Borderline vs. Post Traumatic Stress Disorder of Abandonment: Therapy Goals

 

Borderline Personality Disorder (BPD) and PTSD of Abandonment 

There is a significant overlap between borderline personality disorder (BPD) and post traumatic stress disorder of abandonment (PTSD of Abandonment).  In attempting to distinguish them, we are met with a lot of fine lines and nebula.  Since there is a stigma attached to BPD, defining the difference is a worthy task on behalf of those whose symptoms are specifically posttraumatic to abandonment.  Worthier still would be trying to remove the stigma from the borderline label, but this challenge is addressed in another article.

Complicating an effort to differentiate between BPD and PTSD of Abandonment are three things: 

1) Abandonment trauma is cited as an etiological factor in the development of borderline personality disorder. 

2) Abandonment stressors are known to trigger borderline episodes. 

3) PTSD of Abandonment is not yet recognized as a diagnostic category, so the mental health community lacks a framework for distinguishing BPD from posttraumatic abandonment syndrome.

Needless to say, since abandonment features prominently in both diagnostic categories, quite a few people whose symptoms of PTSD stem from abandonment trauma are labeled borderline.  For the most part, this designation is a matter of how you define borderline.  Certainly people going through an acute abandonment event – let’s say their partner has rejected them, unilaterally ending the relationship – can find themselves in an emotional crisis severe enough to resemble a full blown borderline episode, complete with suicidal ideations, substance abuse, and other self destructive behaviors – at least in the early stages.  Additionally, many people with a history of childhood abandonment trauma can exhibit patterns of projective identification, self-sabotage, and emotional instability that extend into adult relationships.  Fear of abandonment can create a vicious cycle and become a self fulfilling prophesy where your relationships cyclically end in abandonment.

But heightened vulnerability to abandonment triggers and emotionally destabilizing patterns are present with both diagnostic categories.  What then might separate them?

In my estimation, a significant difference has to do with the degree to which the intense emotionality warps the individual’s perception of reality and how tenacious that altered perception remains – whether or not it is amenable to reality testing.  If it is a matter of extremes, I will refer to people with extreme borderline versus those with abandonment trauma, to avoid the pitfalls of ambiguous overlap in the middle of the continuum.  If the idea of a continuum has any validity, and as yet not enough is known to make this claim, I like to think of all of us as having cracks in the psychic egg shell; those of us with PTSD have some yoke encrusted around the cracks, and those of us deemed ‘borderline’ could use some yoke replacement therapy.

In another article I outlined thirty features of PTSD of Abandonment. Here we can summarize it as a syndrome in which people have heightened emotional arousal to abandonment triggers. Previous emotional traumas have conditioned them to detect signs of rejection, dismissal, or not being deemed “good enough” to which they involuntary react with the Fight Freeze or Flight responses ranging from mild to severe. These responses have been called “emotional hijacking).

Anyone who survived childhood – that’s all of us – has some degree of arousal to abandonment triggers owing to the fact that abandonment is a primal fear, universal to the human condition.  Depending on our earlier history of loss, neuro-biological constitutions and other factors, some of us go on to develop greater sensitivity to abandonment than others.  When the emotional reactivity is intense and persistent enough to interfere in relationships and quality of life on an ongoing basis, a label of PTSD of abandonment pertains. PTSD is different from Post Traumatic Stress (PTS), in that the later is not as persistent and tends to dissipate with time and corrective experiences.

People with abandonment trauma tend to react to lovers, family, friends, or therapists through a lens that warps reality in such a way that they perceive slights and injuries that may not have been intentional and/or belong more “in the eye of the beholder.”  When a slight does occur, they are primed to notice it, perhaps feel it keenly, have an involuntarily emotional reaction to it.  During the arousal period, people with abandonment trauma view the situation through a prism that can be momentarily distorted by emotion. But as the embers cool down, they have access to an internal reservoir of insight and self awareness that allows objective reality to help re-balance their perspective.

In extreme borderline, the distorted perception through the warped lens becomes calcified.  When someone struggling with borderline is triggered and lashes out at another, he tends to rewrite the history of the circumstances in a way that seeks to justify his emotionally charged behaviors. The new story features him as the injured party and the other as the perpetrator, a fabrication that his mental apparatus may perform automatically, without his conscious intention or awareness. Regardless, once rewritten, the individual believes the story. He accepts it as reality, clings to it. And he will defend it.

Let’s look at the case of Jaclyn who joined a group of old college friends for a reunion in the Bahamas.  She had recently lost her job, then her boyfriend, and had to move back with her parents, and was lonely and at loose ends in her life, so she looked forward to feeling like her old self with her old friends.  At first things went well on the trip, but at some point Jaclyn noticed that some of her friends seemed to have relationships with each other, had frequently spent time together over the years, and had closer ties than she had to any of them. As time went on, she began to feel on the outside, invisible, sometimes excluded from the dyads and triads that formed informally while they were all hanging out.  She tried to snap out of feeling isolated, but kept noticing that they weren’t drawn to her and that her ideas and needs didn’t seem to count.  Finally the dam broke and she spoke up about it, but her friends reacted defensively, refusing to admit that they were actively ignoring her or being unkind.  She told them they were dismissing her feelings, invalidating her reality. She went argued back and forth with them on this. As the dispute intensified, she felt evermore criticized and rejected.  Devastated, she packed her bags and stormed out.

Months later, her friends tried to tell Jaclyn what, in their perception, had “actually happened” on the trip – that she, not they, had “actually initiated” the conflict. Jaclyn interpreted this group consensus as a sign that they had conspired to create this story, that they were all allied against her. She told them that they were in denial – lying – and that pinning the blame on her was further proof that they were ostracizing her and being cruel.

What would happen in a parallel universe where Jaclyn had access to a greater resource of self awareness (yoke) with which to gain a bigger picture?  In this alternate version, Jaclyn remained hurt following the trip but some doubt prevailed.  Had she been too shaky and vulnerable to positively engage her friends when she was with them?  Had her hypersensitivity help to create the conflict?  Had her strong emotional reactions sparked their angry responses?  As she gained a broader perspective, she allowed for gray areas and multiple realities to emerge into her recollections of the event. She realized she could agree to disagree with some of the group’s perceptions. She tried to imagine how they may have felt when she lashed out at them.  Had she really said those things?  Maybe she’d blocked that part out.  She still felt insecure but realized the value of attempting to make amends with them.  Coached by her therapist, here’s what she said when she met with them– before they had a chance to barrage her with their inevitable critiques:

“I realize this is my issue, and I’m responsible for my reactions. I’m trying to grasp the impact I had on you when I started to get angry the way I did.  As I calm down more and more, I realize a lot of what happened had to do with how raw and vulnerable I was feeling, that it might not have anything much to do with you.  I wish I felt strong enough to invite you to tell me how my anger made you feel.  I’m not quite ready yet because I’m still feeling shaky and defensive and insecure, but I’m working my way out of it slowly.”   

This second version would be difficult for extreme borderlines.  Their re-written story solidifies into an incontrovertible reality, one which consistently holds others to blame and minimized their own behavior.  The tenacity with which borderlines believe their story can create irreconcilable differences in perception – impasses that thwart conflict resolution and alienate them from others.

Therapy techniques help to incrementally dismantle the borderline structure. Through tools that help them calm down their emotional arousal, such as the tools of abandonment recovery, borderlines build an open system where alternative viewpoints and feedback from others can be tolerated and integrated.  Recovering people learn to practice unconditional self acceptance, rigorous and fearless ownership of their own behaviors and character defects, and radical acceptance of reality on its own terms. They accept that their perception of a given event may differ from others and that it can safely co-exist with theirs so that relationships can become emotionally tolerable and sustainable.

Related Articles

Borderline and Abandonment: 12 Tops for Handling the Emotional Hijacking: 12 Tasks http://www.abandonment.net/articles/borderline-and-abandonment-part-i-what-to-do-when-for-emotional-hijacking-12-tasks

Post Traumatic Stress Disorder of Abandonment: 30 Characteristics http://www.abandonment.net/articles/post-traumatic-stress-disorder-of-abandonment-part-i-an-overview-and-list-of-30-characteristics

Causes of Post Traumatic Stress Disorder of Abandonment http://www.abandonment.net/articles/causes-of-post-traumatic-stress-disorder-of-abandonment-part-two

Addressing People Across the Abandonment Spectrum  http://www.abandonment.net/articles/addressing-people-across-the-abandonment-spectrum-part-iii

Does your Outer Child Act like a Borderline? 10 Ways to Stop Outer hild from Sabotaging your Life http://www.abandonment.net/articles/does-your-outer-child-ever-act-like-a-borderline-10-ways-to-curb-outer-child-from-sabotaging-your-life

Reversing Self Sabotage and Overcoming Abandonment  http://www.abandonment.net/articles/reversing-self-sabotage-and-overcoming-abandonment

The Five Phases of Abandonment Grief and Recovery   http://www.abandonment.net/articles/the-five-phases-of-abandonment-grief-and-recovery

By Susan Anderson © 2015

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5 comments

  1. Thank you very much for this incredible article. I have recently become very concerned about the overlap between the symptoms of BPD and those of trauma related to emotional abuse. I have discovered that because very few mental health professionals know what Narcissistic abuse is, they often times miss important “trauma- related” events that survivors have been through that would help put their symptoms in more of an accurate context. Christine Louis de Canonville, a psychotherapist in Ireland, has done some work on this. This is one of the articles she has written about Narcissistic Victim Syndrome on her website NarcissisticBehavior dot net.

    Sincerely,
    Michelle Mallon, MSW, LSW

  2. omar says:

    wow, what a great article!

    thank you

  3. jackie says:

    your article is the first one i’ve found that mentions abandonment as a criteria for ptsd ~ none of my therapists ever discussed that possibility, and the people who are meant to be supporting me mentally / socially, recently said i have a BPD.
    I know i was affected by my dad using me sexually as a kid (from age 8-11), but i was more traumatized by his blaming me after i told him it was wrong / it had to stop (after i got my periods and my junior school friend told me our bodies change to make babies) ~ the sexual abuse had been manipulative not violent, and his total retreat from me left me with no one, because my mum had been physically and verbally abusing me since i was 3. AND YET, all anyone ever wants to discuss is my dads sexual abuse of me.

    That i got too ill to cope with looking after my own kids is being blamed on BPD too, and maybe i have developed that (especially as your article suggests that abandonment issues can manifest as ‘mild’ BPD), but will a diagnosis of BPD really help me be less isolated and will it help resolve issues with other family members? I’m 50 now and am scared these things are never going to be solved.


  4. Raj says:

    Jackie,

    It is arguable that the worst part of abuse is invalidation.

    Take your awful experiences and imagine someone validated to you that your father was wrong and it wasn’t your fault.

    Problem with ‘mild’ diagnoses is that there will be signs of all sorts of pathologies in everyone. Even non BPD’s who have CPTSD can come across as having full blown BPD.
    The crossover in CPTSD traits can get quite extreme. It’s why treatment is so difficult.

    A good start is Judith Hermans ‘Trauma and Recovery’.

  5. Admin says:

    Yes that is a wonderful book!

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