Ask the Therapist

PTSD or BPD?

I am a 27 year old female. Married with two children. I was a first grade
teacher, and decided to become a stay at home mom after the birth of my first
child. After the birth of my second child, I became very depressed. I cried all
the time for no apparent reason. I sought help from a psychiatrist. She
diagnosed me with PTSD. My dad abandoned us when I was 13, and I was raped at
the age
of 15. I became pregnant with the rape, and had an abortion which I will
never forgive myself for. When she told me I had PTSD, I looked at the symptoms,
and really felt that I could relate. It made me feel better, like there was
hope. As time went on during therapy, the nightmares became very intense like
everything was coming out and I could not handle it. I wanted to kill myself by
overdosing. My psychiatrist put me in the psych ward. I was up there a little
while. When I was released, the Dr. up there diagnosed me with BPD. I went home
and read the symptoms of it, and I did not feel like I had barely any of the
symptoms. I asked my Psychiatrist about it, and she said she did not agree
with the diagnosis at all. I am so scared that I could have BPD, and I don t
know
what Dr. is correct. My symptoms are nightmares, depression, very insecure I
am a people pleaser, insomnia, weight loss (20 lbs.), short temper agitated
very easily, and scared of being abandoned. Could you tell me what you think I
might have.

Also, my psychiatrist was a resident (4th year), and she has now left. I am
so depressed about this. I don t want to go to the Dr. she assigned me to, I
want to go to her which I know is not possible. I just want to stop therapy, but
I am afraid of how I might feel down the road. Is this normal to become so
attached to your therapist? I feel like I lost a best friend.

Although you must realize that I can't offer you a diagnosis in this forum, I
can offer an opinion. I would agree with the diagnosis of your first doctor,
PTSD. I would also agree with the evaluation of the second doctor, BPD, and
admonish your first doctor for not doing her homework. Finally, despite what
seems like a reliving of your nightmare, you are making progress. Now, to
explain.

The trauma of abandonment, rape, and abortion in the mid-teens would most
certainly constellate PTSD. At it's most simplistic, PTSD is an inability to
cope
with the residual stress of some experience, both physiologically and
psychologically. Since there's no place for this inner turmoil to go, it comes
out in
different ways. For whatever reason, for you, the post-partum depression of
your second child triggered the latent memory of this trauma.

What you experienced in terms of the nightmares (which are called intrusions,
by the way), waking flashbacks (again, intrusions), anger, depression,
suicidal behavior, etc. is what I like to call the "tale of the telling".
Individuals who finally find themselves in a place where they can face their
original
trauma must completely re-live it and, as a consequence, are re-traumatized. The
feelings, emotions and behaviors that you experienced as an adult are all of
what you would have experienced as a child, if your psyche had been able to
handle it. Since it wasn't, it got shoved into a back closet and then emerged
later.

Here's the no homework part...people who suffer from PTSD often and usually
do manifest borderline or borderline-like symptoms. It is rare for them to
develop a full-blown Borderline Personality Disorder (although it does happen),
but, rather, to get into a borderline state -- usually right when the resolution
of the original trauma is reaching its peak. So, the doc in the ER ward
probably didn't know about the PTSD diagnosis or was not familiar with the
dynamic
from the borderline-ish side and your therapist was probably not familiar with
the borderline stuff from the PTSD side.

Last thing, do not stop therapy. What you are experiencing is characteristic
of the disorder complex...you feel abandoned. Force yourself to go to this new
therapist and use it as an opportunity to recognize that everything is
impermanent, things change and it's OK for things to change...that's what's at
the
crux of the borderline features that are informing the PTSD.

Michael J. Formica is a three time National Board Certified, Licensed Cl
inical Psychotherapist holding degrees in Psychology, Theology and Philosophy,
as
well as advanced degrees in Psychology, Psychotherapy and Counseling, and
Organizational Behavior from Columbia University. He is a Diplomate in both
Forensic Psychology and Sports Psychology, and was recently acknowledged as a
Diplomate Candidate in Clinical Psychotherapy by the American Psychotherapy
Association.


Insanity: doing the same thing over and over again and expecting
different results.

~ Albert Einstein


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