Ruth Blizard, PhD

Individual and Group Psychotherapy


August 2017

Training, Supervision and Consultation

Offering classes, workshops, individual and group consultation on relational, psychodynamic psychotherapy, diagnosis and treatment of personality disorders, complex trauma and dissociation

Borderline Personality or Chronic Relational Trauma Disorder:

Understanding BPD as a disorder of trauma, attachment and dissociation


Ruth A. Blizard, PhD

Open to all mental health professionals


The evidence increasingly shows that borderline personality derives from chronic trauma, neglect and especially, double-bind relationships in the family of origin. An understanding of these factors helps to form a framework for treating this bewildering and challenging disorder.





The hallmark characteristics of borderline personality


1)      affect dysregulation

2)      fear of abandonment

3)      idealization and devaluation

4)      explosive rage

5)      self-mutilation



Can be better understood as resulting from dissociative fragmentation due to

1)      neuropsychological state changes

2)      disorganized attachment

3)      traumatic reenactment

4)      post-traumatic magnification of perceived threat

5)      avoidance of overwhelming memories


A relational approach to treatment, based on an understanding of the traumatic origins of these characteristics, will be demonstrated. Role-play of therapeutic interactions will illustrate how to use empathic confrontation to overcome resistance to change and marshal clients’ strengths. When self-defeating behavior can be reframed as survival responses to trauma that were originally adaptive, but currently have maladaptive consequences, clients can learn to transform their defenses into healthier coping skills.


This presentation is based on the chapter, “Chronic relational trauma disorder: A new diagnostic scheme for borderline personality and the spectrum of dissociative disorders,” by Elizabeth F. Howell and Ruth A. Blizard in Dell, P. F. & O’Neil, J. A. (2009) Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge.


Selected Presentations

Borderline psychosis, double binds and chronic relational trauma in borderline personality disorder, European Society for Trauma and Dissociation, Amsterdam, 2008

Multiple, contradictory presentations in dissociative patients with substance abuse, eating disorders or sociopathic traits: A comprehensive, multidisciplinary approach, ISSTD, Philadelphia, 2007

Empathic Treatment of Borderline Personality: Clinical dilemmas and complex relational trauma, Centennial Peaks Hospital, Louisville, CO, 2007

The interface of borderline and sociopathic personalities on the dissociative spectrum: Is treatment possible? ISSTD, Los Angeles, 2006

Chronic relational trauma disorder: Empathic treatment of borderline personality, UK Society for the Study of Dissociation, Norwich, Norfolk, UK, 2006

Chronic relational trauma disorder: Traumatic attachment on the dissociative spectrum, ISSD, Toronto, 2005

Disorganized attachment, dissociated self-states and a relational approach to treatment, Upstate Medical School, Syracuse, NY, 2005

Alternating, dissociated, victim and perpetrator self-states in domestic violence, ISSD, New Orleans, 2004

Dissociation and personality disorders: Relational dilemmas, borderline personality and pathological narcissism, ISSD, Chicago, 2003

Disorganized attachment and dissociation, and Assessment and treatment of dissociated ego states in BPD and DID, ISSD, New Orleans, 2001

Transference enactment, projective identification, and countertransference traps in the treatment of dissociative disorders, ISTSS, San Antonio, 2000

Dissociated masochistic and sadistic ego states: An object relations approach to treatment, ISSD, San Antonio, 2000

Treatment-Resistant Dissociative Clients: Effective Techniques Derived from Psychoanalytic Theory, ISSD, Seattle, 1998

Therapeutic Alliance with Abuser Alters in DID: The Paradox of Attachment to the Abuser, ISSD, San Francisco, 1996

Dissociative Identity Disorder, United Health Services, Binghamton, NY, 1995

Treating severe personality and dissociative disorders, Seminar series, Vestal, NY, 1993

Attachment to the abuser: Intimacy and isolation in abuse survivors, PPA, Pittsburgh, 1992

Borderline or PTSD: Integrating object relations and trauma-based models, NYSPA, Bolton Landing, NY, 1992

Symptoms and sequellae of sexual abuse in adults, NYSPA, Montauk, NY, 1991