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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: DIFFERENCES|COMORBIDITY: Borderline and Narcissistic Personality Disorder  (Read 90167 times)
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« Reply #10 on: November 06, 2010, 08:41:12 AM »

A difficult thing about "PDs" in general, and specifically about this PD, is understanding where the line of pathology is drawn - which is higher than most think - this term gets kicked around pretty liberally on message boards.  There are some websites out there droning on about malignant narcissistic husbands and fathers -- but this term, which was coined in 1964 by social psychologist Erich Fromm, is meant to describe "severe mental sickness" representing "the quintessence of evil". He characterized the condition as "the most severe pathology and the root of the most vicious destructiveness and inhumanity" -- basically the likes of Josef Stalin, Saddam Hussein, and Adolf Hitler.
 
There is a difference between "being narcissistic" and having NPD and a "malignant narcissistic". smiley
 
This is not to suggest that there are not narcissists or NPD personality types. There are -- and NPD tendencies/traits may better describe your loved one than BPD tendencies.  It is to say that that making a dual diagnosis may be more confusing than helpful for your purposes.
 
The two criteria often cited at bpdfamily as "NPD" are "lack of empathy" and "portray a perfect image to others" (e.g., acting like mother of the year in public events with the family).  Both of these issues may just very well be accounted for in the definition of borderline personality.  Empathy is key criteria in the diagnosis of BPD -- in the DSM-5 it will be rated from healthy functioning (Level = 0) to extreme impairment (Level = 4).  Mirroring (lack of identity, self-direction) could explains the false image portrayal.
 
The overlap of the PD descriptions in the DSM IV are not all that neat and tidy. In a 2008 study, the comorbidity of BPD with another personality disorder was very high at 74% (77% for men, 72% for women).  They attempted to fix this is the DSM-5.0 (2013) but the solution was tabled and will be studied further.
 
Comorbid w/BPD--------------
 Paranoid
 Schizoid
 Schizotypal
 Antisocial
 Histrionic
 Narcissistic
 Avoidant
 Dependent
 OCD
 More info
Men-----------
 17%
 11%
 39%
 19%
 10%
 47%
 11%
  2%
  2%
Women-------
 25%
 14%
 35%
  9%
 10%
 32%
 16%
  4%
 24%

 
When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  Examples of focus would be:
 
  • What is the difference/is there a difference between a BPD and a BPD/NPD with respect to treatment for a child?

  • What is the difference/is there a difference between a BPD and a BPD/NPD with respect to using communication tools with your spouse?

  • What is the difference/is there a difference between a BPD and a BPD/NPD with respect to emotionally detaching from a toxic relationship?

  • Are we just looking for a more toxic sounding name that is commensurate with how much pain or hurt we feel?  A mildly borderline individual can wreck a lot of damage in a relationship - even more so if we were not standing on firm ground the entire time - it doesn't take a lot more than that.

Some helpful hints for sorting through this.
 
  • General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control

  • Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.

  • Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.

  • Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.   smiley  A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.

  • Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 

I hope this helps keep it in perspective.   smiley
 
Skippy
 


DIFFERENCES|COMORBIDITY: Overview of Comorbidity
 
Additional discussions...
 
Personality Disorders
 
Borderline and Paranoid Personality Disorder
 
Borderline and Schzoid/Schizotypal Personality Disorder
 
Borderline and Antisocial Personality Disorder
 
Borderline and Histrionic Personality Disorder
 
Borderline and Narcissistic Personality Disorder
 
Borderline and Avoidant Personality Disorder
 
Borderline and Dependent Personality Disorder
 
Borderline and Obsessive Compulsive Personality Disorder
 
Borderline and Depressive Personality Disorder
 
Borderline and Passive Aggressive Personality Disorder
 
Borderline and Sadistic Personality Disorder
 
Borderline and Self Defeating Personality Disorder
 
Other
 
Borderline PD and Alcohol Dependence
 
Borderline PD and Aspergers
 
Borderline PD and Attention Deficit Hyperactivity Disorder
 
Borderline PD and BiPolar Disorder
 
Borderline PD and Dissociative Identity Disorder
 
Borderline PD and P.T.S.D.
 
Borderline PD and Reactive Attachment Disorder (RAD)
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GENERAL ANNOUNCEMENT

This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question.

Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board.

You will find indepth information provided by our senior members in our workshop board discussions (click here).

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« Reply #11 on: November 24, 2010, 08:46:06 AM »

I see a lot of myself in that caricature.

I am in one-one therapy and also in (separate) relationship therapy, as I have a lot of self-destructive habits I would like to break. I've never been diagnosed with a personality disorder but am aware I have a lot of severe issues from my upbringing. If I lived in a country with better mental health care perhaps I would have been diagnosed with complex PTSD by now - I don't know.  

I see myself in that description above but I am very self-aware and motivated to change.

I think I have some disordered traits but I don't think I have a full-blown personality disorder.

I witnessed a lot of violence against my schizophrenic father from my mother, and my brother and I were severely neglected and verbally/physically/emotionally abused.

I suppose what I am trying to say is that the behaviour Randi describes may have a range of causes.

Annie xoxo
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« Reply #12 on: December 23, 2010, 08:16:50 PM »

This is from the current DSM.IV section on Borderline Personality Disorder 301.83: Differential Diagnosis (the traits that distinguish one disorder from another.)

Quote
Although Paranoid Personality Disorder and Narcissistic Personality Disorder may also be characterized by an angry reaction to minor stimuli, the relative stability of self-image as well as the relative lack of self-destructiveness, impulsivity, and abandonment concerns distinguish these disorders from Borderline Personality Disorder.

From the DSM.IV section on Narcissistic Personality Disorder 301.81: Differential Diagnosis:

Quote
The most useful feature in discriminating Narcissistic Personality Disorderfrom Histrionic, Antisocial, and Borderline Personality Disorders, whose interactive styles are respectively coquettish, callous, and needy, is the grandiosity characteristic of Narcissistic Personality Disorder. The relative stability of self-image as well as the relative lack of self-destructiveness, impulsivity, and abandonment concerns also help distinguish Narcissistic Personality Disorder from Borderline Personality Disorder. Excessive pride in adlievements, a relative lack of emotional display, and disdain for others' sensitivities help distinguish Narcissistic Personality Disorder from Hislrionic Personality Disorder. Although individuals with Borderline, Histrionic,

and 'arcissistic Personality Disorders may require much attention, those with Narcissistic Personality Disorder specifically need thai attention to be admiring.

Hopefully that helps smiley
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Randi Kreger
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« Reply #13 on: January 04, 2011, 08:39:15 AM »

The following is from my notes for my next book. This is all preliminary. *NPD: More sold sense of self less fragmentation No risk of psychosis, more tolerance of being alone; better employment. The narcissist expects you to revolve around them; The BP wraps her world around you and you are her universe. *NPD: Developmentally NP better off: higher functioning. Empathy and compassion less than BP.*BPD: First impressions: BP immediate emotional connection and a rush of knowing the other person very well and being intimate. Now that may sound like BPD. HOWEVER It might SEEM that way with NP, but if you think about it it’s more charming and you’re impressed with them and think you must be special if this wonderful person is paying attention to you…there is a false intimacy and you realize you know much more about them than they know about you. NP opinionated and judgmental, phony. May ask questions about you but doesn’t really care about the answers. *BPD: BPs more inconsistent, *NPD: NPs more consistent. *NPD: NPs idealized vision of themselves with low self esteem shows through when there is some kind of failure or narcissistic injury, while BP ‘s low self-esteem could come through at any time. *BPD:  too needy and NP not vulnerable or sensitive enough. *BPD: more vulnerable to abandonment while NPs get off on new sources of supply. *BPD: BPs have I hate you don’t me abandonment/engulfment dance, lots of changes and moodiness, while relationship with NP is more consistent  
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« Reply #14 on: April 20, 2011, 09:43:17 AM »

This is an area that interests me a great deal. My first H was definitely NPD; my current bf is diagnosed BPD, he has no N traits. There is an enormous difference between his behaviour and my H's. There is a lot less difference between how being in a r/s with either left me feeling. The biggest difference is in the likelihood of either accepting that they have a problem and therefore being able to start seeking treatment etc. The Narcissist is very unlikely to do so.

As to whether it matters, i am not sure. It seems that the people on this site are in r/s with a range of disorders. However we can still all relate to how each other feels in an abusive r/s and that is what this site is for.
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« Reply #15 on: April 20, 2011, 09:51:24 AM »

From what I have read thus far there are obvious indicators of both.

Ironically enough (or perhaps not so ironic at all) is the fact that my wife is a Social Worker (MSW). We have a copy of her DSM-IV and I have done some research there, online and off.

It was odd. The T was hesitant, almost reticent to actually come out and say it. Even pretend to punch himself in the head for introducing the possibility of using the "N" word. My assumption: he knows he has to tread very carefully with W. He was the reason I first started looking into BPD. He introduced it in a general way early in our counseling but always backpedaled from it. Never a diagnosis. Once, after having introduced BPD into a session again, I pressed him on what it means and what it would look like. His response was that it had to do with the intensity of the symptons and whether or not it was the primary defense mechanism.

My assessment has been that he is afraid if he "diagnosed" W would reject it (she has rejected most of his assessments) and/or she would latch onto the diagnosis and it would be counter-productive.
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« Reply #16 on: April 20, 2011, 09:54:24 AM »

One of the biggest differences between an exNPD partner and my BPD H is how much the NPD was concerned with what others thought of him.  BPD H doesn't really care what people think of him, his driver is his own critical voice...you blew it again, stupid. Bam bam bam.  He beats himself up.  He will play a fool and be silly and doesn't care if anyone thinks he is silly.

exNPD got really upset one time because his fancy sneakers had a tiny tear.  He was upset that they were all he had to wear at the time and really concerned that someone would notice.  I thought, oh brother, who cares?  He was very concerned what others thought of him and was never silly a moment in his life.
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« Reply #17 on: May 07, 2011, 05:57:04 AM »

Are many pwNPD traits gifted?

Mine was a doctor by age 24.  In some ways, they seem to have the world by the a _ _.  Looks, brains, whatever.  Makes me wonder if they do this and get away with it because they can.  
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« Reply #18 on: May 07, 2011, 07:32:07 AM »

Mine is an absolute math genius.  Straight A's through her Master's in Math.  Often they're over-achievers from childhood, trying to get approval from emotionally detached parents.  
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« Reply #19 on: May 07, 2011, 08:01:57 AM »

Mine has a shrewd mind and is also a musician. 
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