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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: DIFFERENCES|COMORBIDITY: Borderline and Narcissistic Personality Disorder  (Read 85819 times)
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« on: March 01, 2009, 07:21:26 PM »

Both are personality disorders, and they share some of the same symptoms, so how do you tell them apart?

Finding anything positive about narcissism is difficult, since most T find them very resistant to treatment. Here is a very negative view, but one that I found very informative...

Narcissism

Joanna M. Ashmun.

www.halcyon.com/jmashmun/NPD/index.html

Narcissistic individuals feel that they are special and unique in ways that others aren’t. They lack empathy to a stunning degree, and are amazed when others protest their poor treatment of them. They expect privileges and indulgences, and they also feel entitled to exploit other people without any trace of reciprocation. Their behavior is contemptuous towards others, a dismissive attitude towards other people's feelings, wishes, needs, concerns, standards, property, work, etc. In their minds normal rules don’t apply to them and they will break them when they feel they can get away with it, yet they expect others to follow them. And they criticize, gripe, and complain about almost everything and almost everyone almost all the time. Narcissists have little sense of humor. They don't get jokes, not even the funny papers or simple riddles, and they don't make jokes, except for sarcastic cracks and the lamest puns. Narcissists are not only selfish and ungiving -- they seem to have to make a point of not giving what they know someone else wants.

There is only one way to please a narcissist (and it won't please you): that is to indulge their every whim, cater to their tiniest impulses, bend to their views on every little thing. and do not expect any reciprocation at all, do not expect them to show the slightest interest in you or your life (or even in why you're bothering with them at all), do not expect them to be able to do anything that you need or want, do not expect them to apologize or make amends or show any consideration for your feelings, do not expect them to take ordinary responsibility in any way. Once they know you are emotionally attached to them, they expect to be able to use you like an appliance and shove you around like a piece of furniture. If you object, then they'll say that obviously you don't really love them or else you'd let them do whatever they want with you. If you should be so uppity as to express a mind and heart of your own, then they will cut you off -- just like that. Once narcissists know that you care for them, they'll suck you dry -- demand all your time, be more work than a newborn babe -- and they'll test your love by outrageous demands and power moves. In their world, love is a weakness and saying "I love you" is asking to be hurt, so be careful: they'll hurt you out of a sort of sacred duty. They can't or won't trust, so they will test your total devotion. If you won't submit to their tyranny, then you will be discarded as "no good," "a waste of time," "you don't really love me or you'd do whatever I ask," "I give up on you." These people are geniuses of "Come closer so I can slap you."  

Psychology Today

www.psychologytoday.com/conditions/narcissistic.html

   * Overreacts to criticism, becoming angry or humiliated

   * Uses others to reach goals

   * Exaggerates own importance

   * Entertains unrealistic fantasies about achievements, power, beauty, intelligence or romance

   * Has unreasonable expectation of favorable treatment

   * Needs constant attention and positive reinforcement from others

   * Is easily jealous


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« Reply #1 on: March 02, 2009, 07:00:33 AM »

    Here is a very negative view, but one that I found very informative...

    No doubt. smiley   The late Joanna Ashmun and the late Kathy Krajco, popular blogger/ abuse victim advocates, had some strong opinions about narcissisism.  And the blogger Sam Vaknin's material on narcissisism is frightening.  But, like the other PDs, I think NPD is best viewed as a spectrum of severity with a huge number of people being "subclinical".  In many cases we can learn to communicate in a way to reduce relationship struggles and we can learn to understand the tendencies and how to step back and not become emotionally injured.  

    I saw this description from Jeff Ball, Ph.D. that I thought it was pretty straight forward. Narcissistic Personality Disorder describes persons with an exaggerated sense of self-importance or uniqueness, and a preoccupation with receiving attention. Narcissists will often overstate their own achievements and talents, or focus upon the special nature of their problems. In essence, the narcissist's fragile self-esteem is revealed by their preoccupation with how others regard them. Features of a narcissistic personality include a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. There is also a need for constant attention and admiration, and either a cool indifference or feelings of rage, inferiority, shame, humiliation, or emptiness in response to criticism, indifference of others, or defeat.  ~ Jeff Ball, Ph.D..

    How to Distinguish NPD from Borderline Personality Disorder

    pwNPD traits differ from pwBPD traits in that pwNPD traits have a relatively stable self-image, and lack self-destructiveness, impulsivity, and abandonment fears.

    Otto Kernberg MD (Cornell) differentiates between the person with NPD and those with borderline personality disorder (BPD) on the basis of:

      (1) their relatively good social functioning,


      (2) their better impulse control, and


      (3) their "pseudosublimatory" potential, namely, the capacity for active, consistent work in some areas which permits them partially to fulfill their ambitions of greatness and of obtaining admiration from others.  Highly intelligent patients with this personality structure may appear as quite creative in their fields:  narcissistic personalities can often be found as leaders in industrial organizations or academic institutions; they may also be outstanding performers in some artistic domain.  Careful observation, however, of their productivity over a long period of time will give evidence of superficiality and flightiness in their work, of a lack of depth which eventually reveals the emptiness behind the glitter.  Quite frequently these are the "promising" geniuses who then surprise other people by the banality of their development.  They also are able to exert self-control in anxiety-producing situations, which may at first appear as good anxiety tolerance; however, analytic exploration shows that their anxiety tolerance is obtained at the cost of increasing their narcissistic fantasies and of withdrawing into "splendid isolation." This tolerance of anxiety does not reflect an authentic capacity for coming to terms with a disturbing reality.


    Except for instances of severe forms of NPD, these individuals are more capable of high, sustained achievement and will have a more successful work history than the person with Borderline Personality Disorder.

    Both persons with NPDs and BPDs place great importance on attention; however, unlike borderlines, who "seek nurturing attention because they need it, narcissists feel they deserve admiring attention because of their superiority."

    Persons with either Narcissistic Personality Disorder or Borderline Personality Disorder tend to have have weak interpersonal relationships, struggle to love others, have difficulty empathizing, are egocentric in their perceptions of reality, and have a great need for attention.  Unlike the borderline personality, however, because the personality of someone with NPD is more well-integrated, people with NPD are less likely to have episodes of psychotic states, especially when under stress.

    A key distinguishing feature of BPD is neediness; in contrast, for NPD an important discriminator is grandiosity.  Likewise, persons with NPD are less self-destructive, have better impulse control, a higher tolerance for anxiety, and are less preoccupied with dependency and abandonment issues than are BPDs.

    Finally, the self-mutilation and persistent overt rage that are often characteristic of the borderline personality are absent in NPD.

    Kernberg, O. (1984). Severe personality disorders. New Haven: Yale University Press.

    Ronningstam, E. (1999). "Narcissistic personality disorder."  T. Millon, P. Blaney, & R. D. Davis (Eds.), Oxford Textbook of Psychopathology (pp. 674-693). New York: Oxford University Press.


    How to Distinguish NPD from Antisocial Personality Disorder

    The narcissist's key characteristic is grandiosity, whereas that of the antisocial is callousness.

    While persons with Narcissistic Personality Disorder and Antisocial Personality Disorder (ASPD) share tendencies to be tough-minded, glib, superficial, exploitative, and unempathic, NPD does not necessarily include characteristics of impulsivity, aggression, and deceit.  In contrast to the person with NPD, the person with ASPD may not have as great a need for the admiration and envy of others.  And, unlike the person with ASPD, someone with Narcissistic Personality Disorder usually does not have a history of childhood Conduct Disorder nor of criminal behavior as adults.

    "All antisocials are assumed to have a narcissistic personality structure, but not all narcissists are antisocial.  The most important differential features are the more severe superego pathology [in the ASPD]"that is, lack of concern and understanding of moral functions, and the impaired capacity to be involved in mutual, nonexploitive relationships found in ASPD.  Interpersonal and affective manifestations (anxiety and depression) are more pronounced in NPD, while [ASPDs] show more acting out, particularly with drug and alcohol abuse.  Narcissists are usually more grandiose, while ASPD patients are exploitive, have a superficial value system, and are involved in recurrent antisocial activities . . . .  Exploitiveness in antisocial patients is probably more likely to be consciously and actively related to materialistic or sexual gain, while exploitive behavior in narcissistic patients is more passive, serving to enhance self-image by attaining praise or power.

    Unlike a person with ASPD, the person with NPD has "not learned to be ruthless or competitively assertive and aggressive when frustrated."

    A critical distinguishing feature is that in Antisocial Personality Disorder, there are no feelings of guilt or remorse:  ". . . even after being confronted with the consequences of their antisocial behavior and in spite of their profuse protestations of regret, persons with antisocial personality disorder have no change in behavior toward those they have attacked or exploited or any spontaneous concern over this failure to change their behavior."

    Ronningstam, E. (1999). "Narcissistic personality disorder."  In T. Millon, P. Blaney, & R. D. Davis (Eds.), Oxford Textbook of Psychopathology (pp. 674-693). New York: Oxford University Press.

    Kernberg, O. (1998).  Pathological narcissism and narcissistic personality disorder: Theoretical background and diagnostic classification. In E. F. Ronningstam (Ed.), Disorders of narcissism.  Diagnostic, clinical, and empirical implications (pp. 29-51). Washington, DC: American Psychiatric Press.

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    « Reply #2 on: March 05, 2009, 09:59:55 AM »

    I can definitely see how they can be confused sometimes.

    My wife can and does give - she can be very compassionate, especially with children, people in need, etc.

    She finds it hard to sustain, though.  She's easily frustrated, her expectations of others are high, and she expects a lot of recognition for her efforts. She will quickly feel like she has "given too much", can do no more, etc.

    It does strike me more as a childlike emotional capacity rather than NPD.
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    « Reply #3 on: March 05, 2009, 10:52:37 AM »

    There are NPD tendencies in all of us. It is when it it affects someones ability to function in life that it would seem to be NPD.

    Most BPD's have a touch of narcissism in them, since they have such immature emotional ways of thinking and responding, and we know that children are notoriously self centered. I guess the difference is that someone who is BPD is capable of showing some compassion or real caring, without the undertones of buttering you up or manipulating you like a pwNPD might.

    Selfishnesses not necessarily NPD. Marriage Builders talks about the roles of giver and taker, and how if we are give too much, we often end up with a lot of resentment, so we swing to the opposite extreme to make up for it.

    When one gave too much, didn't feel it was appreciated, they try to take too much

    or vice a versa...

    When one took too much and felt guilty, they shift and give too much to make up for it. Which then causes resentment about how much they are giving and not getting, so they then decide to become selfish again and take, and on and on and on the pendulum swings  

    I'm not sure if a NPD is capable of true giving though, unless there is some benefit for it in them... I think they always have ulterior motives, and are more greedy and grasping, while being totally unaware of anyone else having real needs or wants or desires that could oppose them.

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    « Reply #4 on: March 05, 2009, 01:25:57 PM »

    Quote
    I'm not sure if a NPD is capable of true giving though, unless there is some benefit for it in them... I think they always have ulterior motives, and are more greedy and grasping, while being totally unaware of anyone else having real needs or wants or desires that could oppose them.



    I think NPDs are people with mental illness, just like BPDs, and that it's easy to see the negative behavior and forget the pain it stems from.

    I can't imagine what the childhoods and interior minds of people with NPD must be like. Painful. 'Cause we're not just talking about selfish egomaniacs, we're talking about people with diagnosable mental illness.

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    « Reply #5 on: March 05, 2009, 02:29:15 PM »

    My recent undiagnosed gf is mainly BPD. I think she does have moments of true caring like others mentioned. But she can't sustain it. And she seems self absorbed because she struggles so hard with just taking care of herself that she has little left to give anyone else. I do not think she is consciously manipulative, or that is rare anyway.

    My ex NPDgf was VERY different. She seemed caring in the initial infatuation stage, but I believe that even that was manipulative. EVERYTHING was about her. I think it was all about her getting narcissistic supply ( attention). I don't think she really had a conscience and she had no insight. She never apologized about anything.

    I think that all of these disorders vary in intensity as Skip says -----------there is a spectrum.

    My NPDex was severely narcissistic, while my BPDgf was on the mild end of the spectrum with BPD.

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    « Reply #6 on: March 06, 2009, 11:58:29 AM »

    I've been pondering some of the ways BPDs differ from each other ... I sometimes think that what a given BPD will do is bounded by what they would do "anyway", in an extreme situation - where they "had to" or felt justified doing it.

    E.g. if they would tell huge whopping lies if they "had to", then they will tell you huge whopping lies.  If they would get physically violent if they "had to" or because you richly deserved it, then they will get physically violent. If they would cheat when their partner "deserves it" or doesn't live up to expectations, then they will cheat.

    Because emotionally they feel like almost every situation is extreme - they "have to", or like you totally deserve their worst because of how awful you are to them. So the difference between them and other BPDs is merely going to be in whatever their "worst" happens to be.

    Just my poorly expressed armchair psychology about why some BPDs cheat, some don't, some lie, some don't, etc.
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    « Reply #7 on: March 09, 2009, 10:43:21 AM »

    Hi Gang-

    A year and a half  ago, I went to a therapist convinced that my wife was NPD. I asked him to meet with her. 

    He did and said "good news/bad news " she's not a narcissist though she has very strong traits - she's a borderline . Wow.

    I was off and running in the reading and research department and then joined this board. I highly recommend psychoanalysis as it helps you figure out your own issues but an analyst is also very well versed in the personality disorders and will give you lots of insight into the  BPD in your life.

    While in analysis, one of the examples he gave of the difference between the two disorders is the following:

    1) a narcissist will go to all of the childrens games, plays, etc and take credit for everything the kids do.

    2) A borderline has such a changing sense of self they will look to the children to help them define themselves. When the kids can't do that , the BPD treats the children as nothing more than little pockets of need that interfere with the BPD's quest for unconditional love.

    My metaphor for a borderlines love and attention is that of a lighthouse on the shore.

    When you are in the beam of light/love/attention it is real and genuine. The problem is the light swings away to focus on something/someone new and leaves you in the dark... until it swings back again.When you are once again in the light and you question why your BPD left you in the dark , as you know, they get defensive and cranky and projective and have no idea ( no constancy) that they ever left or why you are angry or suspicious or cautious .

    BPD's can love and do have empathy.  However , with no timeline in their brains ( no constancy) their love and empathy are very hit and miss.  When you don't take them back with open arms -each and every time - you are abandoning them in their minds and the cycle begins again.

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    « Reply #8 on: October 12, 2010, 11:17:17 AM »

    FYI, from wikipedia:

    An NPD diagnosis requires 5 or more of the following:

    *Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

    *Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

    *Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

    *Rarely acknowledges mistakes and/or imperfections

    *Requires excessive admiration

    *Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

    *Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

    *Lacks empathy: is unwilling or unable to recognize or identify with the feelings and needs of others.

    *Is often envious of others or believes that others are envious of him or her

    *Shows arrogant, haughty behaviors or attitude.

    I don't know if my wife could ever be diagnosed with this without the therapist/dr. hearing from a lot of people who know my wife. My wife is very insecure, so when I brought this up to her, she thinks there's NO way she fits any of these, "I'm not a narcisist!" But easily fits some of the symptoms, even if she doesn't see it. I can imagine NPD being a much harder diagnosis for a patient to accept.

    To accept BPD, at least to my wife, it was a relief. Like, I do these "bad" behaviors, I don't like them. Oh wow, there's a whole LIST of the things I do, and there's a name for it. But for NPD, it would take the person doing exactly what the list says they won't: admit fault.
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    « Reply #9 on: October 15, 2010, 03:39:57 PM »

    My MIL is primaryily BPD, but exhibits strong NPD too...

    BPD - criteria require 5 or more:

    Frantic efforts to avoid real or imagined abandonment.

    A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

    Identity disturbance: markedly and persistently unstable self-image or sense of self.

    Impulsivity in at least two areas that are potentially self-damaging[/b] (for MIL it's spending in excess, erratic driving and disordered eating).

    Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.

    Affective instability due to a marked reactivity of mood[/b] (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).

    Chronic feelings of emptiness

    Inappropriate anger or difficulty controlling anger[/b] (e.g., frequent displays of temper, constant anger, recurrent physical fights).

    Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms


    On the flip-side here, while she shows empathy, it's usually not *genuine* (it's learned IMO) if you consider all surrounding the empathy expressed; she has, through decades of self-help workshops, empowerment groups, and therapy to make her an even better person, learned how to express empathy...but, as I said, when you balance it to everything else she is saying and do at the time it is expressed, it's not empathy but looks like empathy - so maybe it should be bold?

    With my MIL it seems that which side of her PD dominates is determined by who she's engaging with...for example, if it's DH, her golden child, it's pure BPD driven by fear he'll abandon her - she praises him endlessly, needs him so much, he is her hero, her very reason for living; if, on the other hand, it's me, his big-bad wife, it's almost purely NPD with sprinkles of BDP mixed in - she expects praise, expects I recognize her as brilliant, strong and successful, see her as superior and admire her as she demands - I am expendable and disposable and she let's me know it, failure to comply means war.  Now that war can be waged at me or DH or both of us - but it will come and toward each of us different.

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