When Trauma Meets Personality and Suicide: A Case Report on Complex PTSD and Borderline Personality Disorder

Complex posttraumatic stress disorder (C‐PTSD), formally recognized in ICD‐11, was proposed to capture the enduring psychological sequelae of chronic and interpersonal trauma, particularly when occurring during development. Its clinical overlap with borderline personality disorder (BPD) remains a matter of ongoing debate. This case report describes a patient presenting with comorbid C‐PTSD and BPD with chronic suicidality, illustrating diagnostic complexity and therapeutic challenges in trauma‐related personality organization. A 35‐year‐old woman with a history of prolonged intrafamilial sexual abuse from ages 5 to 17 presented with chronic suicidal ideation, recurrent suicide attempts, severe affective instability, dissociation, self‐injurious behavior, and significant interpersonal dysfunction. Diagnoses of C‐PTSD and BPD were established based on longitudinal clinical assessment according to ICD‐11 and DSM‐5 criteria, in addition to recurrent depressive disorder. Over 3.5 years of multidisciplinary follow‐up, she underwent multiple pharmacological trials, repeated inpatient admissions, intravenous esketamine, electroconvulsive therapy (ECT), brainspotting sessions, and long‐term psychoanalytic psychotherapy. Interventions resulted in transient and partial improvements but failed to produce sustained stabilization. Despite intensive multidisciplinary follow‐up and repeated crisis‐oriented interventions, the patient died by suicide following a medication overdose. This case highlights the substantial clinical overlap between C‐PTSD and BPD in individuals exposed to early and chronic interpersonal trauma, underscoring the diagnostic and clinical management challenges observed in severely ill patients with persistent suicidality. It further illustrates the limitations of fragmented, crisis‐driven care in the absence of sustained, structured trauma‐focused and suicide‐specific interventions. These findings support a dimensional, developmental trauma‐informed approach to diagnosis and treatment planning in complex presentations marked by chronic suicidality and enduring disturbances in self‐organization. Finally, the case underscores the broader need for comprehensive and transdisciplinary public policies focused on child protection and the promotion of child and adolescent mental health.