Borderline personality disorder (BPD) and narcissistic personality disorder (NPD) are two distinct mental health conditions, but they share some similarities in their symptoms and behavior patterns. Both are classified as cluster B personality disorders and involve instability in behavior, mood, and relationships. However, there are also key differences between BPD and NPD.
People with BPD often display intense and unstable emotions, impulsive and risky behavior, and unstable personal relationships. They struggle with a poor sense of self, chronic feelings of emptiness, fears of abandonment, and dissociative symptoms. In contrast, the main characteristics of NPD are an inflated sense of self-importance, need for excessive admiration, and lack of empathy. Narcissists have an exaggerated sense of superiority and entitlement, and they exploit personal relationships for personal gain.
While the diagnostic criteria for BPD and NPD are distinct, some researchers have noted an overlap in certain traits between the two disorders. In particular, the possibility of narcissistic traits in people with BPD has been examined. There are differing viewpoints on this issue which will be explored in this article.
Views on Narcissistic Traits in BPD
There are several key perspectives on whether people with BPD display narcissistic traits:
BPD Involves Vulnerable Narcissism
Some researchers posit that many people with BPD exhibit vulnerable narcissism. This refers to narcissistic traits that mask underlying emotional fragility and insecurity. Unlike grandiose narcissists who have an inflated sense of confidence and importance, vulnerable narcissists crave validation and have an underlying sense of inadequacy. Their narcissistic behaviors represent an attempt to regulate their fragile self-esteem and feel valued by others.
From this viewpoint, people with BPD may display narcissistic traits like attention-seeking, entitlement, and envy as a way to get their emotional needs met and feel important. However, these behaviors stem from emotional instability, emptiness, and fears of abandonment. So while narcissistic traits may be present, they arise from the core symptoms of BPD.
BPD Involves Comorbid NPD
Other researchers propose that some individuals with BPD may meet the full diagnostic criteria for NPD as well. In this comorbid scenario, a person has the unstable behavior and relationships of BPD combined with the grandiose sense of self and lack of empathy characteristic of NPD.
Studies have found NPD comorbidity rates in people with BPD ranging from 10-40%. These individuals exhibit both BPD symptoms like intense emotions, impulsivity, and unstable relationships as well as narcissistic traits like arrogance, attention-seeking, and feelings of entitlement. This suggests BPD and NPD can co-occur in the same individual despite being distinct disorders.
BPD and NPD Exist on a Spectrum
Finally, some view BPD and NPD as related conditions existing on a spectrum. This perspective sees narcissistic traits as part of borderline pathology rather than a wholly separate disorder. People with BPD may display more or less narcissistic traits as part of their condition.
This viewpoint also conceptualizes grandiose and vulnerable narcissism as two presentations of the same underlying disorder. BPD involves primarily vulnerable narcissistic features, while NPD represents the grandiose manifestation. But they both arise from dysfunction in underlying self and relationship capacities.
From this perspective, the presence of narcissistic traits in BPD does not necessarily indicate comorbid NPD. Rather, it reflects an overlap between two related personality disorder constellations.
Research Examining Narcissistic Traits in BPD
Empirical studies provide some insights into the presence and nature of narcissistic traits in people diagnosed with BPD:
Prevalence of NPD Among Individuals with BPD
– Research finds 10-40% of people with BPD also meet criteria for NPD. This indicates BPD and NPD frequently co-occur, though most individuals with BPD do not have comorbid NPD.
– A meta-analysis reported a weighted mean prevalence of NPD comorbidity in BPD of 28%.
– Studies show people with both BPD and NPD (BPD+NPD group) exhibit worse symptoms and impairment than those with only BPD.
Comparisons of Narcissistic Traits
– People with BPD+NPD score higher on measures of narcissism than those with only BPD.
– The BPD+NPD group shows more grandiose narcissistic traits like entitlement and arrogance. The BPD-only group displays more vulnerable narcissistic features like need for approval.
– BPD samples score higher on narcissism measures than people without personality disorders, suggesting elevated narcissistic traits compared to the general population.
Associations With Symptoms and Behavior
– Narcissistic traits positively correlate with symptoms like impulsivity, anger, and identity disturbance in people with BPD.
– Those with BPD who score higher in narcissism often exhibit greater suicidal behavior, substance abuse, and other self-damaging acts.
– Narcissistic vulnerability in BPD is linked to dysfunctional attitudes about relationships and intense efforts to avoid abandonment.
Key Differences Between BPD and NPD
Despite some overlapping traits, there are core distinctions between borderline and narcissistic personality disorders:
| BPD | NPD |
|---|---|
| Unstable, shifting self-image | Inflated, grandiose self-image |
| Fears of abandonment | Sense of entitlement; views others as inferior |
| Emotional reactivity and impulsivity | Envy; arrogance |
| Intense, unstable relationships | Relationships are superficial and exploitative |
| Identity disturbance and chronic emptiness | Obsessed with fantasies of power, success, and attractiveness |
| Self-destructive behaviors | Lacks empathy; overly concerned with self |
| Displays goal-directed aggression | Displays extreme arrogance and hostile aggression |
This comparison highlights that while BPD and NPD both involve troubled relationships and deficits in self functioning, the nature of the impairment differs. BPD is characterized by unstable identity and intense fears of abandonment. In contrast, NPD involves an unrealistic superior self-image and exploitative treatment of others.
Unique Challenges in Treating Comorbid BPD/NPD
When NPD co-occurs with BPD, it can present unique challenges for psychotherapy treatment:
– Narcissistic traits like entitlement, feelings of superiority, and lack of empathy can interfere with establishing a strong client-therapist alliance.
– People with BPD+NPD often experience more anger, criticism, and hostility toward others including the therapist.
– Their extreme sensitivity to feedback along with narcissistic defense mechanisms makes them more likely to resist treatment approaches.
– Antisocial behaviors and high aggression levels are more common with the BPD+NPD combination. This can increase risk of harming self, therapist, or others.
– Manipulative behaviors linked to narcissism like lying, conning others, and boundary violations can be problematic.
– Grandiose fantasy and excessive need for validation makes those with BPD+NPD more prone to therapy-interfering behaviors.
– Dual vulnerability to abandonment fears (BPD) and narcissistic injury (NPD) creates a volatile mix requiring skilled management.
For these reasons, treating comorbid BPD and NPD often necessitates an integrative approach combining aspects of NPD and BPD therapies adapted to the dual diagnosis. Careful narcissistic vulnerability management and building motivation are also crucial.
Recommendations for Managing Narcissistic BPD Clients
Here are some tips for therapists working with BPD clients exhibiting significant narcissistic traits:
– Validate underlying feelings of deficiency and shame without reinforcing narcissistic defenses.
– Set clear boundaries and limits on unacceptable behaviors while empathizing with their fear of rejection.
– Avoid harsh confrontation; gently reinforce realities and norms without provoking narcissistic injury.
– Foster motivation and commitment to therapy through supportive, collaborative methods.
– Use empathy, consistent emotional validation, and a nonjudgmental stance to build trust.
– Focus initially on self-esteem regulation, impulse control, and emotional skills before addressing entitlement and empathy.
– Reinforce empathy, perspective-taking, reciprocity, and compromise as alternatives to narcissistic relating.
– Probe discrepancies between their grandiose self-image and vulnerable real self experience.
– Integrate DBT, STEPPS, and mentalization techniques to solidify self-regulation capacities first.
– Incorporate narcissistic treatment approaches like schema therapy and transference-based therapy once sufficient progress is made in BPD symptoms and the therapeutic relationship.
Discussion
The research and clinical evidence suggests BPD and NPD are distinct but related conditions. A subset of people with BPD, likely 10-40%, also meet NPD diagnostic criteria. Those with both BPD and NPD tend to exhibit worse symptoms and outcomes.
Many more individuals with BPD display elevated narcissistic personality traits, though not the full syndrome. These narcissistic features correlate with greater instability and impairment. This suggests vulnerable narcissism is intrinsically intertwined with borderline personality pathology for many patients, even if they don’t qualify for an NPD diagnosis.
However, people with BPD alone clearly differ from those with primary NPD in their predominance of vulnerable narcissistic features over grandiose narcissism. They also lack the egocentric, exploitative interpersonal style prototypical of NPD.
These findings have clinical implications for therapy with BPD patients displaying narcissistic traits. Their narcissistic vulnerability and defense mechanisms will likely emerge as psychotherapy challenges requiring sensitive management. Integrating techniques from NPD treatments while retaining a primary emphasis on BPD interventions tailored to each patient’s presentation is recommended.
With thoughtful diagnosis and effective, responsive psychotherapy, the outlook for people with BPD struggling with comorbid narcissistic traits and vulnerabilities can be hopeful. Though narcissistic defenses may complicate treatment, compassionately helping patients build inner security and self-worth can set the stage for greater stability and meaningful change.
Conclusion
In summary, while BPD and NPD are separate diagnoses, narcissistic personality traits and vulnerable narcissistic features are common in borderline patients. A sizable subset likely meets full diagnostic criteria for both BPD and NPD. Compared to BPD alone, this comorbid presentation involves greater symptom severity and difficulty in treatment. However, diagnosis of both conditions is important for guiding clinical interventions. With an integrative therapy approach attentive to both disorders, patients have a good prognosis for overcoming dysfunctional narcissistic defenses and achieving genuine healing.