CPTSD vs BPD: How to Think About the Difference and What to Do About It

Summary

Psychofarm Podcast Episode Summary

Episode: CPTSD vs BPD – How to Think About the Difference and What to Do About It
Date: March 10, 2026
Hosts: Dr. Gregory Malsberg (“A”) & Dr. Fu (“B”)

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Episode Overview

In this episode, Drs. Malsberg and Fu dive deep into the sometimes contentious debate between Complex PTSD (CPTSD) and Borderline Personality Disorder (BPD): what distinguishes them, where their definitions overlap, and most importantly, how understanding this impacts actual patient care. The conversation balances the historical and theoretical aspects of diagnosis with the practical realities of clinical work, deconstructing myths, archetypes, and stigma attached to both diagnoses. The hosts aim to offer clarity, pragmatism, and actionable advice for clinicians and patients alike.

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Key Discussion Points & Insights

1. Why This Debate Matters

• The CPTSD vs. BPD debate is prominent online and in clinical circles; it influences how patients are labeled, the treatments they’re offered, and the stigma they may face. The hosts challenge simplistic divides and focus instead on utility:
  • “I want this to be super duper practical in terms of what does that mean for what you say to patients… Not some theoretical conversation.” (A, 01:47)
  • Both agree that getting lost in nosology (“cutting nature at its joints”) is less important than addressing what helps patients.

2. The Pedantic But Necessary: Definitions and History

• DSM-5 vs ICD-11 PTSD:
  • DSM-5's “PTSD” largely subsumes ICD-11's “complex PTSD,” but there are nuanced differences in criteria and the inclusion of disturbances in self-concept and relationships (02:22–03:54).
  • Diagnostic language matters because, “if people use different definitions, then they're not going to be able to communicate effectively.” (A, 04:12)
• Historical Roots:
  • Dr. Fu quotes extensively from Judith Herman’s Trauma and Recovery (08:23–10:23), highlighting that much of the drive for CPTSD as a diagnosis comes from recognizing the impact of chronic trauma, especially in populations historically diagnosed with “hysteria,” BPD, or dissociative disorders.
  • “BPD isn't the person's fault, and they deserve understanding. And CPTSD people can be manipulative and they're responsible for what they do.” (A, 07:16)

3. False Dichotomies and Stigma

• The caricatured battle between “stoic, scientific BPD hardliners” and “emotionally attuned trauma advocates” is often replicated online but is rarely reflected among actual experts (05:09–07:37).
• The real problem is not the categories themselves but how laypeople and clinicians (who lack depth of training) oversimplify or project values onto the diagnoses.
• “Borderline personality disorder is basically reserved now for patients that the clinicians dislike. And complex PTSD is being given to the patients who they like." (B, 31:40)

4. How Do Experts Actually Use These Diagnoses?

• Dr. Fu: More of a “hardliner”—thinks the CPTSD concept often just renames existing categories without extra value; prefers to use refined existing criteria, especially focusing on personality functioning.
• Dr. Malsberg: Pragmatist—agrees theoretically with Fu but prioritizes meeting patients where they are. Patients’ preferences and understanding often drive which diagnostic language is used in practice.
  • “I'm a pragmatist, so in my head, I agree with what you're saying, theoretically… But when it comes to the patient in front of me…the debate over whether or not it's the category itself is not helpful.” (A, 13:20)

5. Official Diagnostic Criteria (20:00–24:30)

• PTSD (DSM-5): Trauma exposure, re-experiencing, avoidance, negative mood/cognitions, hyperarousal.
• CPTSD (ICD-11): All above, plus disturbances in self-organization: emotion dysregulation, negative self-concept (e.g., shame, worthlessness), interpersonal difficulties.
  • “The ICD PTSD with an additional three categories...difficulties in regulating emotions, changes in beliefs about oneself, and difficulty in maintaining close relationships.” (A, 21:22)

6. Chicken or Egg: Personality or Trauma?

• Both hosts agree: personality and trauma are deeply entwined, and a strict cause-effect separation (“the injury is...circumscribed to the trauma”) isn’t realistic for most patients.
• “I don't like complex PTSD. You see this happen in people without anything that I would consider a personality syndrome prior to the onset of the PTSD.” (B, 18:07)
• While Dr. Fu is skeptical about the utility of CPTSD as a distinct category, he and Dr. Malsberg agree that treatment should fit the patient’s needs regardless of label.

7. Clinical Pragmatism: What Actually Helps? (32:23–54:33)

• Functional Approach: Most patients don’t fit neatly into either box; further, BPD and CPTSD traits overlap and intersect. Many patients have trauma but don’t meet full BPD criteria or any specific PD criteria.
• Using “Traits” and the Spectrum:
  • “BPD…is not a binary thing. It's not like patients are. There's a category of people that have it and a category of people who absolutely don't have it. There's a spectrum of different clusters of symptoms…” (A, 41:46)
  • Hosts recommend talking openly about “traits” and the dimensional nature of both disorders, using tools like the McLean screening instrument for BPD.
• Treatment Guidance:
  • Focus on diagnosing and treating what’s present—not trying to forcibly fit a patient to a label.
  • Treatment for both CPTSD and BPD often overlap: trauma-focused therapies (EMDR, trauma CBT), DBT, group therapy, and affect-focused long-term therapy.
  • Dr. Fu generally uses maladaptive personality traits as descriptors when patients don’t fit clear DSM categories—“It's about self functioning and interpersonal functioning." (B, 33:56)

8. Addressing Stigma and Label Preference (30:00–32:23; 48:20–49:09)

• Re-labeling (e.g., CPTSD instead of BPD) may reduce stigma in the short term, but doesn’t solve the deeper problem, which is clinician misunderstanding and lack of empathy for personality disorders.
• Having a collaborative, empathy-driven approach in communicating the diagnosis and emphasizing therapy referrals is far more effective than the specific diagnosis used.
  • “Most patients really just want help. They want to feel better and they want to understand themselves. And a good diagnosis and a good formulation helps them do exactly that.” (A, 45:06)

9. Advice for Clinicians and Patients

• “I don't care what you call it, give them the right treatment...as long as you're doing the right treatment.” (B, 46:39)
• Be cautious about confirming personality disorder diagnoses on first appointments, especially given cultural and emotional weight.
• Ask patients their understanding of their diagnosis; stigma and misunderstanding can exist on both sides (53:09).

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Memorable Quotes & Notable Moments

• On Misconstrued Debate:
  • “We have these very stoic learned men in bow ties who think BPD is everything… And they deny the reality of women in trauma…The flip side…think everything is trauma and it's CPTSD everywhere. Now it's a totally false dichotomy.” (A, 05:09-06:43)
• On Stigma:
  • “Borderline personality disorder is basically reserved now for patients that the clinicians dislike. And complex PTSD is being given to the patients who they like.” (B, 31:40)
• On Clinical Reality:
  • “What a patient really wants is for you to understand who they are, what their problems are, and to give them some kind of a working solution that works for them.” (B, 14:41)
• On Treatment:
  • “It’s not what we tell the patients, but it’s how we teach psychiatrists and therapists. People need to have a deeper understanding of the personality and how it's conceptualized and what the borderline conditions are, not just the stereotype versions…” (B, 51:06)
• On the Practical Approach:
  • “I don't see borderline personality disorder, and I do see a lot of trauma, and they identify with complex trauma…But there's something on top of it that is important to look at.” (A, 44:40)

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Practical Pearls & Clinical Tips

Timestamps indicate where to find more detail in the episode.

• Defining the Diagnoses: (16:24–22:15)

  • PTSD (DSM): Trauma, re-experiencing, avoidance, negative affect/cognitions, hyperarousal.
  • CPTSD (ICD): Above plus disturbances to self-organization—marked by emotional dysregulation, negative self-beliefs, relationship difficulties.

• How to Choose a Label:

  • Use the language your patient most identifies with—unless it blocks necessary self-reflection or treatment. (13:20, 41:46, 45:06)
  • Consider “personality traits” and spectrum language rather than categorical “yes/no.” (41:46)

• Communicating the Diagnosis: (35:00–39:00)

  • Elicit the patient’s idea of what their diagnosis means before explaining your understanding.
  • Use clear, non-stigmatizing explanations of personality and trauma, pointing out their interconnectedness.

• Treatment Priorities: (37:08–39:00, 51:06)

  • Focus on therapy—ideally trauma-focused, DBT, or affect-focused group or individual therapy.
  • Medications have little role for personality structure alone.

• Resource Recommendations: (54:33)

  • CPTSD: Complex PTSD From Surviving to Thriving, Pete Walker
  • BPD: BorderlinerNotes YouTube channel; John Gunderson interview.

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Notable Quotes by Timestamp

• On Definitions and Category Overlap:
  • "CPTSD...the way I think about it now is it's a very large category of patients...borderline personality disorder is one potential phenotype of someone who's got a complex PTSD history..." (A, 10:23–11:08)
• On Stigma in Clinical Practice:
  • "Borderline personality disorder is basically reserved now for patients that the clinicians dislike. And complex PTSD is being given to the patients who they like." (B, 31:40)
• On Pragmatism Over Philosophy:
  • "I don't care what you call it, give the right treatment. And that's my approach." (B, 14:41)
• On the Impact of Label Preference:
  • "...there is a helpful thing of changing or people not wanting a label that is very harmful." (A, 30:00)
• Advice for Trainees/Clinicians:
  • "Be very careful about...any diagnosis, but particularly culturally laden or emotionally invested diagnoses...functioning as a form of resistance to appropriate treatment..." (B, 46:39)

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Episode Flow & Key Timestamps

• 01:47 – Framing the CPTSD vs BPD debate; emphasis on clinical relevance
• 02:22–03:54 – DSM vs ICD diagnostic definitions
• 05:09–07:37 – Caricatures and false dichotomies in online/informal debate
• 08:23–11:08 – Judith Herman’s historical and clinical framing of complex trauma
• 16:24–22:15 – Clear definitions: PTSD, CPTSD, classic symptom clusters
• 32:23–35:00 – Practical advice: what if a patient doesn’t “fit” either category?
• 38:22–44:40 – Detailed discussion of patient communication strategies and screening tools
• 45:06–49:09 – How do patients react to these conversations? Is it ever helpful to “push” a diagnosis?
• 51:06 – Training and systemic challenges: teaching clinicians, not just picking labels
• 53:09–54:33 – Resource recommendations and “psychoeducation” advice

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Final Takeaways

• The BPD vs. CPTSD debate is less important than understanding each patient’s unique experience and optimizing their treatment.
• The most stigma-reducing, effective approach comes from empathy, collaborative understanding, and transparent, jargon-minimized formulation and explanation.
• Use these diagnoses (and their labels) pragmatically; let patients’ needs and understanding guide your approach.
• For clinicians: focus on functional and personality-based models, and prioritize longitudinal, therapy-focused plans over rigid adherence to diagnostic silos.

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Suggestion Box

• Feedback invitation:
  • “I do wonder from the audience if there's anything that we didn't cover or anything that we didn't make clear...I'd like to hear about in the comments.” (B, 54:35)

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For further resources and updates:
psychofarm.substack.com

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End of Summary

Transcript

[A]

Welcome to the Psychoparm podcast. This podcast is for education and entertainment. It certainly is not medical or psychiatric advice, diagnosis or treatment. Listening does not create a doctor patient relationship with me or Dr. Fu. If you're a patient, certainly don't change your treatment plan because of something you hear on the show. If you're a clinician, do not use this podcast as a clinical reference or substitute for your own training, judgment, thinking and up to date sources. Opinions are our own and don't necessarily reflect any employer or affiliated organization and may even be detached from reality.

[B]

Good morning, Dr. Malsberg. Good morning.

[A]

How's it going?

[B]

Oh, not too bad. A little afraid.

[A]

A little afraid? What are you afraid of?

[B]

Well, I think we're discussing a bit of a complex topic today, aren't we?

[A]

Yeah, we'll be talking about complex PTSD and borderline personality disorder. You actually, on our PTSD episode you opened up saying, are you afraid? And in this episode you're saying, I'm afraid.

[B]

Well, that was supposed to be a little Easter egg for anyone who's halfway paying attention, which is nobody. Before you listen to this episode, if you have not already, you may want to listen to the original trauma episode from back in the day because that's going to cover a lot of more foundational stuff I think that you'll need to understand before this one makes too much sense. But you can always skip it, I think.

[A]

Yeah, you did a spectacular job after that. After that conversation, I had a much better understanding of ptsd and that episode actually didn't perform particularly well. So if you didn't listen to that one, I think it's one of our best episodes. It's a good one.

[B]

I like it. Can never predict what seems to be popular. Maybe this one will be because it's going to garner controversy and the heads

[A]

up when we say popular, we mean. Yeah, maybe like a thousand listeners.

[B]

Yeah, exactly.

[A]

So where should we start? I want this, I'm hoping that this is a very practical podcast. So I see this, you know, CPTSD versus BPD debate and sometimes it can devolve into like symptom clusters, research analysis, all that good stuff. I, I, I think I'm fine if we start with that, but I want at the end maybe I, you know, setting people up to listen to the whole thing. I want this to be super duper practical in terms of what does that mean for what you say to patients and what does it mean for like day to day care? Not some theoretical conversation. That's how I hope it evolves. Yeah.

[B]

That's the important part. I think it's very easier for clinician facing materials, articles, podcasts to really get in the weeds. And I know I have a tendency to do that. I'm going to try to avoid it to the best of my ability. No guarantees. That being said, I think we should kind of get in front of some common things. I see when this discussion comes up online and this discussion does come up relatively frequently, at least on common threads that happen and few things that we need to know before we can start to have a productive conversation about this. I would say that the first one is that PTSD as defined by the DSM 5 is different than PTSD that is defined by the ICD 11 baseline PTSD in the DSM 5 essentially more or less covers what is actually called complex PTSD in the ICD 11. So if you look at studies that are using the ICD11 criteria for complex PTSD, they'll talk about how valid it is as a construction. Americans who are paying attention don't disagree with that. We call it regular PTSD. Now you may disagree with the decision from DSM 4 to DSM 5 to add additional criteria to make you qualify for full on ptsd. Personally, I think it's a good change and I like it. But also that's probably my bias from where I trained.

[A]

See, this is the pedantic stuff.

[B]

It is, but it's necessary because again, every time we talk about this and I go like, oh, but I know these studies, all these studies, look at this research, look at the psychological research, do this. Well, let's define what we're talking about first. Okay. I don't look for any other pre knowledge. Do we mean that?

[A]

I think that's super important as your point is like we. The reason why we need to define these things. It's not like we're as we say, like cutting nature at its joints. Not like we're finding out exactly what's going on. Essentially we have definitions of things and if people use different definitions then they're not going to be able to communicate effectively or just going to be. They're going to be talking past each other.

[B]

Yeah, yeah.

[A]

But yeah, before there's a, there's old

[B]

couples therapist who, you know, we got some training under the person who trained under this couple's therapist. So pretty ancient grandfather style training. But there's old clip of him taking, he's doing couples therapy with these two couples and he picks up like an ornament from his office and he's like, oh, we have to both, we all have to agree that this statue is a statue before we can continue on and talk about anything else. We can't just talk about, you know, two different things. We have to say all sit down and agree this statue is a statue and it's there. And that's the same thing when it comes to these kinds of debates.

[A]

Yeah, we have to. We can't just talk past each other by saying different things, by using definite different definitions. Before, before we jump into the debate, I want to talk about what is my underlying fantasy of what this debate is. And I think what it is is essentially straw manning both sides. But this is how I think most people think what the debate is. We have these very stoic learned men in bow ties who think BPD is everything, BPD is the problem. And these are stoic, rigorous, scientific men. And they deny. So they say borderline Personality disorder is real and CPTSD is just nonsense. And they deny the reality of women in trauma.

[B]

Then we have this line that was used once online by something like a Hungarian genius in a wood lined office in Manhattan or something. Yeah, something like that. You could replace BPD with borderline organization, depending on who's the thinker. Anyway, go on.

[A]

But Eastern European is what I'm picturing. Then the flip side are these perfectly emotionally attuned, very caring, typically women. And they think everything is trauma and it's CPTSD everywhere. Now these providers, they're a little emotional and they think that all these people need is understanding and accommodation. Now it's a totally false dichotomy. So there's so many.

[B]

Aren't you talking about Kernberg et al and Herman et al right now? No, that's libelous.

[A]

I think those are the archetypes. Those are the archetypes. But so there's so many false things within what BPD versus CPTSD is in that, in my little fantasy of what people's fantasy is, people think that the BPD means it's the person's fault, that the person just needs to be more, be less emotional and that they're manipulative and that CPTSD means this person needs understanding, accommodation, their reactions are justified and they're not responsible for the outbursts. The persecutor is responsible for the outbursts. And both of these are just totally wrong ideas of what these two disorders are. BPD isn't the person's fault and they deserve understanding. And CPTSD people can be manipulative and they're responsible for what they do. And we'll get into more nuance. So it's not like there's just two groups of BPD people versus CPTSD people. But all I'm saying is the whole thing is built on a house of lies.

[B]

I guess the problem is this. I doubt that either of the academic camps, the expert camps, who put forward either borderline conditions as a major explainer or who put forward complex trauma as a major explainer are ever so simplistic and silly in terms of how they conceptualize these things. Yeah, it seems to be. My impression is that it's laypeople and clinicians who have a superficial reading of these thinkers who lack knowledge about the history and as a result almost operate on a caricature of these ideas when they're pretty complicated ideas. But I think we gotta talk a little about history, I suppose.

[A]

Yeah.

[B]

Because people don't know where complex trauma comes from. Yeah. If you actually read Judith Herman, her book, she came up with this term. She more or less says there are three major categories in diagnosis. Borderline personalities, dissociative disorders, and somatoform. Disorders that you see a lot in women are identified in a lot in women. And I think that it's better if we conceptualize these as the result of or related to traumas. That's a very simple way of putting it. Let me read from her book, Trauma and Recovery. Survivors of childhood abuse often accumulate many different diagnoses. Before the underlying problem of a complex post traumatic syndrome is recognized. They are likely to receive a diagnosis that carries strong negative connotations. Three particularly troublesome diagnoses have often been applied to survivors of child abuse. So child abuse, somatization disorder, borderline personality disorder, and multiple personality disorder. All three of these diagnoses were once subsumed under the now obsolete name hysteria patients. Usually women who receive these diagnoses evoke unusually intense reactions in caregivers. Their credibility is often suspect. They are frequently accused of manipulation or malingering. They're often the subject of furious and partisan controversy. Sometimes they are frankly hated. These three diagnoses are charged with pejorative meaning, et cetera, et cetera. I'm not going to keep going, but you get the idea. There are values, there are feelings that are driving, in my opinion, the decision to categorize in one direction or another. And we have to understand that it's not just such a simple situation where we're just having an intellectual disagreement.

[A]

Yeah, that book's great. It's very readable. And I feel like my takeaway from that Paragraph when I had read it was when I hear complex ptsd, it's often in the context of is complex PTSD just a renaming of borderline personality disorder? And this really helped me to understand that complex ptsd. The way I think about it now is it's a very large category of patients and there's a lot of different phenotypes that kind of present. And borderline personality disorder is one potential phenotype of someone who's got a complex PTSD history. And. Whereas somatization and what's the third one?

[B]

Dissociative identity.

[A]

Yeah, multiple personalities. So those I think now of CPTSD as a big bucket that contains a bunch of small buckets and one of those small buckets is bpd. But I'm not saying that they perfectly overlap, that all BPD is subsumed under cptsd. But if you've ever seen, when I did my child psychiatry rotation, they have these circles of the different childhood diagnoses and it's oppositional defined disorder, DMDD and adhd. And you see this giant. It's not even a Venn diagram. It's just like these majorly overlapping things. And the gist is that, you know, these diagnoses don't, as, you know, quote unquote, carve nature at its joints. Like, it's not like we're talking about different things, it's we. They have this output and we're catching a certain, A certain section of the population with these problems. And sometimes our labels catch the same sections and there's a little overlap and then there's areas where, you know, a patient can have only one or only the other. That was probably a little confusing in my wording, but if you had the picture, it would make more sense.

[B]

But I think you put it nicely. But I also think that now it's time for us to stake our positions. And I'm frankly more of a hardliner than you are. I don't think that complex trauma should exist as a concept. I think that it while is clinically useful and can be used to accurately describe many clinical types, that it's flawed in this origin, that the origin doesn't exist because the original concepts were poor, inaccurate in any way other than certain areas that probably should have been updated. I can't argue against that. But we should have refined the diagnostic criteria and description of the original conditions, including DSM defined borderline personality disorder, instead of just trying to lump them essentially into one category. And worse yet, to attribute it to external forces trauma. Because I Don't think that it is a settled science. And I also personally doubt that external forces are the sole cause of these conditions. I think that it's a mixture of external forces and internal tendencies.

[A]

Just a small plug to leave a review if you can. Leave me review will help other clinicians find our show and will let us keep making it. If you're on Apple podcasts, open the show page, scroll to ratings and review. If you like us, tap five stars. If you're not sure what to put for the review, just say, hi, Dr. Fuji. And if you're on Reddit or YouTube, leave a comment. Dr. Fu reads absolutely every single one. Let's get back to the show. So here's my response to what you're saying. I am a pragmatist, so in my head, I agree entirely with what you're saying, theoretically. But when it comes to the patient in front of me, when they have certain ideas of these things, the debate, that debate, I'm going to say, like, it doesn't, doesn't matter to them. And so it's weird in that in terms of like my, my, my philosophical nosological. Dr. Malsberg agrees entirely with that. But then the clinician, Dr. Malsberg has so many patients that go, but I don't, I don't, I don't care how you guys categorize it. What do I have? And that, this, that debate isn't. I just see so many patients with CPTSD and I don't. The debate over whether or not it's the category itself is not helpful because I have to, I have to live in the world with that patient. Sorry, I know I'm moving because I

[B]

thought you might have had more genuine opposition and we could have a debate. But the fact is my patients never hear about that kind of position. I don't get into nosological arguments with my patients. I do the same thing. What I say to trainees is, I don't care what you call it, give the right treatment. And that's my approach. And so whatever a patient prefers to call something, we're going to go ahead and call it that. Now, does my population really talk about complex trauma all that often? Not necessarily. The college students do sometimes. On top of that, are my patients unwilling to accept the borderline condition once I've actually done my diagnosis and given the psychoeducation in a empathic and fair manner? Very, very, very, very rare. I don't know if I've encountered that, because in the end I think that what a patient really wants is for you to understand who they are, what their problems are, and to give them some kind of a working solution that works for them. And so that's another reason why intellectually, academically, I'm so opposed to the concept of complex trauma. It is a solution for a problem that was, in my opinion, misidentified in the first place. The problem at the outset was not the diagnostic categorization. The problem was the lack of general practice in building therapeutic alliance and having collaborative care where both the patient and the physician are equal parties. Or there.

[A]

Absolutely, absolutely, absolutely. I apologize. I'm going to move us too much. Why don't we define what we mean? But we're using the terms right now.

[B]

Okay.

[A]

Other things you want to. Before we move on to that.

[B]

I guess it depends on the terms. Well, let's go on.

[A]

So I guess we'll start with. Well, first off, when we, you know, we need to use definitions when we talk about diagnoses. So PTSD. We're referring right now, I'm referring to the. The DSM 5 PTSD. I really like how you taught it in the last podcast. And just to you almost use it. So, like, it jumps. The criteria build off of each other. Criterion A being that the person had a trauma, then the trauma comes back to that person, so they have re experiencing. Then the person avoids that trauma, so they have avoidance. Then that person. A broken mood and spirit is how you kind of put it. But negative mood and cognitions. And then the last criteria is hyperarousal.

[B]

Yeah. Physiological changes.

[A]

Yeah. Now, I think you kind of mentioned this earlier. This was the criterion, the fourth criterion, the one negative mood and cognition was added. So before it focused less on the negative mood and cognition and it was more about the specific trauma occurring, the avoidance and the reoccurrence in a person's life. And the fourth criterion, the one negative mood and spirit, as we call it, was added when trying to add more of that complex. Acknowledging the complex PTSD stuff of how it impacts the person's personality in some sense. The DSM 3 had. Or one of the DSMs had a diagnosis of personality. I'm messing it up because I actually lost my notes on these. It was like personality alterations due to a trauma. And this to me, that was a predecessor diagnosis to cptsd. Yeah.

[B]

You know, I haven't had the opportunity to interview the people who actually made these decisions, even though that's theoretically possible for me to do. I don't think I should do it. It would be bothering them. But I'll give you my sense of what happened. I think that Starting from the 1980s and onwards, the important work of Judith Herman and people aligned with that camp began to show the psychiatric community that PTSD was not just a issue from war veterans and I suspect not VA psychiatrist myself. I suspect that in war veterans that population tends to show PTSD with more numbness and repression as there are major areas of alterations in mood and cognition or spirit. And so prior to DSM 5 that was the emphasis. It's not that there was never any reference to mood and cognition changes, it's that it was emphasizing basically numbing withdrawal type symptoms. But if you have this is from my clinical experience now, sufficient experience with people who are not war veterans with ptsd, then you're going to see that in the really clear cases, almost without exception, you are going to see criterion d of the DSM 5 PTSD construct. It's going to be there, there's going to be changes in mood changes in cognition, how you experience yourself in the world. And this is why I don't like complex ptsd. You see this happen in people without anything that I personally would consider a personality syndrome prior to the onset of the ptsd. PTSD properly should be something that interrupts and impairs the normal flow of somebody's personality functioning. Now, if you already have low personality functioning or personality problems of any kind to begin with, then certainly it's going to make it worse. But I think that I'm not happy with psychiatric categorization where we only look at symptoms. I think that we should operate on some hypotheses about what happens, why and when. And that's why I don't like complex ptsd. I think that the way complex PTSD has been conceptualized is really pointing to majority things that are problematic in terms of personality. And while a lot of that adult personality problem stems from impairments and stre and traumas, true traumas occurring in the developmental period, the injury is not to some fear response and understanding of the world issue that's circumscribed to the trauma. It's a wholesale inhibition or change of this person's personality due to developmental issues.

[A]

Absolutely, yeah. Now let me maybe we should keep our categorization going. So complex ptsd. Now, CPTSD is not in the dsm. It is defined in the icd. But again, my contention is that that's

[B]

the same as DSM 5, but gone.

[A]

Now how it's defined in the ICD is it uses the exact depth the ICD. PTSD with an additional three categories. So it includes PTSD plus. What's the major category of the three categories is disturbances of self organization. And that includes three things that they name. So difficulties in regulating emotions. Number two is changes in beliefs about oneself, such as feeling worthless with significant shame. And number three is difficulty in maintaining close relationships with important people. So the ic, according to icd, how it categorizes CPTSD is. I'm just reiterating what I just said. PTSD plus disturbances and self organization, which are defined by those three things which are essentially emotional dysregulation, negative self beliefs, and interpersonal difficulties.

[B]

Yeah, we again run into a problem. Right. Chicken and egg. Chicken and egg. Where do personality syndromes come from? Why do some people develop PTSD from traumas, but some do not? These are difficult questions to answer, but I still think that we should be maintaining a separation. The DSM 5 for these kinds of issues that are called complex in the icd, maintains that these have to be worsen, worsening basically as a result of the traumatic event. And I, if I see that, and that's clearly the case for someone with childhood traumas, I just call it ptsd. Now, could they have maladaptive personality traits on top of that? Sure, but I'm gonna have to see additional evidence for that. Right. What I'm not gonna do is I'm not going to say that someone has complex PTSD when they simply have a bunch of little T traumas in their history. I've seen that done. I've seen that done clinically. I've seen that done clinically, even in the objection of the patient. The patient may even be saying to the clinician, I think I might have borderline personality disorder. And then some clinicians will not make that diagnosis.

[A]

And then I've seen the same thing in that people are like, don't even think of CPTSD as they don't even include PTSD as part of the cptsd. It's like, oh, no, they had a lot of difficulty things in childhood, and now they're experiencing, you know, all their symptoms are the result of trauma, which is not even how it's, you know, defined in the dsm. One little acronym that is actually in Judith Herman's book, that's that I like. And for ptsd. And CPTSD is fear for the symptoms of ptsd. So it's fright, exposure, avoidance, and re experiencing. And then CPTSD is bad fear. So that adds betrayal, affect, regulation, and developmental impact. I rarely actually think through acronyms, but sometimes it's helpful for me to kind of just to think about it if I'm struggling to think of one. Or it also is helpful for me to think of PTSD or see PTSD as PTSD plus the disturbances in self organization.

[B]

Should we talk about the concept of C PTSD in Herman's book at least go over kind of the major categories? Because another challenge here is that there's no single body that defines it necessarily like the dsm. So again, when people say complex ptsd, they mean a bunch of different things, including the icd.

[A]

Sure.

[B]

Okay, let's read the highlights anyway. Complex post traumatic stress disorder, A history of subjection to totalitarian control. I mean, that's a very loaded way of writing its criteria already, if you ask me. Over a prolonged period, months to years. Examples include hostages, prisoners of war, concentration camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation. On top of that you get alterations in affect regulation, and they list different types of alterations in consciousness, alterations in self perception, alterations in perception of the perpetrator, alterations in relations with others, and then alterations in systems of meaning that comes on top of something that you have already developed. You were humming along in a certain way and then something really threw you off kilter. Then maybe that's a trauma disorder or a stressor disorder. That's how I'd like to just cleanly do things. I want to try to keep judgment values. Add this as much as possible because the purpose is simply what happened to you? Why? What is happening to you? How much of this is something that you can control and what should we do about it?

[A]

I want to change, move the conversation a little bit. Do you have anything else you want to say that's connected to this before I make a small movement that's partially connected?

[B]

I suppose the problem is this. We try to make the title of this episode. Which one's more valid, I suppose, or I'm not even sure. I'm afraid that has become we vent about why we don't like complex ptsd, but maybe we need to give as hard of a argument as we can. We need a steel man or steel woman. The diagnosis of complex ptsd. Why should it exist as a diagnostic entity? What are the strongest arguments for it?

[A]

Oh, I actually. And I want to move away from arguments for or against the validity and talk about what I see in practice and how I operate in practice. But.

[B]

Okay, but then before we have an answer for the audience. I guess the answer is pretty obvious on my end. I think complex PTSD is invalid category that was created for ideological reasons and it simply reorganizes existing categories. And we should be open about that and we should have open debate about that. And we need to come to a decision about whether we're going to keep the old categories. If so, why not? And maybe we should just rename the old categories.

[A]

That's the big initial debate is that like it doesn't add anything and it's the cptsd. Mark Ruffalo talks about this a lot is essentially just PTSD plus some borderline personality disorder sub syndromal symptom symptoms.

[B]

Yeah.

[A]

And that like we're not adding anything. We've just taken something that can be viewed as. Can already be kind of described in our diagnostic system and just have an ad like doesn't have discriminatory power. Now. I disagree or it's not that I disagree, it's just that I don't like when you add plus BPD subjournal symptoms, you can't pick. And to me it's like you've buffeted the BPD part. And if you loosen up BPD in terms of subsyndromal, you. I don't know, I don't love that. And I think CPTSD does capture something that's a little bit different than. Because there's a lot of patients who don't have typical BPD symptoms. And I do see a lot of the CPTSD stuff. So I do think it's actually cat. I don't know. I think it's a useful term.

[B]

Okay. I suppose then we should have gotten someone who's an advocate because neither of us are advocates enough, I think, to argue well in the other direction. But my summary then for the other camp is that we can make this a valid diagnosis. We can create a construct and a way to describe complex PTSD that separates it from the rest of the disorders. We can do that when we can get there and it's clinically useful. I suppose you have to be. No, I should not qualify that anymore because that's further criticism. I would then add for their camp. The way the older diagnoses were constructed was based on biases that were unique to the cultural backdrop of the framers, the people who wrote the diagnostic constructs and therefore are not. They don't capture enough of what is really going on. And what is really going on is that if you are victimized in a fashion in A long term way. If you are under totalitarian control, then you are naturally going to respond to that no matter who you are in a particular fashion. And that's complex ptsd maybe that's the steel manner.

[A]

Yeah. And when we say totalitarian regimes, like a lot of her book is about Holocaust survivors, so. And saw a lot of characteristic ways that people were responding now. Sorry, I'm jumping around a lot. One of the biggest arguments against the CPTSD is that like changing the names of things, it's not helpful. Like you can't just change the name of things and that gets rid of the stigma because the stigma exists like independent. And it's not helpful to just kind of keep moving things and changing terms. Now the again the theoretical me agrees, like we can't just keep renaming terms and renaming BPD something different. Which I'm not even saying is what CPTSD is doing. But the pragmatic in me says there is major stigma against BPD that exists as a result of the fact that many patients view the most sickest patients of BPD as BPD only. And there's so many people who, when they think of bpd, think of these awful manipulative people and they're going like that's not me. And they want a label that isn't stigmatized that they can say to their doctor and not have their care completely change as a result of this label. So the pragmatic can be understands that there is a helpful thing of changing or people not wanting a label that is very harmful.

[B]

Yeah. I guess what I would like if I could control the APA and the ICD is that I in a totalitarian fashion, if I could control them in a totalitarian fashion, I would rename everything.

[A]

Okay?

[B]

That's what I would do. I would just rename everything and I would tweak some of the diagnostic criteria. I do think there is too much stigma, but that's not where I would end things. I think that's only at least half of the problem. And there is much more problems. And the major problem is that clinicians do not understand and empathize with personality problems. And as a result, in my opinion, borderline personality disorder is basically reserved now for patients that the clinicians dislike. And complex PTSD is being given to the patients who they like. Because if you look at the life history of patients with borderline personality disorder, they have a lot of trauma. Okay? They have a lot of trauma.

[A]

So now I want to move to the pragmatic, like the clinical part, that

[B]

stuff yeah, let's go. Let's go to clinical practical.

[A]

So one thing I do want to point out is there are a lot of patients that fit complex PTSD that have personality dysfunction. But BPD isn't the personality that best categorizes them. And I think that's one of the problems that clinicians have is that they don't have a good way of communicating to patients or way of thinking through the facts that it's like this person has complex PTSD and they don't have real fears of abandonment and they don't have all these other things. So, yeah, they don't like, why would I call them bpd? And a lot of providers don't have an effective way to communicate or like I said, even think through the fact that you can have personality dysfunction. It can be the result of your personality and you can either not meet full criteria for one of the personality disorders or not be one of fit neatly into the box. You can have severe personality dysfunction but not fit neatly into BPD or npd. So a lot of providers get caught up on that in that because they don't have a way of thinking or talking about personality dysfunction. That's not the most absurd, the most archetypal bpd. They don't know how to talk to the patient about it.

[B]

Yeah, no, that's a very good point. And I think it's because of that that many clinicians will then reach for the complex trauma bucket. They won't even call it complex ptsd. Right. They'll just say, oh, this is a complex trauma patient. It's a much cleaner, easier way to capture and describe a patient's issues when they frankly and obviously do not meet borderline personality disorder, DSM criteria. But we have a solution. Today it's 2026 and I think the field is moving in this direction, at least I hope it is. It's the alternative model for personality disorders in the DSM 5. And if we simply look at criterion A and we look at level of personality functioning, I don't know if I've made a borderline personality disorder diagnosis in the last two years. Okay. Most of the time I just point to maladaptive personality traits or problems of personality functioning. And those are the things I'm going to be discussing with patients and other clinicians, that it's about the self functioning and interpersonal functioning.

[A]

Now I guess I want to talk about maybe my approach, but I guess before I jump into that, so how, how do you communicate to patients when, like you don't say like, oh, you have other specified. Or you don't say to the patient, obviously, like, well, we need to use the alternative model in the dsm. So let's say you do have a patient that doesn't fit neatly into a bucket or is doesn't meet full criteria. What is like your typical spiel for that patient? For how do you package that? Like, it's the personality that's causing the dysfunction? Well, it's rare.

[B]

That personality is the only thing going on. So the first thing I'll do is discuss the things that are going on. I do think that you have XYZ conditions, you meet criteria for those, or it seems pretty reasonable that these are problems for you. It could be ptsd, it could be depression, it could be alcohol use disorder, it could be anything. Right. And let's pretend in the rare case where those are not present, all I think it is is personality dysfunction, then I'll say this is what I usually do. We've probably covered this in a previous episode. Have you heard of a personality disorder? What does that mean to you? What is a personality? Get the information from the patient first. Okay, this is what I mean when I talk about the personality. Your personality is the way that you are used to dealing with yourself and other people and how you think and feel about yourself and other people. And where does that come from? It comes from the things that you went through growing up and who you are as a person. A combination. And let's look at all the things that you've been through growing up that was not easy. Right. And I think you can agree that you maybe didn't have the right guidance parenting or the opportunities that many other people did have when you were growing up. So that has caused some problems for you, in my opinion, about how you deal with yourself and others and how you think and feel about those things. And that's the personality. And that's really not something that responds to medication. That's something that you will have to work a little bit more slowly towards in a talk therapy, one on one and in group and in making lifestyle changes. So it's a long spiel, but that's how I do it.

[A]

And then what therapy would you refer them to? Typically, let's say you're a provider who doesn't. You just move there and you don't know any individual therapist. So you're really just basing it off of different modalities people offer that you can find on the Internet.

[B]

Honestly, it kind of depends on the patient's individual problems. But let's pretend that it's somebody who's essentially fairly well within the borderline cluster B range or camp and they're essentially subsyndromal for it. For me, if they are getting sufficiently severe and if the resources are there, I will want them to get a named therapy for borderline conditions like transference focus psychotherapy, mentalization based therapy, dbt, if there's a program for that, if you see more of that classical picture. But otherwise what I'm more focused on is that they're in some longitudinal talk therapy that is affect focused, that hopefully provides some skills too. But this is my setting. My setting is too under resourced. I don't get to pick and choose. It's more important to me that they're actually in a talk therapy that they commit to and they're engaged in than specific recommendations. Gotcha.

[A]

Now I kind of want to talk about a little bit of my approach to with patients in terms of. And again, when a patient I'm more comfortable, I kind of think of it as, you know, there's patients who I think fit really well into CPTSD and patients who fit really well into bpd patients who are both. And I'm in some. Me and my wife kind of make a joke of like I'm fine if they want both. If they want both, that's fine. But there's some patients that I need to like they, I need to give them bpd. And there's some patients where it's like if they just want cptsd, all right, they don't, we don't need to give them bpd. But I want to kind of talk about my approach that I've kind of developed and I'm sure you'll have some. There will be aspects that you don't love. But typically what I do is so a lot of my patients come like the initial thing is like, do I have what do I have cptsd? Do I have bpd? Or they'll say I have CPTSD and then I do the intake. But how do I differentiate it? So I'm going to try to make this super simplistic. Assuming you don't have a deep theoretical knowledge of personality. I really like the McLean screening instrument for BPD. So if I have a patient that I'm starting to pick up or I do this with a lot of patients when I'm seeing signs of like, especially if they ask do I have CPTSD? And I search McLean M A C L E A N BPDPDF because I need to pull it up very fast, usually. And then I'll mix these questions in with. We've talked about how we do intakes. I usually have a very free form narrative based in the beginning. And then at the end I'm kind of just like giving them more specific questions to hone down on it. And I'll go through these questions and usually sprinkle in other questions so that it's not like they feel like it's leading towards one particular thing. And I go through these list of questions and it really helps me to formulate whether I feel like one, if they have insight into whether or not they have BPD, and two, if I think they have primarily BPD, if they screen really, really high on the McLean screening instrument, then I'll feel like more of a necessity to talk about BPD and say that that's a part of their diagnosis. And there's particular things that pop up on there that lead me to saying like bpd, to prioritizing bpd. The big one is if they have a lot of close relationships that are marked by arguments and repeated breakups, if there's a lot of anger, if they feel chronically empty, things that I think of as core and part and parcel of borderline personality disorder. Now there is some research when they're trying to differentiate CPTSD or borderline, that externalizing behaviors are more part of bpd. So things like impulsivity, attempts to avoid abandonment, temper outbursts, theoretically those are more BPD type traits. C ptsd. Typically you're going to get more of the avoidant attachment style in that these are people who think the world is unsafe and they don't want to engage in it and they desire closeness but move away from people. Whereas bpd, you have more of that fluctuating idealization, devaluation. These aren't just theoretical terms. It's like what you see in patients with BPD is they have relationships that are super close, super intimate, and then just explode in some dramatic fashion. And cptsd, there's more of an avoidance of relationships. So again, I do the. And those are overgeneralizations. So I do the maclean screen. And that usually is a great jumping off point for at the end when I'm kind of giving my formulation. And typically what I'll say is I'll talk about CPTSD and I'll talk about bpd. And let's say that I think that there's. They're not full criteria for bpd. I had the conversation of BPD traits. So what I'LL say is, you know, bpd. It's not a binary thing. It's not like patients are. There's a category of people that have it and a category of people who absolutely don't have it. There's a spectrum of different clusters of symptoms, and some patients have some of those symptoms, some patients have some of those symptoms to varying degrees. And a lot of the things that you've been describing to me really fit into those BPD traits. Now, do you meet the full criteria? I don't really think so. I don't think you fully meet the criteria and the extent of the dysfunction of someone with borderline personality disorder. But I think we can say you have complex ptsd. But there absolutely is borderline personality disorder traits in there. And I use that as a jumping off point to talk about treatment. That's sort of how I think about. I don't know, there's some patients that I don't think it's appropriate for them just to have the CPTSD label. And some patients use it as a defense to not look at their personality dysfunction. And I feel like the McLean screen and the conversation about traits allows me to open up that conversation earlier than I would in terms of having the official conversation of, you have bpd.

[B]

I actually like your approach quite a lot. And I suppose it's an approach that exists because you actually see a substantial amount of patients who are coming and asking to be differentiated between these conditions and are aware of these conditions and ongoing debate. I probably don't do that for two reasons, because I don't get that situation for patients coming in. They don't do that. It's still more of an ADHD issue. And then on top of that, as you might suspect, I will refuse to make an official diagnosis of complex trauma. I will agree with a patient and they think they have complex trauma and it fits the definition of complex trauma. But that's not my word in diagnosis. My approach is simply, is there PTSD or not? If there's ptsd, that's PTSD to me. And we're going to subsume most of those problems under ptsd. There may or may not be maladaptive, maladaptive personality traits on top of it. Okay, if there is not ptsd, then I want to find out, are there any other explanations for this, or is the clear explanation personality dysfunction? And if it's personality dysfunction, I'm going to be working on telling the patient about that and coming to some kind of a mutual agreement about what this is and what we're going to do about it. So I suppose that's why it's simply, it's a practical approach that you have, and I don't need it, but if I need it, someday maybe I'll use it.

[A]

And, you know, the thing, the reason why it's. I think it's helpful for especially beginners and people who aren't. I mean, I think it's helpful I use it, but it's. I think it's helpful for people who aren't as comfortable talking about personality. Because, you know, there are patients, I think there's like a. You know, there's different patients that I do think it's. I don't see borderline personality disorder, and I do see a lot of trauma, and they identify with complex trauma. So I don't think it's necessary. I don't think they're using that label to not look more deeply into themselves. Like, I don't think they're avoiding another diagnosis. But there are a lot of patients that the complex PTSD label is used as a way not to look further into themselves and what's going on in their life. And those are the patients that I think it's important to kind of have a structure and an ability to say, listen, yes, there's certainly elements in your history that were traumatic, but there's something on top of it that is important that we look at. And I think we even said this earlier. Some people think that these conversations go awfully. Every single time I've had this conversation of whether I say you have borderline personality disorder or I say there absolutely are traits, the conversation has gone really well. Most patients really just want help. They want to feel better and they want to understand themselves. And a good diagnosis and a good formulation helps them do exactly that. Now, the flip side is there's a lot of people who argue that you shouldn't be giving a personality disorder label on the first appointment. And I think that's appropriate. I think it's not good practice to just be throwing out that label a ton after speaking to someone for 45 minutes. But for patients who have insight, who know the label, who have thought about it, it can be a really productive conversation. And the important thing is it guides treatment. So it's not like I'm just saying, like, you have bpd, your problem, but it really helps me to talk with the patient about what I think treatment is, the work that we're going to do, and then the referrals can be provided for them to continue working on this.

[B]

Yeah, it's probably not responsible to confirm a personality diagnosis on the first visit. But that's also probably true of many diagnoses. Unless it's hitting you in the face. Patient comes in saying, I've been diagnosed with borderline personality disorder by two prior practitioners. I've been two ruins of DBT and I've been hospitalized 30 times. And I think you're probably safe if you can rule out the other conditions. But you know, to highlight the aspects of what you just said. Be very careful about the possibility of any diagnosis, but particularly culturally laden or emotionally invested diagnoses and functioning as a form of resistance to appropriate treatment consciously or unconsciously for patients. Really, really important. I don't care what you call it, give them the right treatment. I don't care what they call it, as long as you're doing the right treatment. Okay. And then the other aspect is basically how that conversation goes. I think that the conversation going well or good is not about so much the specific words you use. It's about what you feel inside, if you truly feel care and that you want to help patients and you're really actively having that inside of yourself. I think as a human being, unless you're quite impaired as a clinician, sorry, you're going to do just fine in telling the truth to a patient. It's when there are parts of ourselves who are biased against a patient or who hate the patient either for good or bad reasons, for wrong or right reasons. I think that's when things get in the way. You're going to automatically act in a way that is not going to make a conversation go well. So it's a lot of internal self regulation to me anyway.

[A]

Yeah. And it's funny you say like internal self regulation because a lot of the times I think of it as less like I don't think I'm self regulating at the moment. It's that my formulation of BPD doesn't contain a lot of elements of anger and hate towards these patients. I think that comes across, whereas I think a lot of, especially like inpatient attendings, the label is used very pejoratively. So of course it's going to come across. If you think, you know, BPD patients eye roll and these patients are manipulative, if that's your formulation, then it's going to come across when you talk about it. Whereas my formulation is it's a really helpful label for a lot of people. And I really like when we're able to capture that diagnosis and get that treatment. And I don't Think that manipulation and being a bad person is part of the diagnosis whatsoever?

[B]

Yeah, I guess if a layperson has listened this far and they listened with the intention of finding out what is real or not, what is more valid or not, I think that the disappointing answer is that's not very important. The debate will rage on and the field will get to some kind of consensus. And the field has had consensus that are wrong ultimately and some that are right and we're not going to be able to know in the moment. That's life. Worry less about what you call something in terms of a single label. Worry more about your overall understanding of yourself and how your clinician understands you and whether you guys agree on that and whether you agree on the treatment plan and whether you do it. That's the important part. Doesn't matter what you call it. Make sure you're hitting those marks.

[A]

Yeah, and that's why I like CPTSD is that there's all these patients that in the past, here's my pragmatic reason for liking it, that in the past they go to psychiatry, they get labeled depression treatment, resistant depression. They get labeled all these things that get thrown all these different medications. And so a lot of times they don't fit typical personality disorders. And unlike you, a lot of providers don't have the ability to communicate about the alternative model in a way that, that resonates with the patient. And now there's a diagnosis that patients can understand themselves a little bit more and can understand that maybe medications aren't the best treatment and can understand what are some treatments that help. So you do see a lot of the treatments that help with BPD also help with. It's very, very similar to me. The only difference is maybe CPTSD should focus more on trauma focused therapy. So EMDR and traumas focused therapies and BPD should focus a lot more on the interpersonal dysfunctioning and the emotional regulation.

[B]

Yeah, yeah, I guess it's ultimately utilitarian versus truth seeking kind of perspective. My concern, as you might have already caught onto, is that it's just going to worsen stigmatization of the worst, most severe borderline conditions that need the most help. That's my bias as a SMI primary psychiatrist these days. But, you know, we just have to make do. It's an imperfect world. It's an imperfect system. We just have to try our best. I do think though, it's like giving opioids to a broken bone instead of setting the bone, you know, and the equivalent of setting the bone in our world, here is not what we tell the patients, but it's how we teach psychiatrists and therapists. People need to have a deeper understanding of the personality and how it's conceptualized and what the borderline conditions are, not just the stereotype versions that you see in the traditional DSM 4 model.

[A]

Yeah. Now, there's one last thing I want to sign off on, or, you know, a little thing in terms of something I commonly do in treatment with CPTSD or borderline patients. I think what's important when someone has CPTSD or borderline or you're giving those diagnosis. When I'm communicating it to the patient, I ask, what's your understanding of what this means? Because it's very interesting that it's very possible you and the patient will be in agreement with a diagnosis, but then you hear what they think that actually means, and it's like, oh, wait, I don't think that at all. And it can be on the end of, like, you ask them what they think borderline personality disorder means, and they go, well, I have one friend who constantly is threatening to kill himself, and he does it manipulatively, and then he asks for money and he says he needs money. So then he, like, does all these awful things and he's a drug user. And then that's a great jumping off point for explaining that that's not what borderline personality disorder means. And then the flip side is you ask, what does complex PTSD mean to you? And you'll hear patients say, well, it means that because my parents weren't that nice to me and all the problems I'm having now are the result of the way that my parents treated me. And you have to go like, well, actually, that's not what complex PTSD is. So regardless, I do think whenever a patient has a diagnosis, I think it's really important that they. Or for when I see a good prognosis and patients do really well, that they better understand what that diagnosis is. And for complex ptsd, the book I very commonly recommend is Complex PTSD From Surviving to Thriving by Pete Walker. I, you know, it's written by a person who has complex ptsd. There's elements that I don't love in the book, but I have seen a lot of patients who have found it really, really helpful. For borderline Personality Disorder. The opening resource I commonly Give is the YouTube channel Borderliner notes. And I really like the John Gunderson interview in. He's got, like, five different videos, so I'll find the one that I think fits the best for the patient, whether it's there. He's explaining globally what BPD is one of them. He's explaining like the common relationship patterns in bpd. And I say I'll send them that one video and I'll say but check out the other videos and see what resonates. So those are my two, like openers for I think it's really important if a patient has diagnosis that they better understand themselves through that diagnosis and not let it be something that is simplistic.

[B]

Yeah, yeah.

[A]

Got nothing to add.

[B]

Great resources there, I suppose. With nothing to add, I only have a question. I do wonder from the audience if there's anything that we didn't cover or anything that we didn't make clear that they would like made more clear to have more discussion on. That's something I'd like to hear about in the comments. And yeah, I think we are probably overdue for a reader comments or questions recap kind of episode, though I don't know how popular those really are since they can be a little bit more individualized.

[A]

Yeah, absolutely. Anything else add before on the topic? Nope.

[B]

I think I'm good to go. I want to hear from you guys and hopefully this was at least somewhat interesting, even if it wasn't necessarily helpful for everybody. It's kind of a niche topic, even if it's a popular one.

[A]

Thank you so much Dr. Fu. I'll.

[B]

I'll catch you next time. See you next time. Bye.

[A]

Thanks for listening. If you want to support the show, check out my very practical Antidepressant course. If you want to check that out, go to Psycho Farm Farm. If you prefer to read, you can go to Amazon.com you can just search my name Gregory G R E G O R Y Malzberg M A L Z B E R G and the book is Psycho Farm's Guide to Treating Depression. It's a nice, easy, readable, practical guide to medications for depression.