretaker, often resulting in disorganized attachment. The sudden shifts between helpless, submissive and clinging to dismissive, angry and distancing can be understood as defensive tactics aimed at avoiding abandonment or preventing abuse and betrayal. This workshop will begin with a comparison of the diagnostic criteria for PTSD, BPD and DID, followed by a critique of the ambiguity in the BPD criteria, and a brief review of the literature comparing these categories. Treatment of persons with alternating relational states, with co-occurring features of BPD, PTSD and DDs will be illustrated with case examples. Role-play of therapeutic interactions will demonstrate how to identify shifts between idealizing and devaluing self-states, and how to recognize defenses in transference-countertransference enactments.
Compare and contrast characteristic symptoms of BPD, Complex PTSD and Dissociative Identity Disorder
Describe why it is necessary to address the role of disorganized attachment in development of BPD and dissociative disorders
Describe how to work with transference reenactments to reveal the origins of attachment models and help clients develop healthier relationship patterns