BPD is a complex condition presenting with a wide array of features, making it difficult to diagnose and treat. Controversially, there is also concern about BPD misdiagnosis due to under-recognition of trauma and PTSD/CPTSD (Complex PTSD) because of common aetiology. PTSD/CPTSD has a better track record of successful treatment; as typically BPD treatment focuses more on symptoms, while PTSD/CPTSD treats underlying traumatic causes. Aim: The research objective is to assess if early screening for traumatic exposure and PTSD/CPTSD symptoms will enhance BPD diagnosis, and lead to improved treatment. Methodology: Following clinical and academic reviews, two stages were completed. Stage 1: Initially medical records of BPD (N=60) patients in three UK Mental Health Hospitals were examined for evidence of BPD, trauma, PTSD and CPTSD. Stage 2: Separate BPD outpatients (N=40) were screened for trauma, PTSD/CPTSD using a new simple ‘BPD Trauma Exposure and Reactions Screen’ (BTERS). Reliability and validity was then assessed using recommended reference instruments (CAPS and SIDES). Results: Trauma was recorded in 47% of the stage 1 medical records, 100% in stage 2, 92.5% trauma in childhood. Sixty percent of stage 2 patients suffered distressing non-life-threatening trauma consistent with Adjustment Disorder. High trauma percentages in BPD are explained by a combination of life-threatening trauma, requiring specialist PTSD/CPTSD treatment, and non-life-threatening, which is treatable using similar techniques by BPD clinicians without specialist training. Conclusions: Although insufficient evidence for BPD misdiagnosis was found, an under-diagnosis of comorbid PTSD/CPTSD was confirmed. Without initial screening (BTERS) of BPD patients, clinicians are missing PTSD/CPTSD diagnoses, and hence are losing the opportunity for early treatment for a significant percentage of BPD patients, which could be critical to improved recovery and reduced suicide rates.
Permanent link to this resource: https://doi.org/10.24384/jk4g-v037
Tallon, Doris
Supervisors: Wellman, Nigel; Coombes, Lindsey; Oskrochi, Reza
Faculty of Health and Life Sciences
Year: 2014
© Tallon, Doris Published by Oxford Brookes UniversityAll rights reserved. Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.