Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

There remains controversy surrounding the nature of the relationship between borderline personality disorder and posttraumatic stress disorder, with strong arguments that it would be more accurate and less stigmatizing for the former to be considered a trauma spectrum disorder. This article reviews the major criticisms of the DSM-IV diagnosis of borderline personality disorder that have fueled this controversy, including the absence of an etiology for the disorder, which is widely believed to be associated with early traumatic experiences. Also reviewed are recent attempts to redefine the disorder as a trauma spectrum variant based on the apparent overlap in symptomatology, rates of diagnostic comorbidity, and the prevalence of early trauma in individuals with a borderline diagnosis. The conceptual and theoretical problems for these reformulations are discussed, with particular reference to discrepancies in theoretical orientation, confusion of risk with causation, and the different foci of interventions for borderline personality disorder and posttraumatic stress disorder. (HARV REV PSYCHIATRY 2009;17:322-328.)