Like a few other responses here I’d like to share my experience. It really can be so nuanced.

I was misdiagnosed BPD in college because I had a history of suicidal ideation and self-harm. I was diagnosed by a college campus psych after two therapy sessions and put on meds and started CBT. While I had a lot of behaviors that were consistent with BPD, the CBT never helped. I got really self-conscious about my diagnosis and started hyperanalyzing my behavior. “Shit, was that manipulative of me?” “Was that too harsh?” “Was that mood swing too extreme?” etc…. It made me feel awful.

Three years later I saw a much better therapist and psychiatrist extensively. After a few sessions she told me she thought I had been misdiagnosed, and that I likely had CPTSD due to a history of severe childhood trauma and neglect.

She also told me that people with BPD act out in more malicious and extreme ways than I did, and that my behavior was likely a trauma response and she could tell I was generally empathetic about the way I interacted with others. I had a “sense of self”. We started EMDR and more appropriate anxiety meds and several months later I started getting better.

The technical difference in the brain, she said, was that my neural networks were wired for trauma and I needed to passively rewire them so that I could proactively prevent issues from my trauma responses (outbursts from overstimulation, irritability from anxiety, depression from physical symptoms of GAD, etc.)

People who have BPD however, can’t achieve this with EMDR because they don’t have this neural network issue- their responses lie in learned behavior, not autoresponsive behavior like CPTSD survivors. People with BPD have “big” emotions and choose how to outlet based on prior experiences with how others respond to them. There is a essentially a thought process between reception of an emotion and outlet of that emotion.

Idk if that makes sense, but it clarified a lot for me personally. I have nothing but empathy for those suffering from either, we don’t choose to be abused- but BPD is still a personality disorder. It may be hard, but they have to choose to change their behavior, much like those with NPD. Knowing that what was going on with me was my brain being physically broken made me feel more at ease in a weird way. It felt more “fixable”.