Most people who have borderline personality disorder (BPD) have a history of untreated trauma, and a majority also experience a symptom called dissociation.
On their own, either trauma or dissociation can have a profound negative impact on the substance and quality of a person’s life. When someone with BPD is living with both the effects of trauma and recurring dissociation, the disruption can increase exponentially.
In recent years, multiple research efforts explored the impact of trauma and dissociation on people with BPD. As mental health experts gain greater insights into the causes, symptoms, and effects of borderline personality disorder, their newly acquired knowledge will hopefully lead to more effective treatments for this potentially debilitating condition.
A Brief Review of Borderline Personality Disorder, Trauma, and Dissociation
Borderline personality disorder is a complex mental illness that can undermine a person’s ability to live a full, productive, and satisfying life.
People who develop BPD are likely to struggle with impulsivity and instability, primarily in the context of their relationships and their self-image. Symptoms of BPD may include the following:
- A history of many intense but brief relationships
- An intense fear of abandonment
- Rapid, dramatic shifts in self-esteem and self-image
- Impulsive and reckless behaviors in potentially harmful areas such as gambling, driving, substance use, and sex
- Drastic, unpredictable changes in mood and attitude
- Dissociative episodes
- Frequent thoughts and threats of self-harm and suicide
BPD is one of 11 personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The disorder is relatively rare among the general public, with experts estimating that it affects between 1%-2% of the population. However, underscoring BPD’s potential for significant harm, as many as 20% of people in inpatient psychiatric treatment centers have this condition.
What is Dissociation?
Onne of the most misunderstood aspects of borderline personality disorder and trauma is the phenomenon of dissociation. Periods of dissociation can be extremely confusing and distressing, both to the person who is experiencing them and to those who witness them.
In general terms, dissociation describes a temporary sense of detachment from one’s own thoughts, emotions, body, and/or surroundings. The specifics of a dissociative episode can differ considerably from one person to the next.
If you were to experience dissociation, here are a few examples of what may occur:
- Derealization: This refers to the sensation of being detached from your environment. The world around you may appear to be flat, distant, or otherwise “unreal.” Derealization isn’t totally visual – voices and other sounds may also seem to be abnormal during these episodes. One of the most striking aspects of derealization is that you will usually be aware that something is wrong with your perception of the world around you.
- Depersonalization: This aspect of dissociation includes the feeling that you are removed from your body, mind, and senses. During a dissociative episode that involves depersonalization, you may believe that you have no control over what you say, feel, think, or do. You may even feel as though you are observing yourself from above.
- Dissociative amnesia: This typically occurs in the aftermath of a traumatic experience (which we will discuss in greater detail in the next section). Dissociative amnesia can include the inability to remember parts of certain experiences or extended periods from your past.
- Identity confusion: This experience is akin to what was once referred to as multiple personality disorder. During times of identity confusion, you may feel that someone else is controlling your body and mind, or that there is another person living inside your body. Understandably, this aspect of a dissociative episode can be a source of considerable anguish.
The Link Between Trauma and Dissociation
In addition to being a symptom of borderline personality disorder, dissociative episodes may also be caused by other mental health concerns. The dissociative disorders section of the DSM-5 includes entries for the following conditions:
- Dissociative identity disorder (DID)
- Dissociative amnesia
- Depersonalization/derealization disorder
As we noted when discussing dissociative amnesia in the previous section, dissociation is often triggered by trauma. This can be true of people who have the three disorders we just listed, as well as those who have BPD and other conditions for which dissociation may be one of many symptoms.
Here’s how the International Society for the Study of Trauma and Dissociation (ISSTD) describes this phenomenon:
Trauma-related dissociation is sometimes described as a ‘mental escape’ when physical escape is not possible, or when a person is so emotionally overwhelmed that they cannot cope any longer. Sometimes dissociation is like ‘switching off’. Some survivors describe it as a way of saying ‘this isn’t happening to me’.
In an April 2022 article in the journal Borderline Personality Disorder and Emotion Dysregulation, Dutch clinical psychologist Annegret Krause-Utz echoed this description, referring to dissociation as “an (evolutionary-based) defense mechanism to cope with unbearable, overwhelming experiences.”
Although trauma-related dissociation doesn’t seem to be discussed or written about as much as several other mental health concerns are, it is more common than many people realize. A May 2022 article in the Delaware Journal of Public Health reported the following:
- Severe dissociative pathology and dissociative disorders are more common than bipolar disorder, obsessive compulsive disorder (OCD), and schizophrenia.
- 7% of adults in the United States have had at least one traumatic experience.
- 60% of U.S. adults lived through at least one traumatic event during their childhood.
- 25% of U.S. adults endured three or more traumatic events during childhood.
- As many as 46% of people who receive either inpatient or outpatient clinical care have had a dissociative episode.
The authors of the May 2022 article wrote that there is “a robust correlation between dissociative symptoms and exposure to trauma, particularly early childhood trauma and disruptions in attachment and caregiving.”
The Negative Effects of Borderline Personality Disorder: Trauma and Dissociation
Trauma is closely associated with borderline personality disorder. In fact, this correlation is so strong that some experts have recommended that BPD should be renamed complex posttraumatic stress disorder (CPTSD) or at least reclassified as a trauma-related condition instead of a personality disorder.
In the April 2022 article we reference above, Krause-Utz described stress-related dissociation as a “core symptom” of borderline personality disorder. She reported that about 80% of people with BPD have periods of dissociation, noting that the severity of a person’s dissociative symptoms aligns with the severity of the trauma that they experienced.
Krause-Utz’s article explored the impact that trauma and dissociation can have on people who have borderline personality disorder. Suffice it to say, this impact is far from positive. Dissociation, she wrote, has been linked to the following negative outcomes among people who have BPD:
- Increased severity of BPD symptoms
- Cognitive deficits
- Impaired working memory
- Greater fragmentation of personality
- Emotion dysregulation
- Abnormal stress responsiveness
- Altered sense of body ownership
- Decreased ability to perceive pain
- Elevated risk of self-harm
- Reduced response to psychotherapy
- Changes in gene expression
Reasons for Hope
It is no exaggeration to note that the combined impact of untreated trauma and severe dissociation can be devastating for someone who has borderline personality disorder. Thankfully, the news about these three topics isn’t all bad.
For example, Krause-Utz wrote that research suggests appropriate treatment can ease dissociative symptoms. She identified the following approaches as showing promise in this area:
- An adapted version of dialectical behavior therapy (DBT)
- Mentalization-based treatment (MBT)
- Schema-focused therapy (SFT)
- Transference-focused psychotherapy (TFP)
Reducing the impact of trauma and dissociation, Krause-Utz observed, can lead to increased quality of life among people who have borderline personality disorder.
“In a prospective follow-up study over 20 years, a decrease of depersonalization and derealization symptoms was strongly associated with overall BPD recovery status,” she wrote.
Find Professional Help for Borderline Personality Disorder in Southern California
If you or someone that you care about have been living with borderline personality disorder, please know that effective treatment is available. When you get the type and level of care that aligns with your needs and goals, you can build a foundation for a much healthier and more satisfying future.
Crownview Psychiatric Institute specializes in treating adults affected by borderline personality disorder and other complex mental health concerns.
Features of care at our center in Oceanside, California, include:
- Customized treatment plans for each person
- A robust therapeutic component
- An array of beneficial adjunct services
- Dynamic life- and work-skills education
- Full wraparound support
- Thorough aftercare planning
- An innovative community-like environment
CPI is located along southern California’s Pacific coast, about 90 miles south of Los Angeles and about 40 miles north of San Diego. To learn more about our programming, or for details about how we can help you or your loved one, please visit our Admissions page or call us today.
Gianna Melendez
Jodie Dahl, CpHT