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High correlation between PTSD and BPD
June 2007

There is a high correlation between Post Traumatic Stress Disorder (PTSD) and the complex personality type, Borderline Personality Disorder (BPD). PacifiCare Behavioral Health (PBH), a part of the UnitedHealth Group's family of business, in partnership with Harvard Pilgrim Health Care, provides invaluable assistance for practitioners caring for members who may need treatment for these personality disorders that pose particular diagnostic challenges, especially when co-occurring conditions, such as eating disorders, can make treatment more complex.

PTSD, a condition that affects nearly eight million American adults, as well as children, develops following a traumatic event or violent act. It can occur as the consequence of any harmful situation where someone has either witnessed or experienced violence. Even witnessing a violent act against strangers, such as the September 11, 2001 terrorist attacks, may lead to PTSD. The condition is more likely to develop in women than men, with some evidence indicating that PTSD is apt to cluster in families. 

While not every traumatized person develops PTSD, symptoms of the diagnosis begin within three months of an incident and can occasionally manifest years later. Many people going through an event do not develop PTSD, and it's unclear why some people develop the condition, when others do not. Evidence influencing how susceptible a person may be to developing PTSD includes:

  • Degree of intensity of the traumatic event
  • If a loved one was lost or hurt
  • How close the person was to the event
  • How much control the person perceived they had over or during the event
  • How much help and support the person received after the event

Many people diagnosed with PTSD report repeatedly reliving the original trauma, through "flashbacks," which can occur throughout the day, or during vivid dreams. Flashbacks, characterized by lapses in reality and the belief that one is back in time experiencing the trauma all over again, can be triggered by everyday occurrences, like: sights, smells, sounds, or the anniversary date of the traumatic event.  

People with PTSD have several common traits or behaviors including: startling easily; having difficulty connecting with appropriate emotions (claims of "feeling numb"); losing interest in things they used to enjoy; having difficulty with intimate relationships, such as feeling affectionate; displaying irritability, aggression, or sometimes even violence; or having a tendency to avoid situations that remind them of the original incident.

Effective Treatments for PTSD

Cognitive Behavior Therapy


  • Shown to be the most effective psychotherapeutic or counseling modality; can help individuals understand their thoughts and learn ways to cope with feelings, ideally allowing them to be more in control of other life stressors
  • Specifically, selective serotonin reuptake inhibitors (SSRIs), which can improve the depressive symptoms characteristic of PTSD, along with the hyperarousal or anxiety that is often a symptom of the condition

A diagnosis of BPD is characterized by unstable emotions, impulsiveness, relationship problems, and an unstable self-image. People with the disorder often display self-destructive behavior (such as cutting one's body), have problems managing anger, and have an intense fear of being rejected or abandoned. They also often struggle with other co-occurring conditions, such as depression, eating disorders, or substance abuse problems.

There is no cure for BPD, and the root cause of BPD is unknown, however, both environmental and genetic factors are thought to play a role. Studies have shown that many, but not all individuals with BPD report a history of abuse, neglect, or prolonged separation as young children, with as many as 70% of people with BPD reporting a history of having been sexually abused. Other causes of BPD are not well-understood. There may be a chemical imbalance of brain neurotransmitters that help regulate mood, which is similarly influenced by genetic and environmental factors.

Effective treatments for BPD

Dialectical Behavior Therapy


  • Specific type of counseling shown to be successful in managing symptoms; can help individuals understand their thoughts and learn ways to cope with feelings, ideally allowing them to be in better control of other life stressors
  • Psychopharmacolgic treatment with antidepressant medication or mood stabilizers: helpful for depressed people with BPD, particularly those experiencing mood instability or "mood swings"
  • Low-dose antipsychotic medication: helpful in instances where significant thought distortion is present

PacifiCare Behavioral Health resources
Practitioners interested in referring a patient for behavioral health services, or looking for help facilitating the coordination of treatment for patients who may be experiencing PTSD and BPD, may call PacifiCare Behavioral Health, toll free, at 888-777-4742. For complex clinical situations, practitioners may want to contact the PacifiCare Behavioral Health Consultation Service, toll-free, at 800-292-2922 during regular business hours.


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