Borderline/CPTSD
Personality Disorders have long been considered too extreme in nature or too “entrenched” to respond well to treatment. Newer advances in research and therapeutic interventions have shown otherwise!
“Learning to create a sense of inner safety and calm is an integral step in restoring emotional regulation.”
Debra’s work with Complex Post Traumatic Stress/Personality Disorders includes work to help individuals explore childhood neglect and abandonment, learn how to integrate emotions and bodily sensations, and tolerate feeling states that were previously too overwhelming. Within the safety of a supported, therapeutic relationship clients can explore their betrayals in early chilhood attachment and create a sense of safety for selfcare and healing.
Debra is level-II trained in EMDR (Eye Movement Desensitization and Reprocessing) and utilizes this modality, with great success, to treat early traumatic disturbances. Her clients have learned effective and successful tools in creating inner emotional safety and trust.
What is Borderline Personality Disorder (BPD)
Borderline Personality Disorder is a controversial diagnosis that is closely associated with Post Traumatic Stress Disorder (PTSD). The nomenclature of BPD is often used in a diminishing reference to those who struggle with the issue. Further, the diagnosis of BPD is more a description of behaviors than an accurate definition of the trauma.
These include:
- A pattern of intense and unstable relationships (professional and personal)
- Chronic sense of loneliness and emptiness
- Self-mutilating behaviors (also known as para-suicidal behavior)
- Chronic fear of abandonment and rejection
- Unstable mood; inappropriate anger that is reactive and rageful
- Impulsive behaviors; specifically in areas regarding sex, food, and spending
As a result of research into the origins of this personality disturbance more is understood as to its biological, psychological and social origins. Since PTSD does not speak to nor take into consideration traumatic experiences endured in early childhood, a newer more current diagnosis of Complex Post-Traumatic Stress Disorder (CPTSD) does address and speak to the ensuing problems that can later surface as a result of that early trauma. Along with the previously delineated behaviors an individual may go on to experience elements of identity and relationship disturbance.
Understanding Complex Post-Traumatic Stress (CPTSD)
As Bessel A. van der Kolk, M.D., so eloquently wrote, “compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one’s current life, rather than repeating trauma in action, mood, or somatic states, is the goal of treatment.” 1
Within the CPTSD constellation, self-injurious acts are as consistent as the emotional inconsistency that drives them. In other words, a traumatized individual makes repeated attempts to gain control over feelings of being out of control. Concomitant with substance abuse and compulsive and/or impulsive sexual behavior is the exchange between one’s sense of victim and perpetrator that is chronically reenacted in pendulating measures of eating disorders (ED) and self-injurious behavior.
Origins of Trauma Repetition
Repeated exposure to chronic adverse childhood experiences induces behavioral and physiologic changes. It is known that the developing brain under extreme inexorable distress will undergo changes in neurotransmitter activity. Children, particularly newborns and infants “who have been exposed to severe, prolonged environmental stress, will experience extraordinary increases in both catecholamine and endogenous opioid responses to subsequent stress.” 2
We also know that a newborn’s attunement to the world is externally focused. The incoming stimuli is stored in and controlled by the lower segments of the developing brain such as the thalamus and the amygdala. The amygdala considered to be a part of the limbic system, performs the crucial and fundamental role in the establishment of memories associated with emotional events. The system’s primary function is to maintain appropriate levels of arousal; too little stimuli and the neurons cannot register. If there is too much stimuli the newborn’s sensory signals become overloaded thus inducing system disorganization and temporary “collapse.”
In brief, a newborn’s caregiver must regulate arousal states until the infant’s developing system can self-regulate internal and external states of arousal. As a result of early uncontrolled arousal states abused children tend to manifest a higher threshold of stimulation of the endogenous opioid system in order to self-soothe. This is in comparison to those whose early developmental experiences were met with consistent early nurturing.
[1/2] van der Kolk, B. The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism. Psychiatric Clinics North Am 1989;12(2):389-411