Complex PTSD = PTSD + BPD ?
Differentiating symptom profiles of ICD-11 PTSD, complex PTSD, and borderline personality disorder: A latent class analysis in a multiply traumatized sample.
출처: Personal Disord. 2019 Jul 1. doi: 10.1037/per0000346.
Complex posttraumatic stress disorder (CPTSD) has been included as a diagnostic category in the International Classification of Diseases, 11th Edition, consisting of six symptom clusters: the three PTSD criteria of reexperiencing, avoidance, and hypervigilance, in addition to three disturbances of self-organization (DSO) symptoms defined as emotional dysregulation, interpersonal difficulties, and negative self-concept. As borderline personality disorder (BPD) shares similar features to DSO presentations and is commonly associated with PTSD, there is debate as to whether and how CPTSD is distinct from PTSD comorbid with BPD.
복합 PTSD와 PTSD, BPD는 임상적 특징을 서로 간에 공유합니다.
The latent class analysis determined three distinct classes: a CPTSD/High BPD class characterized by high symptom endorsement across both conditions, a CPTSD/Moderate BPD class characterized by high PTSD and DSO symptom endorsement and moderate BPD, and a PTSD/Low BPD class characterized by PTSD symptoms and low DSO and BPD symptom endorsement. The two CPTSD classes were associated with greater exposure to multiple, interpersonal traumas earlier in life and exhibited higher functional impairment.
위에 인용한 이 논문의 결과에서 보시다시피 PTSD에 해당되지만 BPD 증상이 뚜렷하지 않은(즉, low DSO) 집단이 있기 때문에 PTSD와 복합 PTSD는 구분되는 진단적 실체임을 알 수 있습니다.
그럼 복합 PTSD가 PTSD와 BPD의 단순 합일까요? 그렇지 않습니다. BPD의 임상 특징 중에는 DSO처럼 복합 PTSD와의 공유 지점이 있지만 공유하지 않는 부분도 많습니다.
Although there is a large degree of overlap between the risk factors and presentations of CPTSD and BPD, there is a growing field of research demonstrating their differences. The two constructs share difficulties in emotion regulation, yet this presents markedly differently for both. For CPTSD, emotion dysregulation is commonly in the form of reactive anger and substance misuse, whereas for BPD this is expressed as self-injurious behaviors and suicidality (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014). Both disorders express disturbances in sense of self; within BPD this is noted as being highly unstable and alternating between polarized positive and negative self-perception; however, in CPTSD the sense of self is defined as a stable, deeply negative self-perception. Difficulties with relationships are characterized as volatile and oscillating between intensely idealized and disparaging in BPD, yet in CPTSD relationship difficulties stem from mistrust, are associated with being hurt, and are kept at a distance more consistently (Brewin et al., 2017).
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