BPD plus NPD

[zondolit]

There are lots of resources to learn about BPD and the same for NPD. I've come across numerous lists that try to show the differences between these two personality disorders. But what about people who are both BPD and NPD? This is apparently quite common. Any thoughts, experiences, or resources particular to BPD+NPD?  Thanks.

[livednlearned]

I found Elinor Greenberg's book on BPD, NPD, and Schizoid Adaptions helpful.

She describes personality disorders as "adaptations of the self" that become fixed rather than flexible.

"They persist in organizing all or most of their relationships in the same way, instead of allowing the unique characteristics of each relationship and the moment-by-moment flow of the interaction to determine what is figure and what is ground for them. Presumably, this is because these clients have great, unmet interpersonal needs from the past which are pressing for fulfillment and, hence, they are continually organizing the interpersonal field in terms of what seems to offer them the best chance to complete the unfinished situation."

"The pressing nature of clients' need interferes with their ability to be fully present with others and to assess accurately who they are. Instead, they tend to project onto others one of the roles in their old, incomplete, interpersonal drama; and then they frequently misinterpret the other's response because they are only seeing it from the point of view of their own unmet needs and fears."

People with BPD "tend to be drawn to people who they imagine will love and take care of them. They then enact separation and individuation dramas marked by clinging and distancing behavior and a focus on intense one-to-one relationships."

Whereas people with NPD are unable to regulate their self-esteem by themselves. They can't reassure themselves of their own worth, so tend to seek people who have high status as a form of validation of their own worth. "They often act as if everyone they meet is there to admire or shame them, as if these were the only possible and appropriate responses the other person could make."

With my ex, he was definitely seeking someone who would love and take care of him. He had a big boy job but in the home it was like caring for a child. He became needy/clingy when our son was born, and had difficulty when I was traveling or at work, needing reassurance that I was thinking of him or coming home soon and would claim he couldn't do something without me. However, feeling vulnerable (whether it was demonstrating neediness) seemed to kick narcissistic traits into high gear. I would be devalued for not achieving higher status things in his mind, but this seemed to happen when he either felt vulnerable or abandoned.

n/BPDx was ordered to get a psychiatric evaluation after a psychotic episode during our custody battle. In the state where we divorced, psych evals can only be read by lawyers. My lawyer could read parts of it to me, and the judge could read it, but I wasn't permitted to have a copy. Yet, in court my ex cross-examined me on the witness stand about his psych eval (he was representing himself). When the judge told him I hadn't read it, n/BPDx insisted I have a copy, which struck me as a narcissistic way to handle this extreme vulnerability. He was laid bare in that evaluation so had to perceive his greatness, and then needed me to confirm it, except the purpose of the hearing was about our son, not whether n/BPDx graduated at the top of his class in college.

I see some similarities in my stepdaughter, although she is much more overt about being a waif. However, there is definitely a streak of narcissism. My guess is that competition with a sibling for praise became deeply entwined in the pathological way they both tried to adapt to the family dysfunction.

Both n/BPDx and my stepdaughter have BPD mothers who cared about status, though you would never think that if you met them given the way they lived.

What is it that makes you think BPD/NPD combined is common? I would guess that BPD with some narcissistic coping mechanisms is more common than NPD who are childlike and require caretaking.

[zondolit]

Thanks, livednlearned. I'm struck by how sad Greenberg's descriptions are.

I've come across many references that say up to 40 percent of people with BPD also have NPD. It appears this comes from one 2008 study (Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533-545. doi:10.4088/jcp.v69n0404). https://www.verywellmind.com/narcissistic-personality-disorder-425426 has more information. A more recent 2018 study (https://guilfordjournals.com/doi/abs/10.1521/pedi_2017_31_306) found co-occurrence to be 13 percent in people with BPD.

 

[livednlearned]

This line from the verywell article made me laugh: "If you are in a relationship with someone who has BPD, NPD, or both, encourage them to seek treatment."

What did you find useful from the article?

[zondolit]

This line from the verywell article made me laugh: "If you are in a relationship with someone who has BPD, NPD, or both, encourage them to seek treatment."

I don't know. . .Maybe a band-aid or throat lozenge will help?

Mostly I found it helpful that the article had the source of the 40 percent factoid I've come across a lot and was beginning to think had no basis in reality.

Also it suggests that, while treatment is difficult for BPD, it might even be harder for BPD+NPD. (Maybe a band-aid plus a throat lozenge?)

[livednlearned]

I found it helpful that the article had the source of the 40 percent factoid I've come across a lot and was beginning to think had no basis in reality.

Also it suggests that, while treatment is difficult for BPD, it might even be harder for BPD+NPD.

It's a bit of a double-edged sword for me. On one hand, it validates the difficulties I had with n/BPDx and why leaving was the only option.

On the other hand, it made me think I must have problems being attracted to someone with so many issues.

[Cat Familiar]

Prior to realizing that my husband has BPD, I asked him to go to marital counseling with me, thinking that our issues were related to communication problems.

I’d been told repeatedly that I was a very good communicator by friends and acquaintances, and my husband is extremely intelligent and had worked as an attorney for years. Yet…

Naively I assumed that if we just went to therapy with someone who was well versed (a psychologist) and intelligent—our issues would be solved.

Didn’t exactly work out that way.  He accused the psychologist and me of “ganging up on him” and even after a year of therapy, little had changed. We could talk slightly better before things went off the rails.

A couple of years later, I found this website and decided to do individual therapy with the psychologist. She then told me that my husband has a personality disorder. When I asked her to define which one, she declined, saying that the current thinking is that personality disorders are fluid, and that more than one can be involved.

Thinking back on our joint sessions, it was obvious that he displayed much more narcissism, while privately he acted out his BPD, when I was the only witness to the crazy.

Some years later, knowing what I now know, I tend to agree with the therapist. I’ve often seen him display overt narcissistic behavior when he is angry or frustrated with others, while the BPD is always covert and only manifested around me.

[EyesUp]

I don't know. . .Maybe a band-aid or throat lozenge will help?

Also it suggests that, while treatment is difficult for BPD, it might even be harder for BPD+NPD. (Maybe a band-aid plus a throat lozenge?)

 

Thoughts...

I'll echo Cat Familiar's comment about fluidity/spectrum/continuum descriptions of B-Cluster disorders...  I can't offer an academic or clinical citation, however I find this view fits with a variety of people I've known who appear to meet a sort of mix-and-match set of B-Cluster criteria...

In discussing my n/BPDx with my PsyD therapist over the years, said therapist echoed the idea that the B-Cluster is a framework that identifies certain prevalent or event dominant traits or attributes - but that individuals generally tend to meet some but not all criteria for a given type, and may also present co-morbidities across the range, or may express other behavioral conditions such as anxiety or depression...

[zondolit]

Cat, I cannot believe how much my story follows what you write here.

[zachira]

Cat Familiar's comments also resonate with me. I think the question is what fear predominates most of the time. Does the person mostly fear being abandonned (BPD) or being found out as being driven to appear superior to others to hide deep feelings of inferiority without empathy for others (NPD)? I agree a person can have both BPD and NPD just like a drug addict can apperar to have an underlying personality disorder, particularly NPD. Once all diagnosis are treated including the addiction, the symptoms of NPD may mostly disappear or still be very predominant.  

[livednlearned]

I do think a combination of BPD and NPD means good luck trying to survive that relationship.

It seems like a treatment resistant combination.

Our worst night post-divorce was n/BPDx having a psychotic episode while our son was with him. I thought he was going to kill himself and then S11. One of the most harrowing nights of my life with a firehose of texts, DMs, emails, voicemails about never seeing my son again etc.

Of course it was a weekend. My therapist responded to my SOS call and said so matter-of-factly "He won't kill himself. He's too narcissistic. He'll be at your door on time for drop off."

Which is exactly what happened.

Might be the only silver lining to narcissism if that's in fact accurate.

[zachira]

The most dangerous type of person is one that is suicidal and homicidal. Some of these people are extremely narcissistic with sociopathic traits.

[zondolit]

Might be the only silver lining to narcissism if that's in fact accurate.

The 2018 study referenced above found that people with BPD and NPD are hospitalized less than those with only BPD and they self-harm and attempt suicide less (although this second result isn't statistically significant). The authors speculate that narcissism may be a "protective factor" for this group.

[scraps66]

Read my intro story.