Therapeutic Communities

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Complex Trauma Borderline Personality Disorder
and EMDR? Mark McFetridge The Retreat York
April 30th 2008
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Youll get labelled as a problem penguin if you do
If they dont throw me a fish soon Im gonna just
act normal
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Borderline Personality Disorder

• How do you treat BPD?
• You refer them! (from Herman 1994)
• Borderline - the word that strikes terror into
  the heart of the middle-aged comfort-seeking
  psychiatrist (Yalom 1989)

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CSA and subsequent mental health (USA National
Comorbidity Survey)

• Significant associations found between CSA and
  subsequent onset of mood, anxiety, and substance
  use disorders
• In a subsample of respondents reporting no other
  adversities, odds of depression and substance
  problems associated with CSA were higher.
• Among women, rape (vs molestation), knowing the
  perpetrator (vs strangers), and chronicity of CSA
  (vs isolated incidents) were associated with
  higher odds of some disorders

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Briere (2005)

• Traumatic events intentionally caused by others
  more likely to produce PTSD
• Trauma is necessary but not sufficient to cause
  dissociation
• Trauma moderated by
• level of posttraumatic symptoms
• affect regulation capacities
• Self-Trauma model exposure within the
  therapeutic relationship

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Complex PTSD and Borderline Personality Disorder

• The most significant discrepancy between
  Borderline Personality Disorder and chronic PTSD
  is the absence in the criteria for BPD of a
  recognisable stressor in the patients history
• (Herman, Perry van der Kolk 1989)

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Repeated Trauma over time (Complex Trauma)

• Major disturbances in-
• Affect regulation
• Impulse control
• Reality testing
• Interpersonal relationships
• Self-integration

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Affect regulation and Complex PTSD

• Poor affect tolerance
• Heightened aggression
• Heightened reactivity to mild stimuli
• Irritability
• Chronic dysphoric mood, emptiness and inner
  deadness
• Recurrent depression

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Impulse Control and Complex PTSD

• Risk-taking behaviour
• Self-mutilation
• (Re-enactments of trauma?)
• Drug alcohol abuse
• (Defence against the distress of recurrent
  intrusive memories of trauma?)

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Reality testing and Complex PTSD

• Episodic disturbances of-
• Dissociative episodes (re-experiencing
  peritraumatic depersonalisation, partial BASKing,
  denigrating voices etc.)
• Paranoid ideas of reference (re-experiencing
  waiting for rejection or violence)

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Interpersonal relationships and Complex PTSD

• Repeated victimisation in adults with CSA
• Alternating periods of -
• intense searching for closeness with an idealised
  other
• angry/despairing withdrawal furious denigration
  of others

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Self-integration and Complex PTSD

• Identity diffusion (self-states/ modes)
• Splitting of good and bad self
• Relentless sense of inner badness

13
Diagnosing BPD

• Having that diagnosis resulted in me getting
  treated exactly the way I was at home. The minute
  I got that diagnosis people stopped treating me
  as though what I was doing had a reason. Good
  therapists were those who really validated my
  experience

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Alternatively?

• When survivors recognise the origins of their
  psychological difficulties in an abusive
  childhood environment, they no longer need
  attribute them to to an inherent defect of the
  self. The way is then open for for a new meaning
  to experience and a new, unstigmatised identity
  (Herman 1994)

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Three stages of therapy for Complex
Post-Traumatic Stress (Herman 1994)

• Safety
• Remembering and mourning
• Reconnection

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The three phases of EMDR for CSA (Parnell 1999)

• Beginning Assessment, preparation and ego
  strengthening
• Middle Processing and Integration
• End Creativity, Spirituality and Integration

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Still prefer a nice piece of Mackerel
That wasnt so bad was it?