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Cited by 55Personality Disorders and PsychopathologyPosttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology Research

Multiple and interpersonal trauma are risk factors for both post‐traumatic stress disorder and borderline personality disorder: A systematic review on the traumatic backgrounds and clinical characteristics of comorbid post‐traumatic stress disorder/borderline personality disorder groups versus single‐disorder groups

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Jowett, Sally, Karatzias, Thanos, Albert, Idit·2020·Psychology and Psychotherapy: Theory, Research and Practice
DOI 10.1111/papt.12248
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Abstract

Background: Both borderline personality disorder ( BPD ) and post‐traumatic stress disorder ( PTSD ) are associated with exposure to traumatic events and are highly comorbid. No review to date has addressed the clinical presentations and traumatic backgrounds associated with these disorders although this work is essential for the development of effective interventions. Objectives: To systematically explore similarities and differences in traumatic history and clinical presentation in comorbid BPD and PTSD as compared to PTSD or BPD alone. Method: The Web of Science, Cochrane Library, Psyc INFO , MEDLINE , and PILOTS databases were searched systematically. Eligible studies included adult populations, compared comorbid BPD / PTSD to a single disorder, and published in English. Results: A total of 10,147 cases across 33 studies were included: 2,057 comorbid BPD / PTSD , 2,648 BPD only, and 5,442 PTSD only. The comorbid group overall reported greater exposure to multiple and interpersonal trauma and elevated emotion dysregulation compared to both single‐disorder groups. In terms of methodological quality, most papers achieved a Fair rating with improvements required in minimizing bias through recruiting adequate and representative samples, and reporting on traumatic exposure. Conclusion: Multiple and interpersonal trauma might have a unique role in the development of comorbid BPD / PTSD features, particularly so for emotion dysregulation. Future research is required to unravel the unique characteristics of interpersonal trauma that can generate BPD and PTSD symptoms. Practitioner points: Practitioners should routinely assess for interpersonal trauma considering its impact. Tackling emotion regulation difficulties might promote recovery from both PTSD and BPD symptoms. Presence of self ‐injury might be used to discriminate between PTSD and BPD and offer suitable interventions.

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  • The comorbid BPD/cPTSD class was more likely to report histories of emotional abuse and physical neglect than the cPTSD classes.

    “and the comorbid BPD/cPTSD class was more likely to report histories of emotional abuse and physical neglect than the cPTSD classes.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [83]

    The Clinical findings—Interpersonal trauma history section reports greater emotional abuse and neglect in comorbid BPD/PTSD groups than in PTSD-only groups. It does not establish the claimed comparison between BPD/cPTSD and cPTSD classes, or specify that the neglect was physical. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The two cPTSD classes were more likely than the PTSD class to report histories of emotional, sexual, and physical abuse and emotional and physical neglect.

    “The two cPTSD classes were more likely than the PTSD class to report histories of emotional, sexual, and physical abuse and emotional and physical neglect”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [83]

    The Clinical findings—Interpersonal trauma history section reports greater exposure to emotional and sexual abuse and neglect in comorbid PTSD/BPD groups than in PTSD-only groups, with mixed findings for physical abuse. It does not report a comparison of two cPTSD classes with a PTSD class or distinguish emotional from physical neglect. Page numbers are unavailable in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • 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 [83]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Compared with other psychiatric groups, borderline personality disorder patients have a 3.15 times higher chance of experiencing childhood adverse events.

    “Compared with other psychiatric groups, BPD patients have a 3.15 times higher chance of experiencing childhood adverse events (13)”

    From Timing of imagery rescripting during schema therapy for borderline personality disorder: the LUCY trial (2023) · cites this paper as [13]

    The Introduction (page unavailable) says people with BPD report greater levels of childhood sexual abuse than other clinical groups. It does not give a 3.15-fold estimate or establish that comparison for childhood adverse events generally; a search for “3.15” found no matching result. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Cumulative exposure to interpersonal violence over the lifespan was found to be associated with comorbid BPD/PTSD rather than either BPD or PTSD alone.

    “Further, cumulative exposure to interpersonal violence over the lifespan was found to be associated with comorbid BPD/PTSD rather than either BPD or PTSD alone [83, 84].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [83]

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Authors
Jowett, S., Karatzias, T., & Albert, I.
Affiliations
  • King's College London (GB)
  • NHS Lothian (GB)
  • Centre for Anxiety Disorders and Trauma London UK
Corresponding author
Jowett, Sally
ORCID
Venue
Psychology and Psychotherapy: Theory, Research and Practice
Publisher
Wiley
Published
2019-08-24
Volume
93
Issue
3
Pages
621-638
ISSN
  • 1476-0835 (ISSN-L)
  • 2044-8341
DOI
10.1111/papt.12248
OpenAlex
W2969251693
Cited by
55
References
67
Citations by year
2026: 2 · 2025: 15 · 2024: 11 · 2023: 8 · 2022: 6 · 2021: 12 · 2020: 1
FWCI
0.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychology and Psychotherapy Theory Research and Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
  • Research Output (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
post-traumatic stress disorder, borderline personality disorder, comorbidities, polytrauma, interpersonal trauma, trauma exposure, emotional dysregulation, self-harm, clinical features, risk factors
MeSH terms
Adult, Borderline Personality Disorder, Emotions, Humans, Risk Factors, Stress Disorders, Post-Traumatic, Comorbidity, Self-Injurious Behavior

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