Understanding Trauma in IPV: Distinguishing Complex PTSD, PTSD, and BPD in Victims and Offenders
Abstract
:1. Introduction
2. Distinctive Features of Complex PTSD, PTSD, and BPD
2.1. Complex Post-Traumatic Stress Disorder and Post-Traumatic Stress Disorder
- Affective dysregulation (e.g., shifts in affective regulation that may occur as enduring feelings of dissatisfaction, tendencies towards self-harm or suicidal thoughts, explosive or notably restrained anger, compulsive or inhibited sexual behaviors, and/or suppressed or unpredictable emotional responses);
- Behavioral dysregulation (e.g., difficulties in controlling impulses, violence towards others, and/or risky behaviors);
- Impairments in interpersonal relationships (i.e., avoidance, isolation and withdrawal, disruption in intimate relationships, repeated search for a helper with pervasive or dysfunctional demands for care and reassurance, persistent distrust, and/or repeated failures of self-protection);
- Attentional or monitoring difficulties in the ability to direct or shift attention away from trauma-associated stimuli;
- Dissociation—alterations in consciousness (e.g., amnesia or hypermnesia due to traumatic events, transient dissociative episodes, and/or depersonalization/derealization);
- Somatic suffering (e.g., chronic pain, difficulty in regulating nervous system activation);
- Dissociative identity symptoms (i.e., altered self-concept with extremely fluctuating, unstable, and chaotic representations;
- Altered meaning systems (i.e., negative self-concept symptoms are defined as persistent beliefs about oneself as belittled, defeated, or worthless and are accompanied by deep and pervasive feelings of shame, guilt, or failure) [45,46]. Affective dysregulation, negative or altered self-concept, and disturbances in relationships are the three additional clusters of symptoms that, according to ICD-11, reflect disorders in self-organization [45,50,51].
2.2. Borderline Personality Disorder and Complex Post-Traumatic Stress Disorder
3. IPV as a Cross-Cutting Factor between PTSD, cPTSD, and BPD
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Authors | Type of Study | Aim of the Study | Main Result |
---|---|---|---|
Armenti & Babcock, 2021 [118] | Experimental study | Impact of rejection on IPV linked to borderline traits and anger | BPD features were positively associated with rejection sensitivity, physical assault, and psychological aggression, with trait anger mediating the relationship between BPD features and psychological aggression but rejection sensitivity not serving as a mediator. |
Atkinson et al., 2024 [69] | Systematic review | Similarities and differences in cPTSD and BPD symptomatology | Most studies found distinct profiles for cPTSD and BPD. The two profiles may present as comorbidities when they have experienced earlier and more recurrent interpersonal trauma and show greater functional impairment. |
Birkley et al., 2016 [106] | Meta-analysis | Association between PTSD symptoms, IPV, and relationship functioning | Hyperarousal had a small association with IPV, while emotional numbing and avoidance were moderately associated with parent, child, and family functioning, as well as intimacy problems; emotional numbing showed large associations with marital and parent problems. |
Carney & Buttell, 2005 [13] | Theoretical study | Discussion of attachment theory as a treatment variable | Women court-ordered into treatment for assaulting their intimate partners are excessively dependent on their partners before treatment. This dependency correlates with various forms of domestic violence, predicts treatment completion, and increases among those who complete the treatment. |
Crane et al., 2014 [11] | Cross-sectional study | Association between substance use and IPV perpetration | Alcohol and cocaine use disorders were significantly associated with IPV perpetration, while cannabis and opioid use disorders were not, and a comorbid alcohol use disorder increased the likelihood of IPV in those with cannabis or cocaine use disorders but decreased it in those with cannabis use disorder, with these patterns consistent across gender. |
Davis et al., 2001 [85] | Cross-sectional study | Association between types of child abuse, intimacy dysfunction, and trauma symptoms | Dysfunctional sexual behaviors, impaired self-reference, and depression significantly predicted the quality of current interpersonal relationships, while childhood sexual or multiple abuse experiences and anger/irritability predicted the quality of prior interpersonal relationships. |
Dutton & White, 2012 [21] | Cross-sectional study | Association between attachment insecurity and IPV | The spectrum of insecure attachment encompasses BPD and predicts the use of adolescent aggression and adult IPV. |
Dutton et al., 2006 [103] | Review | Associations between IPV, PTSD, and health outcomes | Explores the link between IPV, PTSD, and adverse health outcomes. |
Fernández-Fillol et al., 2021 [107] | Cross-sectional study | Risk factors for cPTSD among IPV survivors | Higher prevalence of women survivors that meet cPTSD over PTSD criteria. Low levels of resilience and expressive suppression are related to DSO symptoms. |
Gilbar & Ford, 2020 [108] | Cross-sectional study | Indirect effects of PTSD and complex PTSD on IPV | cPTSD symptoms, rather than PTSD symptoms, may link childhood polyvictimization to IPV victimization and perpetration among men mandated for IPV treatment, with high lifetime trauma exposure increasing their risk of sexual IPV victimization. |
Gilbar et al., 2018 [31] | Cross-sectional study | Construct validity of complex PTSD and associated risk factors | Cumulative lifetime trauma and physical childhood neglect were associated with both PTSD and DSO, cumulative childhood violence exposure and anxiety were associated only with DSO, depression was more strongly associated with DSO than PTSD, religious level contributed only to PTSD, and compulsory military service only to DSO. |
Gobin et al., 2013 [26] | Cross-sectional study | Effect of childhood maltreatment on PTSD | Both childhood maltreatment and IPV were positively associated with PTSD symptom clusters; IPV did not mediate the relationship between childhood maltreatment and the severity of PTSD symptom clusters among acute IPV survivors. |
Goldenson et al., 2014 [113] | Review | Psychopathology and treatment of female IPV perpetrators | Reviews female perpetrators of IPV, including within-group heterogeneity and related psychopathology, with treatment recommendations. |
Guzmán et al., 2024 [120] | Systematic review | Overview of the association between BPD and IPV | BPD is associated with both IPV perpetration and victimization, but different factors and the presence of particularities in each profile are observed based on gender and the role of the victim/perpetrator. |
Henderson et al., 2005 [22] | Empirical study | Association between attachment and intimate abuse | Attachment variables significantly predicted both the receipt and perpetration of psychological and physical abuse, with preoccupied attachment serving as an independent predictor; gender did not moderate these associations. |
Hines, 2008 [114] | Empirical study | Links between borderline personality traits and IPV | The results indicated that BPD predicted several forms of IPV, and gender did not moderate the association between BPD and IPV. |
Iverson et al., 2013 [104] | Cross-sectional study | Impact of PTSD symptoms, dissociation, and coping on IPV revictimization | PTSD hyperarousal symptoms, dissociation, engagement coping, and disengagement coping each significantly predicted physical IPV revictimization at the 6-month follow-up, with disengagement coping linked to higher revictimization risk and engagement coping associated with lower risk. |
Joksimovic et al., 2023 [2] | Review | Discussion of risk factors and associations | Females had a more complex IPV profile than males, with female risk factors, including younger age, having children, lower income, and reduced social support, while male risk factors included urban living, having children, and lower social support; all IPV exposures significantly increased the likelihood of multiple suicide-related phenomena for both genders. |
Krause-Utz et al., 2021 [117] | Cross-sectional study | Predictive value of childhood maltreatment and borderline traits on IPV | Affective instability and interpersonal disturbances play a key role in IPV perpetration, while interpersonal and identity disturbances may mediate the impact of childhood maltreatment on IPV victimization. |
Kuijpers et al., 2011 [116] | Cross-sectional study | Association between borderline traits and PTSD symptoms | BPD traits significantly increase the vulnerability for developing PTSD in IPV victims, independent of the severity of IPV. |
Moreira et al., 2022 [53] | Empirical study | Efficacy of cognitive-narrative therapy for IPV victims | Cognitive-narrative therapy seems to be an effective and essential tool in treating depression, PTSD, and BPD. |
Munro & Sellbom, 2020 [115] | Cross-sectional study | Relationship between BPD and IPV | Differences in diagnosis (DSM-traditional vs. DSM-alternative) of BPD and IPV. |
Owczarek et al., 2023 [71] | Cross-sectional study | Investigation of the connections between ICD-11’s PTSD symptoms and DSO with BPD in a clinical sample of individuals who have experienced multiple traumas | The results suggest that BPD and cPTSD are separate constructs, with affective dysregulation contributing to the potential overlap of constructs. |
Peters et al., 2017 [121] | Cross-sectional study | Role of negative urgency in the BPD–IPV relationship | Identifies negative urgency as a key factor linking BPD’s features and IPV in young men. |
Pichon et al., 2020 [122] | Mixed-method systematic review | Associations between infidelity, jealousy, and IPV | Reviews infidelity, romantic jealousy, and their associations with IPV against women using mixed methods. |
Pugliese et al., 2023a [14] | Theoretical study | Cognitive model of PAD and IPV | Cognitive model of PAD and its relationship with IPV. |
Pugliese et al., 2023b [17] | Pilot study | Cognitive model of PAD related to IPV | PAD as a precursor to IPV; cognitive model of PAD in IPV victims. |
Rauer & El-Sheikh, 2012 [105] | Longitudinal study | Relationship between IPV and sleep disturbances | Examines reciprocal pathways between IPV and sleep issues in both men and women. |
Richards et al., 2017 [109] | Cross-sectional study | Influence of childhood abuse on IPV perpetration and victimization | The results revealed significant relationships between child physical abuse and both IPV victimization and perpetration for males and females, but this effect diminished when emotional maltreatment was included in the model, with maltreatment effects altering when considering IPV victimization or perpetration. |
Saraiya et al., 2021 [70] | Cross-sectional study | To examine the construct validity of cPTSD in a sample of trauma-exposed and non-treatment-seeking young adults considering trauma characteristics such as social emotions and interpersonal functioning | The results indicated overlapping symptoms of PTSD, cPTSD, and BPD. In addition, shame may be a central emotion that differentiates the severity of presentation after exposure to trauma. |
Stopyra et al., 2023 [72] | Narrative review | Summarizing diagnostic differences and similarities and comparing qualitatively the neuroimaging findings related to affective, attentional, and memory processing in cPTSD, PTSD, and BPD | cPTSD, PTSD, and BPD might be related through a spectrum where overlapping brain regions are involved, but the specific symptoms differ based on how these regions are activated. |
Taft et al., 2011 [101] | Meta-analysis | Association between PTSD and relationship problems | True score correlations revealed medium-sized associations between PTSD and intimate relationship discord, physical aggression perpetration, and psychological aggression perpetration. |
Taft et al., 2016 [110] | Randomized controlled trial | Effectiveness of the intervention program | The Strength at Home Couples program, a cognitive-behavioral trauma-informed IPV preventive intervention for married or partnered military service members and veterans, effectively prevents physical IPV and reduces psychological IPV. |
Weaver & Resick, 2014 [27] | Cross-sectional study | Relationship between injury dimensions and PTSD | Residual injury status and two forms of psychological maltreatment uniquely predicted PTSD (but not depression), while body image distress and one form of psychological maltreatment also predicted PTSD, controlling for abuse length, physical assault severity, and number of acute injuries. |
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Disorder | General Characteristics (Core Symptoms and Features of Each Disorder) | Associations with IPV (How the Disorder Influences or Is Influenced by IPV) | Victim Profile (Common Traits or Behaviors of Victims with the Disorder) | Perpetrator Profile (Common Traits or Behaviors of Perpetrators with the Disorder) |
---|---|---|---|---|
PTSD | - Hyperarousal - Emotional numbing - Difficulty disengaging from abusive relationships | - Revictimization due to emotional numbing and hyperarousal - Aggression linked to threat perception | - Hyperarousal - Emotional numbing - Struggles to leave abusive situations | - Aggression driven by heightened vigilance - Perceives constant threats |
cPTSD | - Avoidance - Emotional detachment - Disturbance in self-organization (DSO) | - Emotional detachment and avoidance lead to revictimization - Severe relational instability and psychological violence in perpetrators | - Avoidance - Emotional detachment - High revictimization risk | - Relational instability - Psychological violence - Aggression fueled by paranoia and self-hatred |
BPD | - Emotional volatility - Identity instability - Fear of abandonment | - High risk of both victimization and perpetration - Strong links to IPV through emotional volatility and impulsivity | - Fear of rejection - Identity instability - High vulnerability to IPV | - Impulsivity - Aggression (psychological, physical, sexual) - Intense, unstable relationships |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Pugliese, E.; Visco-Comandini, F.; Papa, C.; Ciringione, L.; Cornacchia, L.; Gino, F.; Cannito, L.; Fadda, S.; Mancini, F. Understanding Trauma in IPV: Distinguishing Complex PTSD, PTSD, and BPD in Victims and Offenders. Brain Sci. 2024, 14, 856. https://doi.org/10.3390/brainsci14090856
Pugliese E, Visco-Comandini F, Papa C, Ciringione L, Cornacchia L, Gino F, Cannito L, Fadda S, Mancini F. Understanding Trauma in IPV: Distinguishing Complex PTSD, PTSD, and BPD in Victims and Offenders. Brain Sciences. 2024; 14(9):856. https://doi.org/10.3390/brainsci14090856
Chicago/Turabian StylePugliese, Erica, Federica Visco-Comandini, Carolina Papa, Luciana Ciringione, Lucia Cornacchia, Fabiana Gino, Loreta Cannito, Stefania Fadda, and Francesco Mancini. 2024. "Understanding Trauma in IPV: Distinguishing Complex PTSD, PTSD, and BPD in Victims and Offenders" Brain Sciences 14, no. 9: 856. https://doi.org/10.3390/brainsci14090856