Borderline Personality: The Most Common Dissociative Disorder?

For decades, the diagnosis of borderline personality has been used to disparage abuse survivors as “difficult to treat,” often minimizing their experience of trauma, as noted in Herman’s classic Trauma and Recovery. In contrast, from 1989 to the present, studies have repeatedly shown the high co-occurrence of BPD and severe dissociative symptoms. Nevertheless, within the dissociative disorders field, BPD is often characterized as separate and apart from trauma-related dissociative disorders. Although the DSM-5 criteria show a high concordance between the symptoms of BPD and Post-traumatic Stress Disorder, they’re understood very differently. PTSD is conceptualized as the sequelae of a history of discrete incidents of trauma. BPD is often diagnosed based on the clinician’s experience of the patient - a disorder of the capacity for relationship – and has always been described as a disorder of alternating, dissociated, idealizing and devaluing self-states,

BPD can be better understood as a disorder of chronic relational trauma, usually beginning in childhood. The characteristic alternating states may develop from the alternating approach and avoidance strategies needed to manage attachment to a frightening or abusive caretaker, often resulting in disorganized attachment. The sudden shifts between helpless, submissive and clinging to dismissive, angry and distancing can be understood as defensive tactics aimed at avoiding abandonment or preventing abuse and betrayal.

This workshop will begin with a comparison of the diagnostic criteria for PTSD, BPD and DID, followed by a critique of the ambiguity in the BPD criteria, and a brief review of the literature comparing these categories. Treatment of persons with alternating relational states, with co-occurring features of BPD, PTSD and DDs will be illustrated with case examples. Role-play of therapeutic interactions will demonstrate how to identify shifts between idealizing and devaluing self-states, and how to recognize defenses in transference-countertransference enactments.

This session was originally presented as a live conference session in May 2020.

Target Audience


Learning Objectives

At the conclusion of this session participants will be able to:

  • Compare and contrast characteristic symptoms of BPD, Complex PTSD and Dissociative Identity Disorder
  • Describe why it is necessary to address the role of disorganized attachment in development of BPD and dissociative disorders
  • Describe how to work with transference reenactments to reveal the origins of attachment models and help clients develop healthier relationship patterns
Course summary
Available credit: 
  • 3.00 ISSTD Certificate Program
    This program is eligible for 3.00 credits in the ISSTD Certificate Program.
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Presenter:  Ruth Blizard, PhD
Presenter Bio: Ruth A. Blizard, PhD, is a psychologist practicing in the Binghamton, NY, area with over 35 years of experience in treating persons with severe trauma, dissociation, and personality disorders. BA in psychology from University of Colorado, Boulder. PhD from Alliant University, Fresno. She has presented internationally and published articles integrating psychoanalytic concepts and attachment theory in the treatment of trauma, dissociation borderline personality, and psychosis. She has taught the official ISSTD course, “Diagnosis and Treatment of Dissociative Disorders.” She is on the editorial board of the Journal of Trauma and Dissociation, has served as editor of the ISSTD News and Division 56 of the APA, Trauma Psychology News. She enjoys folk music, hiking, bicycling, kayaking, and most of all, being a grandmother.

Available Credit

  • 3.00 ISSTD Certificate Program
    This program is eligible for 3.00 credits in the ISSTD Certificate Program.


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  • ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation. 
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