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Title: The under-recognition of trauma in the diagnosis of Borderline Personality Disorder (BPD)
Author: Tallon, Doris
ISNI:       0000 0004 7430 8358
Awarding Body: Oxford Brookes University
Current Institution: Oxford Brookes University
Date of Award: 2015
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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.
Supervisor: Wellman, Nigel ; Coombes, Lindsey ; Oskrochi, Reza Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral