Van der Kolk and his team proposed that these people be re-diagnosed as having complex PTSD.įor this to happen, the American Psychiatric Association would have to add complex PTSD as a new diagnostic category to the DSM. Their hunch proved right: 81% of patients diagnosed with BPD reported severe child abuse, including sexual, and/or neglect, usually before the age of seven. They began to interview male and female patients with a BPD diagnosis and published their findings in 1989 in the American Journal of Psychiatry. What if these patients didn’t have disordered personalities, but were suffering the psychological consequences of childhood abuse? BPD was added to the DSM in 1980, and to the UK’s International Classification of Diseases (ICD) in 1996.Īs these changes were happening, Bessel van der Kolk, a professor of psychiatry at Harvard Medical School, and Judith Herman, a Harvard professor of psychiatry, began to wonder if the developments were correct. There is little hope of re-diagnosis with complex PTSD because therapists are reluctant to diagnose patients with a condition that isn’t recognized by the DSMĬoncerns about the misdiagnosis of sexual abuse victims surfaced early on. “BPD is a label that is often misused and applied especially to women, or people who were assigned female at birth, to pathologize them for emotional expressions of suffering,” Sarkisova says. BPD has become associated with a “parody of supposed feminine characteristics”, explains Glyn Lewis, the head of psychiatry at University College London. “The borderline diagnosis for sexual abuse survivors is nonsense and misleading because it suggests that the problem is within the personality of the survivor rather than a result of what has happened to them,” explains Gillian Proctor, program leader of the psychotherapy and counselling master’s program at the University of Leeds and a clinical psychologist in private practice.įor others, it’s political. This means that sexual abuse victims have to wrestle with receiving a BPD diagnosis that is pejorative and stigmatising (they are told their personality is “disordered” they are called “difficult” and as the condition can’t be cured, some psychologists avoid treating them.) As a result, “Someone who is dealing with complex trauma will be told that they are having a problem regulating their emotions,” Sarkisova explains. This misdiagnosis affects sexual survivors more than anyone else because they commonly display the psychiatric symptoms common to both disorders, such as anxiety, mood swings, depression, emptiness and displaced anger. While BPD is defined primarily by risk-taking symptoms (such as suicidality, impulsivity, self-harm, anxiety, emptiness, difficulty with relationships, and extremes of volatile emotion), complex PTSD patients tend to be less impulsive, frantic, unstable and less likely to engage in self-harm, according to a 2014 study in the European Journal of Psychotraumatology. But one major indicator sets them apart: the latest research shows that BPD is 55% inherited whereas complex PTSD is not caused by genetics but prolonged exposure to traumatic events, usually in childhood. Rather than being diagnosed with complex PTSD, many will be misdiagnosed with borderline personality disorder (BPD), says Sly Sarkisova, a Toronto-based psychotherapist who specializes in trauma.īPD and complex PTSD are different disorders, but have similar symptoms. This lack of recognition means it is difficult for sexual abuse victims who might suffer from it to receive the right psychological diagnosis. Someone who is dealing with complex trauma will be told they are having a problem regulating their emotions Sly Sarkisova, psychotherapist The DSM determines how mental illness is defined, and is the key to insurance coverage, special services in schools, disability benefits and treatments. ALEXANDRA SHIMO MANUALWhile the condition is referenced and discussed in peer-reviewed publications, North America’s official bible of psychiatry – The Diagnostic and Statistical Manual (DSM) – doesn’t recognize its existence. A decade later, new science – in the form of brain scans – revealed this was a distinct condition affecting certain areas of the brain. It was identified in 1990 by American psychiatrists studying the experiences, behavior and symptoms of sexual abuse victims and other patients who have experienced extreme trauma and neglect, usually at a young age.
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