4 - (SYM 21) Characterising the Relationship and Treatment Needs of CPTSD and BPD: Implications for Cognitive Behavioural Treatment Approaches of Those Who Meet Both Diagnoses

Ongoing discussions relating to the relationship between Borderline Personality Disorder and trauma nosology have been reignited following the introduction of Complex PTSD (CPTSD) into ICD-11.  Such debates are grounded by common aetiology, shared clinical features and more recently, increasing concerns relating to the robustness of, and stigma associated with, the BPD diagnosis. Specifically, it has been questioned whether CPTSD offers novelty to diagnostic nomenclature, whether it can be distinguished from BPD and whether it can be used as an alternative to BPD. The current paper presents a review of evidence including a systematic review and meta-analysis of 11 published studies exploring the comorbidity of BPD and CPTSD.  The pooled prevalence of comorbid CPTSD and BPD was 12%, with the highest prevalence, 55%, being drawn from an inpatient personality disorder service.  Results suggest that CPTSD is distinct from, and comorbid with BPD. Findings do not support the use of CPTSD as an alternate diagnosis to BPD,  as between 45-99% of people diagnosed with BPD would not meet criterion for CPTSD. A shift from BPD to CPTSD frameworks could potentially lead to the loss of access to psychiatric services and treatment for the majority of people diagnosed with BPD and  usher a new level of ‘diagnosis by exclusion’. Insights relating to the development of CBT treatment models for dual diagnosis are presented.  Given the predominance of CBT models in the treatment of trauma and personality disorder needs, developing evidenced based  treatment programmes that can address comorbid CPTSD and BPD are clinical priorities for a population experiencing significant symptoms burdens and poorer quality of life and mental health outcomes.