BPD and Trauma Therapy Together
If you have Borderline Personality Disorder, there's a high likelihood you also have a trauma history—studies show 75-90% of people with BPD have experienced significant trauma. As a Seattle therapist trained in both BPD treatment (DBT, Masterson) and trauma therapy (EMDR, Somatic Experiencing), I specialize in addressing both conditions together. Let me explain why integrated treatment is essential and how it works.
The BPD-Trauma Connection
Understanding the Overlap
Why They Co-Occur
Early trauma disrupts attachment
Chronic invalidation creates BPD patterns
Developmental trauma affects identity formation
Nervous system dysregulation underlies both
Coping mechanisms become personality patterns
Common Trauma Types in BPD
Childhood emotional neglect
Physical or sexual abuse
Chronic invalidation
Attachment disruptions
Complex developmental trauma
Bullying or peer rejection
How Trauma Shapes BPD
Trauma Creates:
Hypervigilance (abandonment fears)
Emotional dysregulation (overwhelm)
Dissociation (identity confusion)
Negative self-concept (shame)
Interpersonal difficulties (trust issues)
These trauma responses become the BPD symptoms we see.
Why Treating Both Matters
Treating BPD Alone: Limited Progress
Without Addressing Trauma:
Skills help but don't heal core wounds
Triggers remain active
Body holds trauma memories
Patterns return under stress
Root causes untouched
Like managing diabetes without addressing diet.
Treating Trauma Without BPD Focus: Dangerous
Risks Include:
Overwhelming emotional flooding
Increased self-harm
Destabilization
Therapy relationship ruptures
Retraumatization
Standard trauma therapy can destabilize BPD.
My Integrated Treatment Approach
Phase 1: Stabilization First (Months 1-6)
DBT Skills Before Trauma Work Essential skills include:
Distress tolerance for emotional flooding
Emotion regulation for trauma feelings
Interpersonal effectiveness for boundaries
Mindfulness for present-moment safety
Building Container
Establish therapeutic trust
Create safety protocols
Develop coping strategies
Stabilize daily life
Prepare for deeper work
Phase 2: Modified Trauma Processing (Months 6-18)
EMDR with BPD Adaptations
Shorter processing sessions
More frequent grounding
Careful target selection
Enhanced stabilization
Slower pacing
Somatic Experiencing Integration
Track nervous system capacity
Titrate activation carefully
Complete thwarted responses
Build body awareness
Integrate gradually
Masterson Developmental Repair
Address attachment trauma
Work with child parts
Rebuild self-structure
Integrate split representations
Develop coherent identity
Phase 3: Integration (Months 18+)
Weaving It Together
Connect trauma healing to daily life
Update relationship patterns
Consolidate identity changes
Build meaning from suffering
Create future vision
Special Considerations
Managing Emotional Intensity
BPD + Trauma = Amplified Reactions When processing trauma with BPD:
Emotions feel life-threatening
Body sensations overwhelming
Abandonment fears activate
Self-harm urges increase
Dissociation more likely
My Specialized Tools:
Moment-to-moment attunement
Frequent check-ins
Smaller processing chunks
Multiple grounding techniques
Flexible session structure
Relationship Dynamics
Trauma Work Triggers BPD Patterns Expect temporary increases in:
Idealization/devaluation of me
Testing behaviors
Crisis calls
Missed sessions
Attachment panic
How I Navigate:
Name patterns compassionately
Maintain consistent boundaries
Increase support without enabling
Process relationship directly
Stay steady through storms
Dissociation Challenges
BPD + Trauma = Complex Dissociation May experience:
Identity switching
Memory gaps
Depersonalization
Young parts emerging
Body disconnection
Integrated Response:
Parts work integration
Grounding before processing
Co-consciousness building
Gentle pacing
Safety first always
Treatment Modifications
EMDR Adaptations for BPD
Standard EMDR vs. BPD-Modified
Standard:
Full activation encouraged
Process to completion
Limited stabilization
Session-contained
BPD-Modified:
Careful activation titration
Partial processing okay
Extensive stabilization
Between-session support
DBT During Trauma Work
Skills Become Essential
TIPP for trauma flooding
Radical acceptance for past
PLEASE for vulnerability factors
Wise mind for integration
Self-soothing for processing
Diary Card Additions:
Trauma triggers
Dissociation frequency
Body sensations
Nightmare tracking
Integration experiences
Somatic Considerations
Body Work Modifications:
More psychoeducation
Slower approach to touch
Clear consent protocols
Predictable movements
Escape routes honored
Common Challenges and Solutions
"I'm Too Damaged"
BPD + severe trauma can feel hopeless
Reality:
Complex doesn't mean impossible
Slower doesn't mean stuck
Different path, same destination
Your resilience is remarkable
Healing happens in layers
"Therapy Makes Everything Worse"
Initial intensification is common
We manage by:
Slowing pace
Increasing support
Adjusting expectations
Building more resources
Trusting the process
"I Don't Remember Trauma"
Common with developmental trauma
We can work with:
Body memories
Emotional patterns
Relationship dynamics
Present-day triggers
What you do know
Success Indicators
Early Progress Signs
Using skills during triggers
Staying present more
Less therapy chaos
Body awareness growing
Hope emerging
Middle Phase Markers
Processing without destabilizing
Patterns connecting to trauma
Identity coherence building
Relationships improving
Self-compassion developing
Recovery Indicators
Trauma integrated, not ruling life
BPD symptoms significantly reduced
Stable functioning
Meaningful relationships
Post-traumatic growth
Is Integrated Treatment Right for You?
Consider this approach if:
You have BPD and trauma history
Previous therapy felt incomplete
Either trauma or DBT alone hasn't worked
You're ready for comprehensive healing
You can commit to the process
The Hope in Integration
When we treat BPD and trauma together:
Healing goes deeper
Changes last longer
Integration becomes possible
Root causes resolve
True transformation occurs
You don't have to choose between addressing your trauma or managing your BPD, with the right approach, both can heal together.
Beginning Your Integrated Journey
If you're struggling with both BPD and trauma, specialized integrated treatment can address both simultaneously. During our consultation, we'll discuss:
Your trauma history
Current BPD symptoms
Previous treatment attempts
Readiness for integrated work
How my training supports both
You deserve treatment that sees and addresses all of you.
