The Hidden Diagnosis: How Complex PTSD's Absence from Official Manuals Harms Sexual Abuse Survivors

The Problem

When I discovered Dr Robert Kehoe and some of his staff had criminally falsified my medical records stating I had concealed my pregnancy and took every drug other than heroin and had killed my baby, rather than writing the truth that I was a drug rape victim and anorexic who had not known she was pregnant and I certainly DID NOT take all drugs other than heroin during my unknown about pregnancy:

I also discovered a diagnosis of BPD.

I might add this diagnosis was handed out in a few days and is highly suspect, considering is attached to a pack of criminal lies about me. And indeed my contact with him had been for no more than TWO minutes and TWO minutes only when I had walked out on him.

Upon researching it seems that many rape victims are not having their trauma identified and labelled, they themselves are then labelled as having a disordered personality. The insults never end, it appears when you are raped. It seems that this is commonplace and many other women find themselves victims yet again of this shameful misogyny on top of the original crime and trauma. Indeed, many rape victims seeking compensations find they end up having to claim for the BPD they have been misdiagnosed with instead of the PTSD they have not been diagnosed with.

Imagine discovering a psychological condition backed by extensive research and endorsed by leading mental health experts worldwide, yet officially unrecognized in North America. This scenario isn't hypothetical—it describes complex PTSD, a condition whose absence from diagnostic manuals is creating serious consequences for sexual abuse survivors in the #MeToo era.

Sexual abuse victims, psychiatrists, and psychologists globally are raising alarm about this gap in recognition. The condition, identified in 1990 through studies of sexual abuse survivors and others who experienced severe childhood trauma, was later validated by brain imaging technology that revealed distinct neurological patterns.

Despite appearing in peer-reviewed research, complex PTSD remains absent from North America's Diagnostic and Statistical Manual (DSM)—the authoritative guide that determines mental health definitions, insurance coverage, educational services, disability benefits, and treatment options.

The Misdiagnosis Crisis

This recognition gap forces many sexual abuse survivors into a diagnostic maze. Instead of receiving a complex PTSD diagnosis, they're frequently misdiagnosed with borderline personality disorder (BPD), explains Toronto psychotherapist Sly Sarkisova, who specializes in trauma treatment.

While these conditions share similar symptoms, they differ fundamentally. Recent research indicates BPD has a 55% genetic component, whereas complex PTSD stems from prolonged traumatic exposure, typically during childhood. BPD primarily involves risk-taking behaviors including suicidality, impulsivity, self-harm, anxiety, emptiness, relationship difficulties, and extreme emotional volatility. Complex PTSD patients, according to a 2014 European Journal of Psychotraumatology study, tend to be less impulsive, unstable, and prone to self-harm.

Sexual abuse survivors often display symptoms common to both disorders—anxiety, mood fluctuations, depression, emptiness, and displaced anger—leading to frequent misdiagnosis. "Someone dealing with complex trauma gets told they have problems regulating emotions," Sarkisova notes.

This misdiagnosis carries devastating consequences. BPD diagnoses are stigmatizing and pejorative—patients are labeled as having "disordered" personalities, deemed "difficult," and because the condition is considered incurable, some psychologists avoid treating them entirely.

"The borderline diagnosis for sexual abuse survivors is misleading nonsense because it locates the problem within the survivor's personality rather than acknowledging what happened to them," explains Gillian Proctor, who leads the psychotherapy program at the University of Leeds.

Gender and Political Dimensions

The misdiagnosis issue has troubling gender implications. BPD has become associated with "a parody of supposed feminine characteristics," according to Glyn Lewis, head of psychiatry at University College London. "BPD is often misapplied, especially to women or people assigned female at birth, pathologizing their emotional expressions of suffering," Sarkisova observes.

Re-diagnosis with complex PTSD remains unlikely since therapists hesitate to diagnose conditions unrecognized by the DSM.

Historical Context and Missed Opportunities

The misdiagnosis problem emerged early. BPD entered the DSM in 1980 and the UK's International Classification of Diseases in 1996. During this period, Harvard psychiatrists Bessel van der Kolk and Judith Herman questioned whether these patients truly had personality disorders or were experiencing psychological consequences of childhood abuse.

Their 1989 American Journal of Psychiatry study proved prescient: 81% of BPD-diagnosed patients reported severe childhood abuse and/or neglect, usually before age seven. The researchers proposed reclassifying these individuals as having complex PTSD.

In 1990, van der Kolk's team presented their case to DSM founder Robert Spitzer at Columbia University. Success seemed imminent when the American Psychiatric Association's PTSD committee voted in 1993 to add complex PTSD to the next DSM version.

Twenty-six years later, nothing has changed.

"It was sexist," argues Katherine Porterfield, a child psychologist at NYU Medical School. "Yes, this affected women because they're more likely to be abused, but also because our male-dominated field saw these women as 'difficult.'"

Research and Treatment Implications

These attitudes have stunted scientific progress. The lack of North American recognition discourages research into a condition already labeled "difficult to treat." Without research funding, studies on complex PTSD cure rates and effective treatments remain scarce.

Van der Kolk, now a leading trauma expert and bestselling author of "The Body Keeps the Score," considers misdiagnosis standard practice. "Diagnosis determines available treatment and insurance coverage," he explains. "Without complex PTSD recognition, insurance companies won't reimburse treatments that might work. Instead, patients receive pejorative diagnoses that make their lives more difficult."

Personal Impact Stories

"It's powerfully ironic that women experiencing profound sexual trauma get pathologized as having personality disorders," says Lisa Walter, a Winnipeg-based journalist and sexual abuse survivor who received a BPD misdiagnosis. "It makes it easier for the world to flush us down the toilet."

BPD's historical baggage compounds the problem. Originally applied to treatment-resistant women on the "borderline" of psychosis, the diagnosis later incorporated genetic explanations for its supposed incurability. Though modern definitions exclude psychopathy references, some therapists and the public still use the term to imply irrationality and uncontrollability.

The stigma creates additional barriers. Some sexual abuse survivors avoid disclosing their experiences to mental health professionals, fearing BPD diagnosis. Andrea Nicki, a Vancouver poet and professor, hid her childhood sexual abuse for years. "As soon as you mention sexual abuse, people think BPD," she explains. "They assume instability and personality disorders."

When Nicki finally disclosed her abuse to a psychiatrist in 2008, he diagnosed her with BPD despite her lacking most symptoms. A misinterpreted laugh during the session—when he said "I really care for you"—led him to note emotional volatility.

Consequences of Misdiagnosis

Brain imaging advances have enhanced complex PTSD understanding. Functional MRI and EEG technology allow scientists to examine how prolonged trauma affects specific brain regions, information crucial for developing treatments.

However, misdiagnosis continues affecting treatment success rates. Complex PTSD typically requires trauma-focused therapy, while BPD treatment focuses on controlling aggressive impulses, improving relationships, and moderating difficult emotions and compulsive behaviors.

Misdiagnosis creates stigma from both the public and healthcare professionals. A 2015 British Journal of Clinical Psychology study showed doctors rating panic attack symptoms as worse and offering less hope for recovery when told the patient had BPD.

Walter experienced this stigma firsthand after her 2008 BPD diagnosis following depression and self-harm episodes. As a survivor of childhood molestation and adult rape, she found many symptoms didn't fit. When she raised concerns, her psychiatrist dismissed them, noting the BPD diagnosis was necessary for accessing free therapy.

The diagnosis on her medical chart changed how professionals treated her. Nurses showed less compassion during self-harm incidents. An ER doctor attempted stitching a self-inflicted wound without anesthetic, appearing irritated by her diagnosis.

The stigma extended beyond medical settings. During testimony about police brutality at the 2010 G20 Toronto summit, a defense lawyer used her BPD diagnosis to suggest she behaved irrationally and aggressively. "As soon as you say BPD, people think irrational, angry woman," Walter observes. "The phrase carries extremely negative connotations."

Progress and Ongoing Challenges

The UK is making gradual progress. The National Health Service formally recognized complex PTSD last year, and preliminary ICD-11 versions include it, with final publication expected in 2022.

However, some UK therapists remain skeptical. Clinical psychologist Dr. Jay Watts, who writes extensively about complex PTSD, argues the new ICD-11 diagnostic criteria are "so limited" that most complex PTSD sufferers won't qualify, leaving them "stuck in individualizing, pathologizing diagnostic ghettos."

North America shows no signs of including complex PTSD in the DSM. Research into effective treatments for sexual abuse survivors and other complex PTSD patients remains hampered by institutional rigidity, misdiagnosis, and funding limitations.

The Path Forward

"Trauma and sexual violence survivors deserve appropriate support," emphasizes one advocate. "They should receive care and respect, not further shame and stigmatization through dehumanizing labels."

The complex PTSD recognition battle represents more than diagnostic semantics—it's about ensuring survivors receive accurate diagnoses and effective treatments rather than stigmatizing labels that compound their trauma. Until North American psychiatric establishments acknowledge this condition, countless survivors will continue navigating a system that misunderstands their experiences and needs.