AUTISM (ASD) VS BORDERLINE (BPD) VS COMPLEX-PTSD (CPTSD)?

so I get a lot of questions about the differences between borderline personality complex trauma and autism spectrum disorders and because we can see a lot of overlap between all three I think it can get really confusing and oftentimes for example on Tick Tock I'll see in the comments people saying oh BPD is the same as cptsd which is actually not the case though there is a lot of overlap and I just think it's really confusing and so my goal for you at the end of this video is to say okay you know I generally understand the core and inherent differences and similarities and that way if you need to seek help or treatment you have at least a good understanding of kind of what you may be experiencing and potentially you know where where where it came from how long this has been going on or not so let's just divide them up quickly and do a backdrop of each disorder or criteria now the DSM-5 technically cptsd is not in the DSM-5 and the DSM-5 has all kinds of issues generally historically but this is what we have for the most part and so I'm going to use the criteria as we see it and basically as it might be experienced for somebody who's struggling and I'll link some more good resources down below of the video okay so borderline at its core is a personality disorder it is just who we are and yes the onset can be trauma related but the last research I saw said that up to 20 of those with borderline do not have a trauma history now the issue with all of these things it's really like the chicken or the egg how do we really know what is trauma for me might not be trauma for you and I will say that the majority of the research I have seen on borderline tends to be in highly clinical populations and what does that mean for the layperson that means often people who are actually in programs they are inpatient outpatient programs so their experience of borderline for example was so severe that they were at risk there you know it was really disruptive to their lives and like everything all of these disorders all of these things we talk about in mental health are on a spectrum and when we look at the criteria for borderline for example there are a lot of possible combinations there are nine symptom criteria and you must meet five for the diagnosis and I'll share an old graphic I have here too there just is this wide spectrum for people who had a let's say a parent historically also remember I say parent because I talk a lot about parents with borderline on this channel but borderline has become even in the last couple years in my experience it was always this it was this disorder that everybody you know would recognize but no one wanted to work with their treat and it was this shameful thing to have and I see so many people identifying with this this diagnosis on Tick Tock for example which I think is really really great that we're talking more and more about it where I think it gets difficult for people who are sort of younger and don't really have the history with this disorder in terms of the uh the working with it is that now it feels empowering to say I have this disorder it's difficult not empowering in a good way but I think it can be good to know like this is what I have and you don't want to or need to feel ashamed about it but I think when I talk about like for example my generation of mothers or fathers with borderline that never knew they had borderline that would still to this day so they don't have it that they were basically these often really intense angry loving wide swinging kind of eggshell parents at the heart and the degree is significant on the Spectrum right from just a raging yelling parent to let's say often we see men in prison in the prison system who've been acting out let's say borderline so basically we have this like intense lack of predictability emotional and relational at the core that is the issue emotional and relational instability followed by things like mood instability chronic emptiness impulsivity we all can often see inappropriate anger and rage dissociation really a shifting identity and sort of who they are that can be often changing we can see risk-taking and at the core of borderline is this fear of Abandonment so everything is kind of through the lens of don't leave me and so often how they make sense of things how they respond to you and themselves can be driven by this just don't the sphere of Abandonment don't leave me and so there can absolutely be an obviously a much larger percentage we think that is created by a traumatic environment for example you having a borderline parent could absolutely contribute to you having borderline although many of us have those parents and don't it is definitely possible any kind of chaotic traumatic unstable insecure attachment childhood has the potential to create that and the research so far says that we don't necessarily know what causes borderline specifically we do know that certain risk factors like trauma are huge but also we know we can see brain differences and those with borderline and sort of did that come first or afterwards and then the research shows that there's a pretty strong genetic link so that the closer the person is to you that has borderline the more likely you may have borderline with that like I'm saying doesn't mean that you will or maybe you just have some traits and for example a very strong trait in borderline is splitting because basically for people who have borderline and also for narcissists they have a hard time holding those negative yucky feelings inside and so they split them off and they often go into good bad right wrong then they basically put them on you right so you are the good child the bad child they don't want to deal with those yucky feelings inside those negative feelings so there's a lot of negative self you you know there can be self-harm and there can be a really high self-wounding rate with this disorder in this population but you can have this disorder in borderline and never ever ever come close to doing any kind of self-harm so that's what I'm saying is there's a wide spectrum now we look at complex PTSD which comes out of PTSD post-traumatic stress disorder we're talking about a trauma-based disorder the difference in PTSD and cptsd is that generally we think of PTSD as a single traumatic event now that single event could be witnessing a robbery being in a massive car accident it could be going to war and obviously war is not just one day in war but it's a single the war experience is that type and that creates symptoms like you know avoidance symptoms intrusion symptoms dissociation a lot of these responsive parts that are unprocessed get played out in PTSD the idea behind cptsd complex post-traumatic stress disorder it's complex in that it really is often relational trauma and I always say often at the hands or in the experiences with people that should have been safe but it can be from everything from like I'm talking about eggshell parents for example borderline parents narcissistic parents to being in a war to being a victim of the victimized abuse to adults you know experiences like a you know a very unsafe marriage to high conflict divorce to extreme financial difficulties and Trauma to bullying so we're talking about repeated exposure at the heart but when I talk about complex trauma I'm generally talking about the childhood version but please know that it doesn't mean that just happens in childhood so we're talking about oftentimes symptoms like a loss of belief like in the world so you know if there is a God why did this happen to me a loss of you know just connection to self and and belief avoidance symptoms avoiding certain situations people definitely an increased arousal or basically living in hyper and I think this is really the core of so much complex trauma is that no matter what happened you're often in that fight or flight yes you might also have you know trauma responses like fawning which is like people pleasing and you know trying to get uh to be a kind of in service to someone to get your needs met we can see freezing which is basically like depression collapsing you know fight or flight which is really like definitely fighting or fleeing but we often see that the five or flight are kind of that increased sense of arousal right so I just let's say if the parent was eggshell you know you just never know what to expect as I've given examples you hear the tires on the gravel in the driveway and you know you go to your room because that parent comes home in a rage or they are just they might be fine but they might rage at you or it could be related to walking down the street at night and because of your experience that something bad happened to you you know you're just like in this almost panicked state of fight or flight at all times no matter where you are things like that so as I said before negative self you will oftentimes in a complex trauma thing think about that if a parent doesn't see you as valuable then it's got to be something wrong with you right a child isn't able to say oh well my parent has this disorder and they have this mental health issue and they're struggling with work they internalize especially when we're young that it's our fault and even though we can grow up and say in our minds like I get it my parent was traumatized they were they were struggling I think that's difficult to fully believe because it's already been absorbed kind of by osmosis inside that it's your fault and that's why we have often really low self-esteem and we're often you know that high inner critic and outer critic and all of that stuff I have a lot of videos on on complex trauma here on and also on borderline so please go check those out if you want to learn more and then often emotional dysregulation so a lot of like trying to manage that chaos inside whether it's the hyper vigilance the the you know the fear the depression or just relational stuff because people aren't safe and so let's say if a parent was the source of your trauma then that means that everybody can be unsafe and not trustworthy and that's going to play out like in your attachment Dynamics and your nervous system right and then relational difficulties at the core like I just said earlier really often due to lack of trust because if mommy and daddy or caregiver parents weren't safe how can anyone be safe so you're kind of classic attachment wounds now let's talk about the sort of connection between borderline and complex trauma before we go into the autism Dynamics so we often have obviously borderline can have significant trauma or trauma or complex trauma so you can have borderline that came from your complex trauma right so trauma and connection here um both have negative self view both have mood change issues both can be inclined to dissociate both can have really what I call toxic hypervigilance so in borderline you're scanning for them to leave you the threat is I'm going to be abandoned I need to make sure at all times I'm paying attention to that even though they actually might do things that push you toward abandoning them not understanding that they're doing that and then in the toxic hyper vigilance and in complex trauma that really is that same fight or flight for many reasons but it's not just about are you going to leave me it's actually not so much about abandonment it's about a sense of safety in the world and safety itself and then managing how to respond to lack of trust and sort of chaos inside but for the borderline I would say that would be more about abandonment mood disorders of course with borderline we can see lots really the Heart Like I said is mood and relational instability so I'm sorry emotional and relational instability also including mood instability so you put all that together if you have a difficult time keeping healthy relationships and you're it's constantly chaotic and your mood is fluctuating and your emotions are fluctuating that creates more and more trauma which then reinforces the narrative that you know no one is safe or I will get abandoned so all of that of course is going to mix together same thing with with a cptsd right you're trying to manage all that that those trauma responses inside can really look like also mood disorders and you may also have mood disorders like depression anxiety OCD things like that self-destructive behavior in in a more borderline presentation it's going to be really about dealing with that negative sense of self and fear of Abandonment and for a more complex trauma situation it's about just managing the triggers the actual trying to reduce that chaos inside from a trauma so they can be self-harming for different reasons but similar but different and then of course both can have a very strong inner and outer critic there are even more but these are the basic ones right for different reasons so think about the borderline always being the glasses are you're going to abandon me and that is how I interpret everything that I do or say or think or feel and then for cptsd it's about you know the world isn't safe people aren't trustworthy um I I need to always be on guard in that hyper Vigilant state or prepare myself to be avoiding a dangerous situation so it's really about a core sense of safety that was really not allowed to occur and so we're trying to manage that now let's talk about autism and so you look at the core features of autism we're talking about a neuro developmental Disorder so borderline once again is a personality disorder complex trauma would be a more trauma related or stressor related Disorder so there's a trauma for sure and then while we can have borderline and Trauma and complex trauma as a person who has ASD it is not the defining feature so it is it is developmentally and neurologically part of who you are so we're going to see deficits in social communication and deficits in social emotional reciprocity so basically interpreting and reading social situations responding internally and externally to other people and understanding like what what do I do now and what does this feel like and like there's a deficit there and so that in and of itself can be very stressful and difficult um an inflexible adherence to routines and an insistence on sameness and then repetitive use of objects it's just like the main core features of ASD and autism and remember that there's a wide spectrum also from a more mild to more severe presentations of autism when you look at the graphic here what I wanted to show you is that within ASD if you look at the cptsd Circle the part where it overlaps I wanted to show you where it overlaps within those two disorders so the overlap between Autism and complex trauma and don't forget those who have autism are much more likely to experience trauma in all kinds of forms from event single event trauma right as a result of their own difficulties to complex trauma let's say you have autism and your parent has also has autism and or doesn't understand that and so they repeatedly tried to punish you to control your behaviors what's wrong with you why can't you get this you know in ways that aren't helpful to understanding and treating autism so that in and of itself could be very traumatic and just as a result of the Dynamics of autism there's a much higher increase of exposure and risk of trauma just in general so now what is the overlap we can see a lack of interest in peers in terms of complex trauma and ASD a failure to share emotions and affect repetitive play outbursts and sleep issues generally speaking so but for different reasons right so with autism we're engaging in these behaviors to manage a different set of neurological Dynamics and for complex trauma we're trying to manage the the trauma inside so that can all also blend together you can be doing all of that together and then we look at borderline and autism we can see there's really a lot of overlap here too so we have an increased substance use abuse risk Eating Disorders which are also very common in borderline non-uh wounding self-injury I'm using that language because of YouTube um shame mood issues self-esteem issues relationship challenges a diffuse sense of self difficulty regulating emotions impulse control rejection sensitivity emptiness and paranoia so that's a lot that's a lot of overlap between ASD and BPD which I think we can often see misdiagnoses especially when they're going to give someone a diagnosis a borderline more likely when it may actually be autism so let's go in now and look a little more significantly or specifically I should say into what kind of things we see with the overlap okay when we talk about the difference between Autism and borderline we're talking once again about a neurodevelopmental disorder characterized by social and communication difficulties alongside unusually strong narrow interests or unusually repetitive or restrictive behaviors social problems can occur in ASD due to difficulties with integrating communication Styles making eye contact understanding social cues in contrast BPD is marked by emotional intensity and dysregulation and difficulties in interpersonal functioning empathy trust and intimacy people with BPD also tend to have the personality traits of disinhibition antagonism and impulsivity so the emotions of those with borderline are much more intense and long-lived and is making it makes it more difficult for them to have emotional stability because of this constant fluctuation and the depth and breadth of the changing emotional dysregulation Dynamics inside and then it says when there's a difference here between the two there's some research that shows that when diagnostic confusion between ASD and BPD occurs it is likely related to the fact that both people with ASD and BPD may show lower levels of cognitive empathy the ability to respond and understand to other people's emotions and poor interpersonal skills in BPD however low cognitive empathy is often due to a lack of emotional regulation and so that's different right so the the cognitive empathy is about the difficulty regulating emotions and both ASD and BPD may also involve executive dysfunction that's the part of the brain here like the conductor right that is like making decisions and taking all the information together and then and sort of processing things so there can be deficits there so I'll post some more cards here but I think it's important to understand that at the core there's they both can have the social and occupational difficulty in functioning and some research shows that borderline tends to lessen over time and then we can see there's a study here that's listed it really basically just talks about the differences and the traits and what we're more prominent in borderline and autism and so I'm not going to go into further depth here but if you have any concerns you may have an overlap and or you're not sure if it's borderline or Autism I would definitely seek out an Autism specialist first if you say along with your own research there's a lot of great self-diagnosing going on at least at least initially understanding and being really clear on what's happening to you and that is really important I think I've seen some more studies talking about the importance of honoring self self-awareness diagnosis around autism so definitely but seek out someone like for me I am not someone who specializes in autism I've had been growing to learn more and more and more as we're understanding the impact but I definitely would see someone if I really wanted a formal diagnosis who does specific testing for autism but it also has a great understanding which of course they should these are psychologists typically more than anybody else would be a psychologist so at the heart I hope this gives you a basic understanding of the differences between these two there are a lot of great videos here on YouTube that go in a much further depth but what I want to really acknowledge is how how much you can see where it gets confusing even for clinicians trying to understand where these things come from and it's not like each little thing that you diagnose gives you a specific treatment plan though they can definitely vary so if I'm treating someone who I think definitely has more borderline dynamics of course which I tend to work with the the adult children of these people as opposed to them specifically but we're going to look at things like DBT dialectical behavior therapy helping them manage that emotional unrelational dysregulation and learning the tools and skills to engage with their with themselves and other people if we're looking at something like autism we're going to be focusing on how to help them with those social communication deficits obviously it depends on the severity but we're going to be helping them sort of learn to develop skills and understanding and how to engage in the world in that way it's not just about the fear of Abandonment for example it's not at all really it's a different whole different Dynamic although we can be afraid of being abandoned and not with having autism of course because we might have a lot of social rejection and that feels really bad so that's where it gets gray and then lastly of course if we're talking about complex trauma like separately we're talking about especially helping someone build up those you know internal wounds with relationships and that creating safety for themselves in the world and how to sort of navigate the internal trauma responses which can be happening also in BPD and autism but we're going to be sort of working you know it's like similar but different all these different Pathways and as as I said in the beginning these can all also overlap which really complicates the clinical picture for for us as well uh for us as clinicians so it's really meant to hopefully this video just Empower you and educate you and inform you and also validate that you're not you know wrong for thinking you could have these different Dynamics you absolutely could so thank you for being here please stay safe and well and I'll see you next week take care bye [Music] [Music]

Channel: Dr. Kim Sage, Licensed Psychologist

Views: 41,866

Keywords: bpd, bpd vs cptsd, autism, complex ptsd, c ptsd symptoms, cptsd vs bpd, autism vs borderline, autism vs borderline personality disorder, borderline vs cptsd, autism vs cptsd, ptsd, ptsd vs borderline personality disorder, trauma and borderline personality disorder, symptoms borderline personality disorder, autism spectrum disorder, dr kim sage, dr kim sage borderline, trauma, post traumatic stress disorder, diagnosing borderline personality disorder

Id: 1epFCooDOQU

Length: 22min 50sec (1370 seconds)

Published: Sat Jan 28 2023