BPD and CPTSD Are NOT The Same with Dr. Peter Salerno

Added: 2026-05-26

[00:00:00]What would you say to the people that say, and people said this to me the other day, borderlines are not abusive?

[00:00:07]What would you say to them?

[00:00:09]Well, of course, you know, now we have to define abuse.

[00:00:13]But, um, I've never experienced somebody who has been related to someone with BPD as describing that they haven't been abused in some way.

[00:00:25]Now, I think what people mean by abuse is not all borderlines are physically violent. A lot of male borderlines are.

[00:00:32]This is another, um, statistic that I'm not making up. There are more male borderlines incarcerated because of their aggression and impulsivity than there are narcissists. That surprises people to hear. But, it's because with borderline aggression and impulsivity, there is an uncontrollable element to that.

[00:00:51]Whereas with narcissists, they are often so motivated to save face and create an impression of themselves that is not true, that they can conceal it enough to where it's covert, right? With borderlines, they don't have the mechanism of self-control because of the dysregulation from all of the other, uh, systems I I highlighted earlier, that they literally can't stop themselves from becoming that violent or that aggressive. And so, it gets them in legal trouble often. Um, more males than females actually as far as being incarcerated for that. But, that's just a fact of biology. We're talking again about aggression and impulsivity. We're not talking about someone being bad or good. I'm talk- I'm not even I'm not even creating a, um, a moral perspective with these traits. I'm simply stating that they exist. Aggression and impulsivity exist in human beings. These individuals who are diagnosed with BPD have more of the of that those traits.

[00:01:51]You know? So, um, to say say they're not abusive, and and then one of the arguments I get a lot when I when I talk about BPD is I'm someone says I'm BPD and I've never hurt a fly. I have empathy oozing out of my pores. It's coursing through my veins all the time. I could never hurt I love animals and anytime I'm self-destructive I'm self-destructive to myself.

[00:02:16]Okay, to which I would I would reply I agree and believe I believe that about you.

[00:02:23]How is self-destruction not impactful to the ones who love you, first of all? Because if you are constantly trying to hurt yourself kill yourself, that's tormenting the people who want you to be alive and who love you. So, that's a form of abuse.

[00:02:39]Is the inability to stop self-destructing, just like the inability to stop drinking or taking drugs, is certainly abusive in a way to the people who care about you, even if you're not intentionally trying to harm them by by the the substance use.

[00:02:56]It's you can't deny that it's impacting them, you know?

[00:03:00]And um so this idea that the that borderline is exclusively self-destructive and not other-destructive, there are too many exceptions to that rule. There are plenty of borderline individuals who um have repeated offenses of being physically violent, destructive, excessive in a way where it's so irresponsible that it's affecting the family system.

[00:03:24]Um I think what people get get worked up about when we talk about this is borderlines do have um these periods where they are no longer seeing other people as the bad object.

[00:03:43]They are seeing themselves as the bad object and they have an experience of profound pain and self-loathing and emptiness that people can only assume means that they're traumatized.

[00:03:58]And so they're not being abusive, they're just being reactive to their trauma.

[00:04:04]Right? Reactive to their pain. That's not necessarily the whole story. You know, there there is certainly aspects of that that can be considered true.

[00:04:14]But the idea that um that's the only reason why they're behaving the way they behave when they misbehave is because of trauma, that's also not true. There's no there's no evidence of that across the board. Right. And that's what they would want you to believe. This is all just because of my trauma. And the other thing I hear them say a lot is they have these very plausible explanations and defenses about why they do what they do. And it's sneaky because unlike many narcissists, they'll admit they're borderline.

[00:04:49]They'll admit [clears throat] that they're doing this behavior. But then they have this wild elaboration of why they do it. And it's not accountability though, it's just this excuse about why they're doing it. And they don't actually acknowledge the bad behavior is in there.

[00:05:06]There's a lot of perceptual gaps and distortions in the in the borderline personality profile. Okay? And I'm not I'm not singling any particular person out who has it. Again, there's variations, there's heterogeneity, so the the presentation is, you know, not it it's not one-size-fits-all, you know, there's variations in it. But what's really important to understand is they draw emotional conclusions before they verify facts. And then when the facts are verified, they they they stick to their emotional conclusions.

[00:05:39]That's something that is pretty um consistent with somebody who perceives things uh through the borderline mind.

[00:05:48]is that there's a lot of emotional conclusions drawn.

[00:05:51]But again, when we're talking about disorder, we're talking about perceptual gaps and distortions, so those aren't always credible.

[00:05:59]You know, and we have to factor that in.

[00:06:01]It's not an accident. And I don't mean this as an insult. Um I'm a clinician.

[00:06:06]It's not an accident that borderline is in the same classification of disorders as antisocial and narcissism. It's in diagnostic manuals because of the overlapping features. Now, people don't like that, and there have been again there have been proposals to remove borderline from the personality disorder category and reclassify it as complex PTSD, and the truth is um in order for that to happen the cause of the the presentation would have to be solely from adverse life experiences.

[00:06:39]Like complex PTSD. There are distinct differences in complex PTSD and borderline personality. I can go over them if you want, some of the distinctions. But >> they're not the same disorder. For example when we talk about complex PTSD um by the way, I have two cats now coming at trying to get on camera, so that's why I'm You can You can show them.

[00:07:01]>> [laughter] >> They'll probably make their way over here.

[00:07:03]Uh so, when we're talking about complex PTSD individuals who have post-traumatic stress do have difficulty with self-regulation and calming when they're upset. They have difficulty grounding.

[00:07:16]That's related to a specific um trigger or something that activated them that is similar to the original stimuli that traumatized them. Okay?

[00:07:29]Borderline personalities have a profound lack of emotional control all around.

[00:07:34]It's not Believe it or not, it's not just when they are feeling provoked or triggered. It can happen out of nowhere.

[00:07:43]They It can It can It can manifest based on what's what what their affect is. An affect is related to how pleasant or unpleasant someone feels throughout the day and how calm or irritable someone feels throughout the day. And borderlines have negative affectivity, which means they typically run unpleasant and irritable even when they're not being environmentally triggered. And this is kind of a sad component to that disorder because that's not their fault.

[00:08:13]But it also informs their perception throughout the day. So it doesn't really require something like wronging them for them to get to the point where they're going to start getting emotionally dysregulated.

[00:08:28]And I think that's something that a lot of borderlines wouldn't even understand about themselves, I think. They've got it in their heads that no, it's all just a reaction. When some When I I split, when I act get really upset, it's because of what someone else did.

[00:08:45]And another thing that's interesting, and Christine Ann Lawson said this in her book, Understanding the Borderline Mother, that they said they'll forget things that happened when they were in a different mental state. So depending on their moods, like where in if they're in the black mood, and then all of a sudden they're in a good mood another day, they forget things that were done when they were in that other mood. Do you agree with that?

[00:09:12]Um I believe that because they have this um such an extreme uncontrollable emotion dysregulation, which often involves anger and aggression. Okay, it's not just fear, it's anger and aggression often times. They can actually move into these dissociative states. Now it's referred to more as like micropsychosis.

[00:09:34]So it's not that they're actually psychotic like a schizophrenic, but they have these moments of like losing touch with reality because of how intense their emotions are and their traits expression that they can probably lose some time.

[00:09:49]And then later on they do what's called a disavow where they deny the responsibility and the accountability.

[00:09:54]They don't remember it being that big of a deal. And so when people give them feedback, "Hey, this really hurt what you said." they'll say, "I didn't say that or I don't remember it." or I don't think that, you know, that's exactly how it happened. And I do believe that there's some sincerity in that for some people that they have actually lost access to the memory of that.

[00:10:14]And then there's also other borderlines that intentionally accidentally forget.

[00:10:20]>> [snorts] >> This is true. And they've admitted that to me in in my practice by the way. All right. And after years of rapport were built, I've heard astounding confessions and admissions that I was so pleased for them to make and I didn't judge them for it. I commended them for their sincerity. But sometimes that can take years to develop the amount of trust where someone's going to say, "I did that because I wanted to." Right. And that's a good step in their healing there, too. Being able to get to that point of admitting, "Yeah, I did this thing with this malicious intent." Cuz it cuz it's never about judging them for it. That doesn't have That doesn't hold any weight in in clinical practice. What holds weight is now that you know that you can do that, we want to make sure that you stop because it's not even in your best self-interest to do that anymore. And they And that makes sense to them. It's like, "You're right. I don't want to keep blowing up these relationships. It's not working for me."

[00:11:17]Um So now you install the mechanisms to which they can behave better rather than going down the rabbit hole of their trauma history which really doesn't help uh borderlines recover because it's not a trauma disorder. Um The behavioral interventions are are what really helped them in the beginning as they get a handle on how they can behave. If they can give up threatening to kill themselves, their relationships will improve.

[00:11:43]And you don't have to go down why you do that in the first place with them because you're wasting precious time at that point and it really doesn't matter, you know, to a degree.