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Intolerable Pain: Trauma, Invalidating Environments and Pervasive Emotion Dysregulation in Refugees and Asylum Seekers

Intolerable Pain: Trauma, Invalidating Environments and Pervasive Emotion Dysregulation in Refugees and Asylum Seekers

Borderline personality disorder (BPD) is often associated with a history of traumatic experiences and/or exposure to an invalidating environment. In the trauma field many researchers and clinicians acknowledge that Post Traumatic Stress Disorder (PTSD) is limiting diagnostically in capturing the complex symptom presentations for some individuals who have experienced cumulative and prolonged exposure to trauma, as is common for many refugees and asylum seekers. In order to address this gap expert trauma clinicians have developed criteria to fit more appropriately with the presenting problems commonly exhibited by survivors of severe and cumulative trauma and the diagnostic category of Complex Post Traumatic Stress Disorder (CPTSD) has emerged. Refugee and asylum seeker clients with significant and prolonged trauma histories at times present with prominent symptoms of emotion dysregulation, reduced ability to tolerate distress, interpersonal difficulties and unstable identity concepts, which may be consistent with aspects of both BPD and CPTSD criteria. Through an exploration of a case study of a male asylum seeker, this presentation will demonstrate the potential for overlap between CPTSD and BPD presentations, the challenges of working with such a client within an environment of invalidating refugee status determination processes and the importance of a staged therapeutic approach with an emphasis on validation, non-judgement and skill development.