Post-Traumatic Amnesia and the Co-occurrence of BPD

According to Headway, “Post-Traumatic Amnesia, or PTA, is the time after a period of unconsciousness when the injured person is conscious and awake but is behaving or talking in a bizarre or uncharacteristic manner.” Headway goes on to describe the common symptoms of Post-Traumatic Amnesia, which can include the following:

• Confusion or agitation, distress and anxiety
• Uncharacteristic behaviors, such as violence, aggression, swearing, shouting, and disinhibition
• Inability to recognize familiar people
• Tendencies to wander
• Potential for individuals to be quiet, docile, loving or friendly

What has not been discussed often enough is the strong correlation between PTA and Borderline Personality Disorder (BPD). The two diagnoses are confidently linked due to the prevalence of childhood trauma that can be heavy underlying factors of both PTA and BPD. According to the National Institute of Mental Health, Borderline Personality Disorder can be characterized as “a mental illness that severely impacts a person’s ability to regulate their emotions, this loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others.”

When we glance at the details associated with both PTA and BPD, including overlap of symptoms, we look at three main categories, including dissociation, complex PTSD and BPD consistencies in presentation, as well as history of trauma. According to Crownview Psychiatric Institute, shared symptoms of dissociation between PTA and BPD can involve dissociation such as amnesia, derealization and depersonalization, as the result of a response to both emotional and stress related triggers. Complex Post-Traumatic Stress Disorder, or more commonly referred to as CPTSD, is believed to be heavily correlated with the diagnosis of BPD, as there are also overlaps in symptoms, as well as potentials for co-occurrence.

When discussing CPTSD and the overlap with BPD, BioMed Central states that the correlation stems from the observation of repeated, prolonged trauma, often present during childhood, which can ultimately lead to identity disturbance and associated symptoms, such as dissociation.

Lastly, the third, and if not most significant correlation between Post-Traumatic Amnesia and Borderline Personality Disorder, is that of the trauma history of the individual. The British Psychological Society notes that “a significant portion of individuals diagnosed with BPD report a history of childhood trauma, which can contribute to the development of dissociative symptoms including amnesia.” It is additionally noted that patients with co-occurring BPD and PTA showed symptomatology more severe symptomatology in relation to BPD and dissociation, including a wider range of BPD symptoms themselves, as compared to individuals meeting only one diagnosis of either BPD or PTA. Additionally, individuals with both PTA and BPD were studied as having increased symptoms of personal worthlessness, and felt their well-being was significantly diminished in comparison once again to individuals with either BPD or PTA that were stand-alone diagnoses versus co-occurring.

In order to properly diagnose a patient, it is imperative to address the individual symptoms and then move forward to the discussion of the patient’s presenting symptoms as a whole in regard to coming to an accurate conclusion in terms of diagnosis. With PTA and

BPD having such notable characteristics that overlap, it is quite common for symptoms to be falsely identified due to lapses in memory, manipulation, and other associated presenting factors that can occur in therapy from patient to clinician transference. Therefore, if a clinician identifies there are factors associated with either of the diagnoses, it is clinically imperative to evaluate if the patient’s presenting symptoms are within their scope of practice, before coming to any conclusions regarding diagnosis or diagnoses. For example, if a clinician possesses additional certifications on top of clinical licensure, such as acquiring their C-PD (Certified Personality Disorder Specialist), C-DBT (Certified Dialectical Behavioral Therapist), CCTP (Certified Clinical Trauma Professional), or CCTS (Certified Trauma Services Specialist), they may have additional knowledge better equipping them to properly diagnose a patient with the symptoms addressed in this article.

While there is much more research to be done regarding the overlap of Post-Traumatic Amnesia (PTA) and Borderline Personality Disorder (BPD), it is thankfully a topic that is being addressed more prevalently than prior, as we gain headway into diagnoses that have often been referred to in the past as “untreatable, easy to misdiagnose, difficult, etc.” As a clinician who has dedicated their work to ending the stigma associated with personality disorders, I find it absolutely imperative to continue debunking the myths associated with “difficult diagnoses.” They are not difficult, but rather fascinating in nature, as most individuals I have encountered in clinical practice have the most intricately designed minds, with the ability to educate others on the inner workings of “positively” complex brain structures that may not be otherwise studied or understood.

References

Krause-Utz, Annegret. “Dissociation, Trauma, and Borderline Personality Disorder - Borderline Personality Disorder and Emotion Dysregulation.” BioMed Central, BioMed Central, 19 Apr. 2022, bpded.biomedcentral.com/articles/10.1186/s40479-022-00184-y.

Kristalyn Salters-Pedneault, PhD. “Dissociation in Borderline Personality Disorder.” Verywell Mind, Verywell Mind, 5 Aug. 2024, www.verywellmind.com/dissociation-in-borderline-personality-disorder-425482.

MEDIAmaker. “Post-Traumatic Amnesia.” Headway, www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/post-traumatic-amnesia/. Accessed 2 Mar. 2025.

MEDIAmaker. “Post-Traumatic Amnesia.” Headway, www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/post-traumatic-amnesia/. Accessed 2 Mar. 2025.