Borderline Personality Disorder or Narcissistic Personality Disorder?
Updated: Jan 27
Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD) are two personality disorders recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As both are in the Cluster B category, they share several common characteristics and behavioural patterns, which include, but not limited to:
Constant need for attention and validation
Spending significant energy on their needs
Constant disconnection from reality
Unstable interpersonal relationships
Because of the above similarities, people sometimes mistake NPD for BPD. However, despite being in the same cluster and sharing some standard features, BPD differs from NPD.
Borderline Personality Disorder
The cause of BPD is often rooted in attachment trauma. Children who experience caregivers who abandon, neglect, emotionally absent and constantly ignore them are vulnerable to growing up with poor self-image. The fear of being subjected to repeated experiences of intense emotional pain leads people with BPD to be hypersensitive to any sign of abandonment, leading to episodes of anger (towards self and their partner), depression, and anxiety which may last for a few days. Other symptoms of BPD include:
Suicidal ideation and suicide attempts
Narcissistic Personality Disorder
The cause of NPD is often link to parent-child relationships. Children who grow up with parents who give them too much adoration, such as allowing them to get away with everything, are vulnerable to growing up with a high level of self-importance. On the other hand, children with highly critical parents are also susceptible to narcissism. Other cause of NPD includes genetics and inherited characteristics. People with NPD are excessively concerned with self-importance. Their eagerness to feed their ego leads them to have little empathy for others. Other symptoms of NPD include:
Require constant, excessive admiration.
Feel that they deserve privileges and special treatment.
Expect to be recognized as superior even without achievements.
Make achievements and talents seem more significant than they are.
Believe they are superior to others.
Extremely critical of others
Inability to recognize the needs and feelings of others.
Behave arrogantly and brag, which leads them to appear arrogant.
At the core of both BPD and NPD is a complex and unhealthy way of thinking, acting, and behaving. They may resort to extreme measure to protect themselves from emotional distress. However, there are some differences between BPD and NPD.
People with BPD's primary concern is a fear of abandonment, while people with NPD are preoccupied with pervasive sense of grandiosity. People with BPD also struggle with a sense of unworthiness, leading them to suicidal thoughts or self-harm, while people with NPD feel a sense of entitlement and self-importance. People with BPD struggle with intense emotions, while people with NPD tends to be emotionless, except for rage. People with BPD openly exhibit feelings of abandonment, woundedness, and vulnerability, while people with NPD hide their vulnerability by exaggerating and attributing the issues to others. People with BPD often have a genuine interest in others and can form healthy relationships. In contrast, people with NPD attempt to impress and manipulate their relationships often leads them to have very few friends.
You may wish to consult a psychiatrist for evaluation if you suspect that you or your loved one is struggling with BPD, NPD, or both, and you need a formal diagnosis. The most effective treatment for BPD and NPD is psychotherapy. Popular psychotherapy for BPD and NPD includes Dialectical Behavioural Therapy (DBT), Cognitive Behavioural Therapy (CBT) and Schema Therapy. These therapies aim to reconstruct maladaptive beliefs and provide training on managing behaviours. As the root cause of NPD and BPD is frequently attachment trauma, you may wish to consult a therapist trained in trauma psychotherapy such as Eye Movement and Desensitization (EMDR), Internal Family System (IFS), and Ego State Therapy. Medication may be necessary sometimes as people with BPD's constant fear of abandonment may also caused to have anxiety and depression.
People with BPD are usually aware of their difficulty in regulating their emotions. They are more open to seeking help so they can keep their relationship. People with NPD's sense of self-importance often cause them to project and blame their relationship issues on their partner, friends and family members. Because of it, it can be challenging to persuade people with NPD to attend counselling or psychotherapy. They also tend to stop attending therapy just after few sessions.
Restoring Peace Counselling and Consultancy offers counselling and psychotherapy services for Personality Disorders and other mental health challenges to children, youth and adults, and individuals, couples, families and groups. For more information, please visit www.restoringpeace.com.sg or WhatsApp at +65 8889 1848.