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Summary: Yes, you can get treatment for co-occurring PTSD and BPD. These conditions – posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) – can cause serious disruption separately, and present significant challenges when they co-occur.

Key Points:

  • Both PTSD and BPD are serious mental health disorders
  • The symptoms of PTSD and BPD overlap, and may appear similar
  • Symptom overlap and similarity can complicate diagnosis and treatment
  • New research validates the effectiveness of integrated treatment approaches

Treatment for Co-Occurring PTSD and BPD: Core Concepts

In a previous article, Treating Co-Occurring Borderline Personality Disorder and Post-Traumatic Stress Disorder (PTSD),” we discussed the first large-scale study conducted on treatment for co-occurring PTSD and BPD – “Optimizing Treatment For Comorbid Borderline Personality Disorder and Posttraumatic Stress Disorder: A Systematic Review Of Psychotherapeutic Approaches and Treatment Efficacy” which examined the impact of BPD-specific treatments, trauma-focused treatments, non-trauma-focused treatments for PTSD, and stage-based treatments for co-occurring PTSD and BPD.

That initial article appeared in 2021. Since then, our understanding of both disorders has evolved. However, the basic questions researchers faced – and outcomes they feared – remain the same:

Will treatment for one exacerbate symptoms of the other?

For patients with BPD and suicidality, will processing past trauma during PTSD treatment increase likelihood of suicidality?

Will BPD treatment retraumatize people with PTSD?

Those questions are central to a new study that seeks to revisit the studies from 2021 with evidence from new random-controlled trials (RCTs) on treatment for co-occurring PTSD and BPD. Researchers designed the study “Re-Examining the Comorbidity Between Borderline Personality Disorder and Post-Traumatic Stress Disorder: A Systematic Narrative Review” to learn whether the new studies yielded important novel data, confirmed previous research, or refuted previous research.

We’ll review the outcomes of that study in a moment. First, we’ll offer the basic facts about PTSD and BPD required to fully understand the importance of the new research.

PTSD and BPD: Facts and Figures

Mental health experts define PTSD as follows:

“Posttraumatic stress disorder (PTSD) is a disabling disorder that develops after exposure to a traumatic event. It is characterized by intrusive thoughts, nightmares, and flashbacks; avoidance of reminders of the trauma; negative cognitions and mood; hypervigilance and sleep disturbance.”

The symptoms of PTSD include, but are not limited to:

  • Flashbacks. These are unwanted, intrusive, uncomfortable, distressing memories of the initial trauma or traumatic events.
  • Avoidance. Most people with PTSD will actively seek to prevent experiencing any memories of the event, including people, places, and sensory input associated with the initial trauma or traumatic events.
  • Low mood/persistent negative thoughts. Many people with PTSD develop patterns of thought that reinforce pessimism, fear, and depressive emotional states.
  • This refers to the extreme/excessive/disproportionate emotional and/or physical reactivity people with PTSD experience in response to external stimuli.

Those are the basic facts on PTSD, which show the importance of effective treatment and support.  We have one more PTSD fact to share: the percentage of adults in the U.S. with PTSD. The U.S. Department of Veterans Affairs (USVA) shows the following prevalence of PTSD:

PTSD Among Adults 18 +

To learn more about PTSD, please visit our PTSD treatment page:

Posttraumatic stress disorder (PTSD) Treatment in San Diego

Now let’s shift gears from PTSD to BPD, take a closer look at BPD.

Mental health experts define BPD as follows:

“A mental health condition that characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity to possible rejection and abandonment.”

The symptoms of BPD include, but are not limited to:

  • Intense fear of abandonment
  • Unstable interpersonal relationships
  • Identity instability/frequently changing concept of self
  • Impulsive, risky behavior
  • Suicidality and self-harm
  • Extreme, sudden mood swings
  • Unpredictable rage/anger that’s difficult to control
  • Paranoia/dissociation

Those are the basic facts on BPD, which, like the basic facts on PTSD, show the importance of effective treatment and support. There’s one more BPD fact to share: the percentage of adults in the U.S. with PTSD. The National Institute of Mental Health (NIMH) shows the following prevalence of PTSD.

BPD: Prevalence Among Adults, 18 +

To learn more about BPD, please visit our BPD treatment page:

Borderline Personality Disorder (BPD) Treatment in San Diego

Finally, data shows the following data on co-occurring PTSD and BPD.

Co-Occurring BPD and PTSD: Prevalence Among Adults, 18 +

  • Among patients with PTSD diagnosis:
    • 24.2% have a BPD diagnosis
  • Among patients with BPD diagnosis:
    • 30.2% have a PTSD diagnosis

The facts we share above show the symptom overlap and default severity of both disorders – even in cases of mild severity, functional impairment can be significant – and foreground the need for an expanded understanding of any new treatment for co-occurring PTSD and BPD.

What Does the New Research Say About Treatment for Co-Occurring PTSD and BPD?

The research team behind the study we introduce above – “Re-examining Comorbidity…” – located a total of 27 studies appropriate for review. The treatment studies included research identified four (4) as BPD-specific, five (5) as trauma-focused, and eight (8) as integrated treatment-specific. One prevalence study showed higher general prevalence numbers that the USVA reports, as well as higher rates of co-occurrence:

  • PTSD in general adult population: 8.9%
  • PTSD among people with BPD: 53.1%
  • BPD among people with PTSD: 14.7%

The researchers also noted the symptoms common to both disorders which may be exacerbated by PTSD-BPD co-occurrence. People with both PTSD and BPD may experience:

  • Heightened psychological distress
  • Increased risk of self-harm
  • Increased incidence of risky behavior
  • Dissociation
  • Increased emotional dysregulation

These findings further underscore the need for effective treatment for co-occurring PTSD and BPD. Let’s take a look at their data and learn which treatments can offer the most help for patients. Here’s what they found:

Effective Treatment for Co-Occurring PTSD and BPD

BPD Specific Treatments:

  • Dialectical behavioral therapy (DBT)
    • Showed benefit for patients with BPD
    • Showed benefit for patients with co-occurring PTSD
    • Did not exacerbate PTSD symptoms
  • Mentalization-based therapy (MBT)
    • Showed benefit for patients with BPD
    • Showed benefit for patients with co-occurring PTSD
    • Did not exacerbate PTSD symptoms
  • BPD Compass, which combines CBT, DBT, and mindfulness
    • Showed significant benefit for patients with BPD
    • Showed moderate benefit for patients with co-occurring PTSD
    • Did not exacerbate PTSD symptoms
The most important outcome in that set of data is the finding that these treatments are safe for people with PTSD, which means they followed the golden rule of trauma-informed care: avoid re-traumatization.

Trauma-Informed/PTSD-Specific Treatments:

The two most important outcomes in that set of data are the finding that these treatments are safe for people with BPD, which means they did not increase suicidality or self-harm in people with BPD, and that EMDR for patients with BPD may not be appropriate for patients with complex trauma: the impact of repeated EMDR exposures on people with BPD is not fully understood.

Integrated Treatment Approaches:

  • Dialectical behavioral therapy (DBT) + prolonged exposure therapy (PE)
    • Showed benefit for patients with co-occurring PTSD and BPD:
      • Reduced PTSD symptoms
      • Reduced BPD symptoms
      • Increased social function
      • Improved relationships
      • Improved quality of life
    • Patients with severe PTSD + BPD showed mixed reaction, with severe PTSD associated with increased BPD-associated emotional dysregulation among patients with severe PTSD + BPD
    • Veterans with PTSD + BPD showed improvements:
      • PTSD symptoms
      • BPD symptoms
      • Veterans reported no re-traumatization
    • Eye movement desensitization and reprocessing (EMDR) + prolonged exposure therapy (PE):
      • Led to remission inn 70% of PTSD patients
      • Accompanied by remission in 73% of BPD patients
    • Dialectical behavioral therapy for PTSD (DBT-PTSD)
      • Designed by Dr. Marsha Linehan, founder of DBT
      • Improved symptoms for both PTSD and BPD for patients with co-occurring PTSD-BPD:
        • Reduced dissociation
        • Improved maladaptive behaviors

We’ll discuss these results below.

Important New Understanding of Treatment for Co-Occurring PTSD and BPD

This in-depth analysis of existing research questions two previous assumptions about co-occurring disorders, specifically co-occurring PTSD and BPD.

First, common dogma around co-occurring disorders holds that they lead to more negative emotional and psychological outcomes than disorders that occur without a second diagnosis. This study shows people with co-occurring PTSD-BPD can “achieve similar outcomes to those with either disorder alone.” Second, these results show that the reluctance to use any exposure-based therapy in BPD treatment needs revisiting. When administered in a stepwise manner by experience clinicians, some exposure-based therapies improved not only trauma related anxiety and depressive symptoms, but also helped reduce dissociative symptoms.

In addition, the research team reports that integrated treatments and trauma-focused were both well-accepted by patients with PTSD and BPD, which indicates real progress: individual belief in, commitment to, and acceptance of treatment modalities improve outcomes across all metrics.

How This Research Helps Our Patients

For our patients with complex mental health disorders, this research offers hope.

For years, a significant percentage of mental health professionals avoided patients with BPD, classifying them as untreatable. In fact, Dr. Marsha Linehan, the person who invented the most effective treatment for people with high levels of emotional reactivity and low emotion regulation – dialectical behavior therapy (DBT) – did so because she had BPD and no treatment helped her reduce symptoms, manage her emotions, and meet her treatment goals. This research shows that BPD is treatable, even when it co-occurs with another complex mental health disorder.

The study authors characterize their findings as follows:

“This narrative review captures the significant progress that has been made regarding the treatment responsiveness of comorbid BPD-PTSD. Our review builds on evidence that this comorbidity is treatment responsive. Despite the expanding understanding of these co-occurring disorders, gaps in the literature prevail. Further research on the prevalence, course, and etiology is needed, as well as on the efficacy of psychopharmacology treatments and the underrepresentation of men in BPD-PTSD samples.”

Patients with PTSD and complex PTSD can also find hope in this research. A person with PTSD often experiences terrifying flashbacks and develops patterns of behavior that are isolating and create a negative feedback loop which can make symptoms worse: they need professional help and support, but facing traumatic memories can be both painful and distressing. When PTSD and BPD co-occur, these types of symptoms can increase in severity, but this new research shows – as the quote above indicates – that we’ve come a long way in treating both PTSD and BPD, and that integrated treatment can effectively reduce PTSD and BPD symptoms and improve quality of life and basic efficacy across core functional domains.

That’s a big deal, and we can use this knowledge to not only support our patients with co-occurring PTSD and BPD, but show them that when they receive an accurate diagnosis, and timely, appropriate treatment delivered by skilled, experienced professionals, they can meet their treatment goals and live a full and productive life.

Finding Help: Resources

If you or someone you know needs professional treatment for PTSD, BPD, or co-occurring PTSD-BPD, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.