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Perceived trauma: its etiology and treatment.

Female adolescents in treatment for emotional disturbances are often diagnosed as suffering from borderline personality disorder. The usual treatment plan for such a diagnosis is based upon limit setting and boundary reinforcement. When this fails to produce results, the diagnosis comes into question. The present paper investigated 85 female adolescents who were being treated for problems associated with differentiation and emancipation in an inpatient setting. A treatment variation was introduced which suggested that these females were more likely to be suffering from a variety of post-traumatic stress disorder (PTSD). When their ritualistic behavioral repetitions were addressed by cognitive behavioral approaches, the behavior decreased. The struggle with boundary issues and references to the historical context of misery and deprivation became less frequent when the focus shifted to current behavior. Two groups emerged through the analysis of data. No difference in behavior or response to treatment could be established, but one group lacked a specific troubling experience which is essential for a diagnosis of PTSD. Maladaptive social behavior (e.g., splitting and projection) were accepted as confounding factors associated with cognitive style rather than "borderline" symptoms. With the new approach, recidivism decreased 14% and the number of outbursts diminished 10% to 12%. The altered treatment approach confirmed the hypothesis that these adolescents were experiencing the effects of trauma (actual or perceived) rather than some disabling personality disorder.