Ask the Therapist
Dysthymia and Ptsd
I am a middle-aged woman diagnosed within the last five years with dysthymia and post traumatic stress disorder resultant from severe childhood sexual, physical and emotional abuse. A major depressive episode that lasted (during therapy) for something on the order of 9 months, combined with symptoms of PTSD, initially brought me to seek therapy. At the time, I'd left a 6-year relationship with someone who was likely borderline ( she would not seek therapy), and in the therapeutic process, it has been, to say the least, interesting to realize that my stepmother was likely borderline, if not much more, as well. (Also not diagnosed for the same reason).
I'm writing because I am sometimes frightened by the similarities of symptoms within my diagnoses with the those of the borderline disorder: i.e., black and white thinking, low self esteem that translates into feelings of unworthiness, hopelessness and powerlessness, sadness that is often a cover-up for anger (and the other way around), greater than/less than polarities concerning my view of self, etc.
I learned about the borderline disorder when I accidentally found it on a website while seeking information on depression and suicidal ideation for myself (as a young woman, suicide attempts numbered 4 or 5 within a span of a few years--also promiscuity, likely related to a complete lack of boundaries, was common at this time) because at 41, this was the first time in my adult life that I felt suicidal on a day-to-day basis over what was an excruciatingly long period of time. The BPD symptoms spoke clearly to me of my ex's behavior (particularly the rage and dysphoria) during the six years we lived together, which at the time was a relief, until I realized I played a part in that relationship too.
At that point, I guess you could say, therapy really began, diagnoses were made, I engaged in talk and cognitive therapy, began to take St. John's Wort and eventually began a practice of
mindfulness meditation that has done wonders to reveal who I really am, or think I really am, in terms of thought processes and emotional life. I'm going on here, (sorry) but the question is about how closely these disorders may relate, meaning the the dysthymic/ptsd combination and that of the BPD.
At one time, I was afraid that I had the BPD and that my therapist was just not telling me so because of the stigma attached to it, and because of my reaction to it in terms of my stepmother and my ex. Sometimes I remember the behaviors of those who did suffer with this and can relate them to actions and behaviors of my own, with the exception of the rage and dysphoric
episodes, and become frightened again, and I think it's because I know that so much harm is caused by this disorder. But then again, I guess harm can be caused by any disorder of which the owner is not aware.
I wonder what you can tell me about dysthmia/ptsd and the overlap that appears to exist between these and BPD. I think I'm secretly wondering if it is possible for someone to have BPD in
earlier years that can eventually shift into something like what I now have? Dysthymia is hard to find good information on, but perhaps you may know something about it that can help me understand this. Is it just possible that a variety of symptoms are present in many or even all disorders to varying degrees, and that those of us with these conditions have a lot more in common than may be realized? At any rate, I am happy to have found great relief in the therapies mentioned above--although I still struggle with issues, nothing any longer
approaches the magnitude of a life/death situation.
It is very common for suffers of PTSD with the antecedents you describe to manifest symptoms very similar to BPD; sometimes to the point of looking like a full-blown disorder. The central issue in this is safety. PTSDs never feel safe, BPDs are in constant fear of abandonment. The psychic mechanisms for responding to both of those states of mind are very similar and, as a result, the behaviors they elicit are often similar, as well. Humans are as simple as they complex.
Am I saying that you do or do not suffer from a coincident instance of both disorders? No, because I can't make that kind of a determination in this forum. What I am saying is that BPD is a psycho-social disorder, not organic...you don't have it, it develops through experience. Could you have developed BPD features before being diagnosed with PTSD - yes. Did the BPD come out of nowhere and then change into the dysthymia/PTSD...nope. Trauma/experience first, PTSD 2nd, BPD consequent. And the dysthymia is a feature of both, not a separate state of mind. It's driven by the level of self-esteem, feelings of worthlessness and sense of isolation underlying all of how you are feeling.
