NPD vs. BPD and co-morbidity
I don’t like to quote Sam Vaknin much… for various reasons, but I stumbled on this quote from him about NPD vs. BPD. The reason this came up to begin with is that I was discussing whether certain people in on-line support groups might be dealing with something other than BPD.
There are certain support groups in which women make up a large proportion of the group. This confused me a bit, because BPD is much more likely to be diagnosed in women, rather than men. Removing the homosexual female component, there are still more women complaining about their abusive “BPD” men (most often BPxh – which means “Borderline Ex Husband” for all the uninitiated). When I read their accounts, it appears to me that their “BP men” are (mainly, but not exclusively) either suffering from NPD or suffering from the disorder of being an ass.
We talked about this on my board ATSTP some time ago. I also discussed it with an another knowledageble person about BPD. She disagreed with my assessment that BPD and NPD are (usually) mutally exclusive and my idea that perhaps these self-diagnosed “BPs” are really suffering from something else. (again all of this, as always, is my NON-MEDICAL opinion… and this quote below is from Sam Vaknin’s non-medical opinion – he’s a doctor, but not a medical doctor… and I’m not going into the rabbit hole of his degrees). Anyway, here’s the quote and my take on it (again emphasis mine):
http://samvak.tripod.com/faq82.html
NPD and BPD – Suicide and Psychosis
A sense of entitlement is common to all Cluster B disorders.
Narcissists almost never act on their suicidal ideation – Borderlines do so incessantly (by cutting, self injury, or mutilation). But both tend to become suicidal under severe and prolonged stress.
NPDs can suffer from brief reactive psychoses in the same way that Borderlines suffer from psychotic microepisodes.
There are some differences between NPD and BPD, though:
1. The narcissist is way less impulsive;
2. The narcissist is less self-destructive, rarely self-mutilates, and practically never attempts suicide;
3. The narcissist is more stable (displays reduced emotional lability, maintains stability in interpersonal relationships and so on).
Ok, well, given that quote the separation regarding acting on suicidal ideation makes sense to me. However, that being said, his comment about “borderlines do so incessantly (by cutting, self injury, or mutilation)” is basically inaccurate – self-injury is not about suicide, it’s about pain management (and in some ways even suicide attempts, purposeful or accidental, are about pain management)… but I digress…
I was looking over Dr. Heller’s site some more today and found that HIS “other common disorders associated with BPD,” don’t include NPD, but he’s a medical doctor and doesn’t seem to think any disorder should be called a “personality disorder.”
Although I don’t know much about NPD, I think that a borderline is likely to hate herself … a narcisstist love himself. It’s simple (of course again it’s IMO), but seems right to me. I just wonder if people with BPD have been given even more of a bad rap by being confused with those with NPD (or a similiar disorder like APD). Emotional tools will not work (in my experience and in the experience of members of my list with NPD husbands) for someone with NPD.
[amazonshowcase_aae6001f3f5766bb5a55f3fb147c3088]
UPDATE: Since I posted this in June of 2008, Sam Vaknin has since determined that he is a psychopath. Here’s a link to the documentary about his psychopathy.
11 Comments
John Lucas
Hey Bon,
I looked into NPD as a possible explanation for my wife’s behavior, whom I now believe has BPD, as you know.
Most people seem to argue that that there is a core of self-loathing that is masked by the narcissist, that the display of superiority is a means for denying their fundamental feelings of inferiority, and that the self-loathing itself is responsible for their need for others to idolize them and their desire to destroy the esteem of others, which is seen as a competitive threat.
What do you think? I still struggle to understand the differences between these 2 disorders (although I do think that the narcissistic behaviors seen in many BPs is fundamentally different from actual NPD).
Best wishes,
John
Bon Dobbs
I think the narcissist does mask feelings of inadequacy and self-loathing… however, I think BPD is an emotional disorder and NPD is not. I don’t know too much about NPD, but my feeling about BPD is that it is a subclass of affective disorders and the tools that are effective with BPD are different than those with NPD. I don’t agree that BP’s have narcissistic feelings – they MAY have what seems like narcissistic behavior… but I think those are an outgrowth of a “flip-flop” (in a black and white thinking sense) of being judged. The basic mind-set is “oh yeah? well, what about YOU? Do YOU have a right to judge me?” It seems like narcissistic, but it’s really a defense against deep shame. And perhaps it is a shame closer to the surface than those with NPD.
Bon
V.S.
Alternate theories (none of which are mutually exclusive):
More men with BPD are misdiagnosed with APD or simply written off as criminal (or maybe just “asses”), so that the actual numbers of men and women with BPD are more nearly equal (Makes sense if you buy into the school of thought that most spousal abusers have BPD, which is borne out by quite a bit of study now and goes a long way in explaining why anti-abuser treatment has been so hopeless. 95% of the men who chose to go to the same treatment place as my husband [the only place that will accept abusers without a court order in our area] re-abuse, no matter how hard they try to keep up with therapy, and even though they are in treatment by choice. The therapy pushes things like feeling bad for what you did, admitting it every week, in detail, and trying hard not to do it again. Obviously not very useful for the BPD-abuser)
More women are misdiagnosed with BPD when they actually suffer from another mental disorder or none at all. There’s a long history of psychiatrists diagnosing all female patients who don’t get better relatively quickly with Borderline, as well as teenaged females who claim sexual abuse without proof, lesbians and women who seem “masculine” and other women who fail to fit stereotypes. Again, so that the ratio of men to women with BPD is much more even.
More women are likely to seek support, esspecially public support and esspecially support to keep their marriages together, since in this society the woman is blamed when the marriage breaks up. Even if it’s because he hit her, it must be her fault in choosing the guy or provoking him in the first place. If the problems are less severe, it’s definitely her fault for not trying to keep the marriage hard enough. So they try harder and end up in more support groups.
I doubt that it’s just because many of those guys are asses for no reason. Generally when someone is chronically an ass and chronically mistreats the people they love, something is wrong with them.
V.S.
Also, given what I’ve seen of BPD I’d highly question your ability to tell whose husband has BPD and whose has NPD, APD or something else via email. People with borderline can seem incredibly narcissistic. The differences (as you note) are that someone with NPD will generally not self injure (beyond a manipulative show), actually try to kill themselves, and will not be abnormally impulsive. They will also tend to be consistently narcissistic. Someone with BPD can be narcissistic, but will only be that way some of the time. Someone with APD will never truly have empathy for another and has consistent disregard or contempt for rules, including laws. Most people with BPD are basically law abiding, though they’ll make exceptions for highly emotional things or “unimportant” laws (like traffic laws). People with APD and NPD are generally more emotionally regulated than people with BPD, but for any discrete time slice, someone with BPD absolutely can look like someone with NPD or APD.
“Ass”-like and narcissistic behavior is absolutely part of borderline personality disorder, at least for some people, and a history of abusing one’s partner is a potential sign of BPD, not a sign that someone doesn’t have it.
(And just for the record, my husband was diagnosed by a rather well respected hospital. He isn’t self-dxed)
B.Johnstone
I am MARRIED to a psychologist who has NPD….he is being supervised while he treats a female patient who is a severe BPD….it is really disturbing to me because it seems as if he cannot be objective in order to help her in any way….she rages at him constantly when she is not IN LOVE with him….I am NOT a mental health professional and I am just not sure what to do in this situation. We live in a small community and this woman seems to stalk us and wants to know about our marriage and personal life. My husband and I are also in therapy for his NPD and then this client is really encrouching on our relationship because she calls during our weekends crying and needy. I am just not sure how to deal with all of this….and my therapist is not really responsive when I need to talk about my feelings…this is really hard for me. Can anyone help me understand or provide some sort of suggestions?
Sandra
B… the fact that you are writing your questions on random internet sites regarding similar subjects shows you are desperate, in pain, and you don’t know where to turn. I don’t know if you are aware but BPD/NPD partners make for the most toxic of relationships imaginable and much as been written on the subject. The N likes the clinging admiration of the borderline and her ability to morph into anything he needs and take any kind of abuse. I imagine that if your husband wanted the Borderline to discontinue her attentions he could manage it but he probably enjoys her attention and admiration to some degree… hence you feel threatened. I am no expert but from what I have read about NPD men being in a relationship with them is a constant struggle and never ending cycle of pain and dashed hopes. If he is faithful and respectful to you perhaps you are able to maintain it… but if he is unfaithful and disrespectful to you or in any way abusive I would consider whether this relationship is worth the emotional pain. From what I have read of NPD (especially Vaknin’s book) these men are not able to empathize or truly love anyone… and will absorb your love as supply as well as your pain and anguish, equally. Speaking as someone who is in love with a man who is BPD/NPD I understand your suffering firsthand… but you need to go to your therapist and ask… not what is wrong with him and how can I fix him but what is going on with me that I want to be in this situation? Am I co-dependent? Am I an inverted narcissist? How was my childhood? Am I used to supporting powerful people and having my love rejected? Am I used to feeling insecure in my relationships and accepting less? Do I enjoy being hurt? Do I enjoy reflecting his achievements back at him while I make sacrifices and don’t complain?
Clearly your calling out for help is an indicator that things are not all well.
To the others: I have been searching endlessly for a definitive text on the differences between NPD and BPD… as I feel I have encountered someone who has traits of both. But, he may be co-morbid.
stlouis7
A few years ago, I dated a man with NPD for 3 years. I didn’t try to fix him, but I didn’t really understand him sometimes either. At the time, I had no idea what NPD was (or a personality disorder, for that matter). I was just puzzled by his emotional unavailability and extreme ego-centricism. I suppose I was waiting for the “real” person to emerge; yet, he never did. With him, what you saw was what you got. I was also going through a few extended periods of mania at the time (and some depression- I have bipolar disorder), so I didn’t catch on to the fact that he wasn’t “acting;” he REALLY was that arrogant. He was never depressed, professionally successful, very sneaky, money-hungry, ALL about appearances, not very impulsive, a bit chauvinistic, aloof, flirtatious, and had a few long-term relationships before me. The moment I found out he was cheating on me, though, I got out of there as quickly as possible.
After dating him, I found, who I thought was a “nice Southern guy.” After one month of “idealizing” me, he turned out to be someone with BPD and NPD- double whammy. It was a horrifying rollercoaster, but I only dated him for a couple of months, because I could not take it for very long. He was highly reactive and would get very upset with me for ridiculous reasons (e.g. because I said I didn’t like a song he liked on the radio). He would snap on me behind closed doors and smile in public. Once, in front of all of my friends he began sobbing uncontrollably and ripped his shirt off in anger and told me he hated me. I don’t even remember why. One day he would tell me I was the most beautiful woman he’d ever seen and that he wanted to get married and have kids with me (pretty quick to be saying such things), and then two hours later (for God knows what reason), he’d yell obscenities at me and tell me he hated me and that we needed to break up. He drank excessively, and constantly thought I was lying to him and cheating on him. He would stare at himself admiringly in the mirror sometimes, and thought he knew everything there was to know about every subject. I was always walking on eggshells and was terrified of him. I never knew which emotion was going to come out of him. I did stand up to him one day and told him to leave my house and to get psychiatric help. He was losing touch with reality on a regular basis. This was my first encounter with BPD, but the sheer lack of empathy, callousness, and self-love he always seemed to display was very indicative of NPD as well. After I broke up with him, he would call me and tell me that he could not survive without me, that he was taking classes for anger management, and that he would die if I would not take him back (of course I didn’t!). One of the main reasons I thought he was BPD was because he was VERY emotional. It’s okay for men to cry, but this was truly overboard, and he was a drama king.
I do have issues of my own. As I said before, I was diagnosed with bipolar disorder (screened for BPD, but two separate doctors said no). I am stable on my medications, and have gone through intensive CBT and therapy for codependency (since my therapist knows about the two guys I dated with PDs). My theory is that I simply had bad luck in finding these guys. I had a pretty normal childhood. Today, I am in a relationship with a guy who is loving, emotionally available, stable, respectful, and he treats me as an equal in the relationship. There’s a balance. We have arguments just like any other couple, but they are over regular, everyday issues.
B., finding a man who turned out to have NPD is NOT your fault (it might have been bad luck in your case as well), but now that you know he has it, is it worth it to stay with him- and go to couple’s therapy? Think about it…he may be your husband, but a narcissist does not change- EVER. Why? Because he does not WANT to change. He believes that he is PERFECT in every way (though, in order to preserve the relationship, he may tell you he is not). Are you able to talk to him at all about your feelings and emotions, or does he give you the brush-off and tell you to just “talk to your therapist about it”? It’s really not too late for you to get out if he’s not treating you with love and respect. If you decide to leave, I recommend that you run! Men with NPD have a tendency to stalk, harass, or desperately try to win exes back with manipulative measures. I know that it would be so hard to do this, but trust me, you have to take care of yourself. Don’t voluntarily stay in an emotional cage (IF this is how you feel). You deserve trust, love, intimacy, and respect in your relationship. If you aren’t getting these things, it’s time to go. Don’t try to fix him. You can’t. You can only fix you. Work on building your self-esteem and discovering what’s important to you in a relationship, and then you will find exactly how to best handle your individual situation. There is a grief process, but there is also a light at the end of the tunnel. Good luck, friend! 🙂
BTW, Wasn’t Sam Vaknin recently diagnosed a psychopath, after proclaiming that he was one? Here is the link I found.
http://www.cbc.ca/documentaries/wilddocs/2009/psychopath/index.html
I would be very careful about reading anything a self-proclaimed psychopath writes, and taking it seriously. He is a sadistic internet predator.
Bon Dobbs
I wasn’t aware of Mr. Vanknin’s psychopathic diagnosis and I don’t usually use him as any kind of source for anything as I said.
Sounds as if you’ve gone through a lot. Very painful stuff.
Thanks for your comment.
Hadrian
Cluster B personality disorders are frequently comorbid and individual traits associated with one disorder are frequently – in fact I would guess more often than not – present in people diagnosed with another Cluster B disorder. NPD is probably the most misunderstood and unfairly maligned psychological condition out there, being a defence mechanism against deep-seated feelings of worthlessness. The emotional rationale is I can’t be worthless if I’m the best person in the world, can I? All the grandiosity, entitlement, and attempts to defuse perceived ego-threats stem from this fundamental error, the NPD sufferer believing that the alternative to being the best person in the world is being the WORST person in the world. The worthlessness comes first, and the unpleasant NPD reactions to perceived injuries or threats are born of a desperate desire to stave off feelings of worthlessness.
Given that, it would hardly be surprising if NPD traits or the full-blown disorder developed as a maladaptive defence against baseline BPD shame & identity instability. Narcissism offers a way out of both by developing a false and highly valued self to replace the valueless/incoherent real one. From this perspective you could see comorbid BPD/NPDs as people who – perhaps luckily for them – haven’t succeeded in fully replacing the fragile shame-filled self with the invincible false one. In fact, whatever the source of the devaluation of the real self – whether Borderline in character or something else, NPD is BY DEFINITION *NEVER* a successful ego-replacement, because a successful ego-replacement wouldn’t need narcissistic supply to keep it going and wouldn’t be vulnerable to narcissistic injury. Instability of self-image is a core characteristic of narcissism just as it is of BPD.
Lack of empathy is just one of 9 diagnostic criteria for NPD and so there are diagnosable NPDs who fail to exhibit it, as well as, of course, any number of people with other NPD traits who don’t exhibit that particular one. It is probably the most disturbing NPD trait & it is hard to imagine a BPD genuinely having it, despite appearances when they are disregulated. It too however is comprehensible as a defence against ego-instability, since if your self extremely fragile, other people’s feelings could overwhelm it and all sense of self be lost. If it makes sense, the kind of excessively people-pleasing codependent that narcissists characteristically prey on & exploit, is an example of what a Narcissist might have grown into if he’d never developed NPD.
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K
Hadrian, excellent analysis there. I believe my ex husband is BDP/NPD and what you say certainly rings true. For a long time now, I have understood the NPD to be an additional layer of defence that allows him to function reasonably well in getting his needs met at least