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Cited by 89Personality Disorders and PsychopathologyPosttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology Research

Examining the Discriminant Validity of Complex Posttraumatic Stress Disorder and Borderline Personality Disorder Symptoms: Results From a United Kingdom Population Sample

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Hyland, Philip, Karatzias, Thanos, Shevlin, Mark, Cloitre, Marylène·2019·Journal of Traumatic Stress
DOI 10.1002/jts.22444
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Abstract

Complex posttraumatic stress disorder (CPTSD) was added to the diagnostic nomenclature in the 11th revision of the International Classification of Diseases ( ICD‐11 ). Although considerable evidence exists supporting the construct validity of CPTSD, the distinguishability of CPTSD symptoms from those of borderline personality disorder (BPD) has been questioned. The present study examined the discriminant validity of CPTSD and BPD symptoms among a trauma‐exposed population sample from the United Kingdom ( N = 546). Participants completed self‐report measures of CPTSD and BPD symptoms, and their latent structure was assessed using exploratory structural equation modeling (ESEM). A three‐factor model with latent variables reflecting PTSD, disturbances in self‐organization (DSO), and BPD symptoms provided the best fit of the data, χ 2 (399, N = 546) = 1,650, p < .001; CFI = .944; TLI = .930; RMSEA = .077, 90% CI [.073, .081]. We identified multiple symptoms distinctive to individual constructs (e.g., disturbed relationships and suicidality) as well as symptoms shared across the constructs (e.g., affective dysregulation). The PTSD, β = .24; DSO, β = .23; and BPD, β = .27, latent variables were positively and significantly associated with childhood interpersonal trauma. The current findings support the discriminant validity of CPTSD and BPD symptoms and highlight various phenomenological signatures of each construct as well as demonstrate how these constructs share important similarities in symptom composition and exogenous correlates.

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  • Emotional reactivity, impulsivity, emptiness, terror of abandonment, and a fragmented and unstable sense of self were prominent in a BPD latent variable.

    “Emotional reactivity, impulsivity, emptiness, terror of abandonment, and a fragmented and unstable sense of self were prominent in a BPD latent variable.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [73]

    Table 3 (Discussion; page not provided) shows emotional reactivity, fear that someone close will leave, and changes in self-image and sense of self loading on the BPD factor. The ESEM results say all 14 BPD items loaded moderately to strongly on that factor and identify feeling empty inside as one of them. The passages retrieved do not specifically establish impulsivity as a prominent item, or describe the sense of self as fragmented. (LLM, conf=0.82)

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  • Childhood emotional abuse and neglect and sexual abuse also may be of particular importance in the development of cPTSD or PTSD when they are comorbid with BPD-and this comorbidity of trauma-related disorders with BPD may occur more often than BPD in the absence of PTSD or cPTSD.

    “Childhood emotional abuse and neglect [52] and sexual abuse [156] also may be of particular importance in the development of cPTSD or PTSD when they are comorbid with BPD—and this comorbidity of trauma-related disorders with BPD may occur more often than BPD in the absence of PTSD or cPTSD [52, 73, 83, 84].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [73]

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  • In adults with BPD, emotion dysregulation, particularly involving anger in a context of perceived rejection, is associated with both prior victimization by child maltreatment and subsequent violence perpetration toward self and others.

    “In adults with BPD, emotion dysregulation, particularly involving anger [56] in a context of perceived rejection [4, 48, 132], also has been shown to be associated with both prior victimization by child maltreatment and subsequent violence perpetration toward self and others (primarily intimate partners) [73, 79, 96, 98, 107, 126].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [73]

    The ESEM results and Discussion report an association between childhood interpersonal trauma and BPD symptoms, and the Discussion identifies self-injury and anger as BPD-related symptoms. The study used a trauma-exposed population sample rather than a group diagnosed with BPD, and it does not show that emotion dysregulation predicts subsequent violence toward others or intimate partners. Its cross-sectional data cannot establish that sequence. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Complex PTSD and borderline personality disorder have some overlapping symptoms but are more distinct than similar, particularly in key symptoms and treatment implications.

    “a growing number of studies indicate that, while complex PTSD and borderline personality disorder have some overlapping symptoms, they are more distinct than similar, particularly in regard to key symptoms and treatment implications.”

    From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [34]

    The Abstract and Discussion describe overlapping symptoms and identify features that distinguish CPTSD from BPD. The Discussion also reports moderate-to-strong correlations and says the disorders should not be expected to be entirely distinct; it does not establish that they are more distinct than similar. It mentions a potential treatment perspective but does not establish distinct treatment implications for the two disorders. Page numbers were not available in our copy. (LLM, conf=0.86)

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  • Although PTSD, DSO, and BPD were clearly distinct as latent variables, all three were associated with self-reported histories of childhood interpersonal trauma exposure.

    “Although PTSD, DSO, and BPD were clearly distinct as latent variables, contrary to expectations, all three were associated with self-reported histories of childhood interpersonal trauma exposure.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [73]

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Research works printed but not linked: 2

  1. Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 541-565.
  2. Muthén, L. K., & Muthén, B. O. (2013). Mplus user's guide (7th ed.). Los Angeles, CA: Muthén & Muthén.

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Authors
Hyland, P., Karatzias, T., Shevlin, M., & Cloitre, M.
Affiliations
  • National University of Ireland, Maynooth (IE)
  • National Health Service (GB)
  • University of Ulster (GB)
  • National Center for PTSD Dissemination and Training Division VA Palo Alto Health Care System Palo Alto California USA
Corresponding author
Hyland, Philip
ORCID
Venue
Journal of Traumatic Stress
Publisher
Wiley
Published
2019-11-21
Volume
32
Issue
6
Pages
855-863
ISSN
  • 0894-9867 (ISSN-L)
  • 1573-6598
DOI
10.1002/jts.22444
OpenAlex
W2990815410
Cited by
89
References
38
Citations by year
2026: 10 · 2025: 13 · 2024: 8 · 2023: 17 · 2022: 13 · 2021: 12 · 2020: 14 · 2019: 2
FWCI
11.96
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Traumatic Stress (publishedVersion)
  • PubMed (publishedVersion)
  • Maynooth University ePrints and eTheses Archive (Maynooth University) (acceptedVersion)
  • Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
complex PTSD, borderline personality disorder, discriminant validity, ICD-11, trauma exposure, disturbances in self-organization, emotional dysregulation, suicidality, childhood interpersonal trauma, symptom structure
MeSH terms
Exposure to Violence, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Borderline Personality Disorder, Female, United Kingdom, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Sex Factors, Stress Disorders, Post-Traumatic, Models, Statistical, Young Adult

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