Transcription
We get a lot of stuff on the channel about complex traumatic stress disorder and complex PTSD. Yeah. And you know, um I also like when I was looking for a freaking diagnosis for myself and I hadn't like happened on borderline. Um I I was like, "Oh, maybe that's me." You know, I haven't had any capital T trauma, but I've had probably little micro traumas. This this might be me.
And you know, there is something. So that's so that's a question about that's a separate a differential diagnosis. What that's a differential diagnosis question. What's that mean? Differential like to try and determine is something really X or is something Y. Is it borderline or is it bipolar for example? Right. Exactly.
If you're in a borderline, if you're if you sort of fit that diagnostic category, like it would mean that the process of recovery would involve, as you would say, you know, squaring with your history and your past and your behaviors, which as an adult, you're somewhat responsible for the things you did, even if you aren't entirely responsible or you're not for the home with within which you were raised. There's also this aspect with complex PTSD where because you're less blameworthy if you're in a trauma space, you appear to be less blameworthy if you're in a trauma space diagnosis in terms of your actions than if you're in a borderline space.
At the end of the day, recovery from a borderline diagnosis involves really interfacing with the you've done, you know, because you've done some not good stuff and and it's painful. My thing about the development of BPD and where people are when they seek treatment is this and I say this to families and I say this to people when they first come and see me. BPD is nobody's fault. I really believe that there's it's not about blaming environments and it doesn't mean environments are not responsible for contributing to somebody's problems. But when there is an orientation of blame that somebody has to pay, what it removes is an understanding of how those dynamics developed and we talk about validation or having some empathy. It sort of removes that from a real understanding.
So we have families involved in therapies all the time, parents who um feel terrible about um despite their best efforts creating an invalidating environment for their child and my response is that people are doing the best they can and I really do think people are doing the best they can and um you know the DBT saying is and they can do better. What I would actually say is there were probably really understandable reasons why everyone behaved the way they did. It doesn't make it okay. It does not make those scenarios okay. And somebody's current situation may well be a product of some of their environment. Um, and it's completely understandable and one can validate that very genuinely depending on that person's life circumstance.
And and this is the hard thing for most people to contend with. Despite all of those very justified feelings that that person may have, they're now in a situation of needing to understand how the things emerged in the way they did and what they can now do to move forward in their life. And that's where therapy can feel really difficult or um sort of invalidating at times. The point is actually not to invalidate but to in fact validate the situation and also have some accountability for a stake in moving forward.
I say all these things recognizing that many people who have a diagnosis of BPD have also had a trauma in their life. It is not part of the diagnosis. Just to be clear, you know, you ask me about complex PTSD and borderline. Complex PTSD is more like a chronic trauma. It's not necessarily one incident, but the other aspects of a traumatic event like having flashbacks or nightmares are typically part of a complex PTSD diagnosis. That's not the case with somebody who has borderline. It doesn't mean they may not also have a trauma or PTSD, right? But that's not part of what's required for a BPD diagnosis.
So, um there are many people who have had traumatic experiences and meet criteria for BPD. And I by no means am saying that that person does not have every right to have their feelings based on their traumatic experience. Um, and because they do, but they they're in a current situation of we we really can't change their experience that they've had, and we want to help them understand how it's impacted their personality, the way they um think about themselves and their relationships and what they then want to do moving forward. So, there's a lot to sort of contend with.
We get this all the time on the channel with people thinking, you know, you know, diagnosing themselves because no one else is diagnosing. They, you know, I think probably feel they're not getting served in the diagnostic realm, so they're trying to figure it out. I would really um dissuade people from self diagnosing, but to go to somebody who really has some knowledge of both disorders to get the differential. the treatment actually isn't hugely different, but it does it does, you know, I think it's important to understand what it is one is contending with. Sometimes we see people who have had a trauma that actually causes them to seek treatment, but when you go back to their history, there may be personality vulnerabilities, perhaps borderline traits, or even a diagnosis that preede the trauma. So you're kind of looking at the long-term scenario of somebody's life to really understand these differentials.