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Abstract

Background
Despite overlapping diagnostic criteria and aetiology, the frequency of complex post-traumatic stress disorder (C-PTSD) in people being treated for borderline personality disorder (BPD) is unknown.

Aims
To establish the frequency and correlates of probable C-PTSD in people meeting the diagnostic criteria and being treated for BPD.

Method
C-PTSD was assessed in 87 patients meeting the diagnostic criteria for BPD and initiating treatment in out-patient personality disorder services in the UK, using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders diagnostic interview, items from the Structured Interview for Disorders of Extreme Stress – Self Report and other measures. The cross-sectional association between C-PTSD and demographics, trauma and clinical variables was evaluated with logistic, ordinal and linear regression.

Results
A total of 93% of participants reported a trauma history (95% CI 88–98%), and 57% met the criteria for probable C-PTSD (95% CI 47–67%). Previous sexual trauma increased the odds of probable C-PTSD (odds ratio 6.22, 95% CI 2.21–17.54, P < 0.001). Probable C-PTSD was associated with an increased odds of self-harm in the past 12 months (odds ratio 9.41, 95% CI 1.87–47.27, P = 0.01) and higher levels of abandonment fears (odds ratio 2.78, 95% CI 1.17–6.55, P = 0.02), abandonment–avoidant behaviour (odds ratio 4.25, 95% CI 1.30–13.91, P = 0.02) and identity instability (odds ratio 4.39, 95% CI 1.79–10.78, P < 0.01).

Conclusions
C-PTSD symptoms are likely to be common in people diagnosed with BPD, and are associated with higher overall psychiatric severity, with potential implications for formulation and treatment.

Publication Type:	Article
Additional Information:	© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Publisher Keywords:	Personality disorders, diagnosis and classification, general adult psychiatry, mental health services, trauma and stressor-related disorders
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Population Health & Policy
SWORD Depositor:	Symplectic Administrator

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