To understand the complex combination of Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD), one must first understand the differences between the two.
Often confused for the other, I will briefly lay down the diagnostic criteria for each alone and then explain some key constructs that differentiate BPD from NPD.
It is after this explanation, that the picture of combining the two unfolds with distinction and we can begin to understand the often co-morbid (25-37% rate) and complex case of the BPD/NPD combination.
So let’s get at it!
According to the DSM, to be diagnosed with BPD one must present with 5+ of the 9 following criteria: (*If you’d like a more in depth analysis of BPD, check out my other post by clicking HERE*)
- Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called “splitting.”
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (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, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
For NPD, one must present with at least 5 of the 9 criteria:
- A grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Belief 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)
- Requires excessive admiration
- A sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- Interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
- Envious of others or believes that others are envious of him or her
- Arrogant, haughty behaviors or attitudes
- A perceived lack of concern for how their behavior impacts others (while those with BPD typically show concern AFTER they hurt someone, NPD’s show no concern altogether).
- A fear of abandonment. Both fear abandonment, but it stems from different motives. BPD’s fear losing the connections they have with others, while NPD’s fear losing the “ego” they receive from others.
- Having complicated relationships with people, work, and themselves.
- Displaying overly emotional and over-the-top behaviors.
And some Distinctions:
1. Rates of Self-Harm.
While those with NPD are not immune to self-injury/self-harm altogether, those with BPD are much more likely to engage in suicidal ideation, self-harm behaviors like cutting/binging, etc. and impulsive behaviors that are self-destructive.
2. Feelings of grandiosity.
One of the core features of NPD is believing that one is above others. Those with NPD indulge in talking about their achievements and talents, and expect to be treated as superior to others. Those with BPD alone, don’t have a pattern of feeling superior and in fact, often describe how they feel victimized/as if life is against them & for some a sense of “emptiness”.
Additionally, those with NPD feel that they are “special” and can only be understood by “like-minded superiors”, while those with BPD feel abandoned and misunderstood by any one regardless of their “status”.
While I wouldn’t put too much emphasis on this, the current stats do show that women outnumber men in the BPD population, and men outnumber women in the NPD population. (From a totally non-scientific opinion, I often wonder if perhaps the differentiation in gender presentation has more to do with societal ideology. It is MUCH more acceptable for a man to present as “narcissistic” in general, and for a woman to present as a “victim”–again just a side thought from a developing psych nerd)
Someone with NPD presents as having every emotion EXCEPT for empathy. While those with BPD, tend to present with empathy to a fault of their wellbeing and often those they are “empathizing”.
Because NPD and BPD’s stark differences in empathy, the fear they hold for abandonment is handled in different ways. As Alexander Burgemeester put it, “The BPD will dump on you while the NPD dumps you altogether.”
What about the 25-37% of dual-diagnosis?…
Here’s the scoop on the NPD/BPD also commonly called the “outward-attacking Borderline”.
To meet criteria for being both NPD/BPD, one must meet BOTH 5 of 9 of the DSM criteria for each (see above for reference).
So, what exactly does that look like?
As Randi Kreger expertly puts it, “They masquerade as a giant, but they feel like a kid living in a world of Goliaths.”
Those with BPD/NPD while harsh, menacing, and scary on the outside are often as “fragile as eggshells (hence “walking on eggshells”) on the inside. Although they are adults, the way they deal with emotions often feels like how it does to a child ~6 years old. As a result, the “adult tantrum” feels like a necessary response and can be very hard for loved ones to understand.
The NPD/BPD presents with both extreme emotions they don’t know how to handle AND feelings of superiority. They often do not feel remorse for their emotional displays AND will continuously believe that they are superior to those around them.
Kreger, further demonstrates how the BPD/NPD juggles the intricacies of 3 different concerns:
1. What people did to them.
2. What people did NOT do to them.
3. When someone hasn’t done ENOUGH for them.
Because these concerns come from the BPD/NPD’s own experiences/thoughts, loved ones will never do ENOUGH for the BPD/NPD.
It is important to remember this, not to give up on them–but to embrace this understanding of their experience and discover ways to healthfully respond and interact with individuals with this struggle:
Ways to healthfully cope, respond, and support loved ones with BPD/NPD:
1. Look into your own “stuff” first, and try to make an extra effort to temper these traits/behaviors around the BPD/NPD. Because they are extra sensitive, it is helpful to make sure you are relating to them in the healthiest/boundary honoring ways possible. Being reactive around the BPD/NPD only adds fuel to the confusing emotions they are experiencing.
2. Become a team and negotiate together during periods of calm. When you use statements like “I know we are upset right now, but I know these issues our important to US and WE can get through this TOGETHER” can be very reassuring to someone who is emotionally reactive. When the BPD/NPD is in a calmer state of mind it’s helpful to negotiate boundaries together to continue that “team” sense of security.
3. Curb the sarcasm and jokes. Because of the sensitive nature of BPD/NPD’s you can assume they’ll respond like a Vulcan and take it seriously. Again, the way their brain processes can filter out certain social cues and hone in on other SENSITIVE material, it’s like their wiring is geared to magnify criticism and selectively focuses on any signs in their environment.
4. Do not try to change them. As much as you could want a BPD/NPD to be different, it is important to remember that this is part of their structural wiring. If they want to make changes, it has to come from their own experiences. If we try to change them it only hurts us in the end. Again, focusing on your own “stuff” proves a lot more helpful in changing the reaction/responses of others (and to feeling good about ourselves at the end of the day).
5. Get creative in postponing responses to mean outbursts. If you can delay it, sometimes you can discuss it with less emotion/fire/intensity. For example, if you’re on the phone you can state, “Oh, someone is at the door–let me call you back.” Although this is not ALWAYS an option, it can be a useful skill for avoiding heated arguments.
6. Lastly, empathy is the key to loving them. Remember, they lack empathy. And remembering that it’s really an issue of their wiring, and not an insult to you can be EXTREMELY helpful when they seem like a monster out to rip apart your emotions. While yes, their behavior can be terrible, it is important to remember that it stems from anxiety/sensitivity/and a wave of emotion that come from their brains. Remembering their emotional capacity mocks a 3-6 year old, can often help you think of holding that child instead of abandoning them or retaliating.
On that note, I will be writing an empathy piece next, but wanted to address this concern first (as requested by readers). I hope this clarifies the NPD/BPD debate, and look forward to hearing any concerns, q’s, and feedback.
Until next time, Jenny out.
Of course, kudos to my awesome sources:
Psychologytoday.com, Author Randi Kreger