Borderline Personality Disorder and Narcissism

Borderline personality disorder and narcissism (more accurately, narcissistic personality disorder, or NPD) are both personality disorders. When the two occur together, symptoms of each may worsen. It may be more challenging to diagnose and treat the conditions. But it's possible that treating BPD (borderline personality disorder) may help alleviate some of the symptoms of NPD.

Narcissism itself is not a symptom of BPD listed in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). However, as many as 40% of people with BPD may also have narcissistic personality disorder, so people with BPD may also show signs of narcissism.

The term "borderline narcissist" is sometimes used to refer to people with both conditions, but it is important to note that it is not a diagnosis. It may be used informally to refer to someone with borderline personality disorder (BPD) who also has narcissistic personality disorder (NPD). Or, it may refer to someone who has some symptoms of NPD, but not enough for a diagnosis.

Differences Between Borderline Personality Disorder and Narcissism

Both borderline personality disorder (BPD) and narcissistic personality disorder (NPD) both personality disorders and can share some characteristics. Both involve dramatic, overly emotional, or unpredictable thinking or behaviors. However, the two conditions are significantly different, says Avigail Lev, PsyD, founder and director of the Bay Area CBT Center.

Ego-syntonic means people's thoughts, feelings, and behaviors align with their self-image. People with BPD or NPD have poor insight into their conditions and do not see anything wrong with their behaviors and perceptions. This can play a role in complicating treatment.

People with both types of disorders may have very low self-worth. But in NPD, that leads to egotistical behavior and a lack of empathy. In BPD, anger may be turned inward, resulting in frequent changes in behavior and mood.

"Individuals with NPD tend to score extremely high in cognitive or 'cold' empathy but are substantially below average in affective or 'warm' empathy. Conversely, those with BPD generally score below average in cognitive empathy and around or slightly below average in warm empathy," explains Lev.

Narcissistic Personality Disorder (NPD)

Narcissistic personality disorder (NPD) is one of 10 personality disorders recognized in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). NPD is one of the "Cluster B", or dramatic/erratic, personality disorders.

Narcissistic personality disorder is characterized by the presence of five or more of the following symptoms:

• A sense of entitlement
• An inflated sense of self-importance
• Arrogant, egotistical, or haughty behavior
• Envious of others or believes others are envious of them
• Lack of empathy
  
• Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love
  
• Requiring excessive admiration
  
• Taking advantage of others
• Believing that they are "special" and can only be understood by other special or high-status people

In short, people with NPD might be described as self-absorbed or egotistical. This self-absorption rises to the level of a clinical disorder when it significantly interferes with the person's relationships, job, or other important domains in life. Many experts believe that this egotistical style is actually an attempt to deal with an underlying poor sense of self-worth.

Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is also a Cluster B personality disorder. It is characterized by consistent changes in behavior, mood, and self-image. Episodes of anger, depression, and anxiety lasting up to a few days are common for people with BPD.

People with BPD frequently change their opinion of themselves and others and their interests. Drastic changes in opinion often lead to tumultuous or unstable relationships with others. Other symptoms of BPD include:

• Extreme fear of abandonment
• Impulsive behaviors (such as unsafe sex or substance use)
• Self-harm
  
• Thoughts of suicide

Especially during times of stress, people with BPD can experience dissociation. Someone experiencing dissociation can feel like they don't have a sense of self or identity. They can feel detached from their emotions, memories, and thoughts. They can also experience significant memory loss of times in their life, people, and events.

How Often NPD and BPD Co-Occur

While the overlap between NPD and BPD is discussed often in the popular psychology literature and online, very few careful studies of the co-occurrence of NPD and BPD have been conducted. One older study reported that almost 39% of people with BPD also have NPD.

Another 2018 study showed a strong correlation between BPD and a certain type of narcissism: vulnerable narcissism, which is characterized by hypersensitivity, defensiveness, and low self-esteem. The same study also found that male patients had higher narcissistic scores than female patients. But its sample size was small (65 people).

How NPD Affects BPD

There are a number of theoretical reasons to believe that someone with both NPD and BPD would be less likely to get better over time. People with NPD can be resistant to treatment, and often have poor insight into the ways that their behaviors are detrimental to themselves or others.

Also, people with NPD may cause more emotional pain to others than they cause themselves. This can mean that their motivation to change their behavior is very low.

"They possess a high level of emotional intelligence, enabling them to understand others' thoughts and feelings and to adopt their perspectives. But they are not emotionally or physiologically affected by others' pain and suffering," Lev explains.

One study that followed BPD patients over six years found that rates of co-occurring NPD were fairly low, about 6%, in patients whose BPD eventually went away (remitted).

However, rates of co-occurring NPD were higher (around 19%) in patients whose BPD did not remit after six years. So there is a subset of people with non-remitting BPD and higher rates of NPD.

NPD and BPD in Relationships

The relationships of people with BPD are often quite dysfunctional. Adding NPD into the mix can create even more disordered conditions. One study notes, for example, that as the severity of NPD increases, so does aggression (directed at oneself or others) and difficulty with interpersonal behavior and moral functioning.

In addition to the chaotic emotional life and fears of abandonment associated with BPD, a person with co-occurring NPD may also take advantage of or manipulate others while having little empathy for others' concerns. This combination can be incredibly destructive in relationships.

"People high on narcissism including those with antisocial personality disorder, may even feel pleasure from other people’s suffering, which is not the cause with BPD," says Lev.

Treatment for NPD and BPD

There are currently no empirically supported treatments for NPD and no published clinical trials of treatments for NPD alone or co-occurring with BPD.

Published research on the treatment of NPD is limited to some case studies or anecdotal accounts, but these types of studies tend to be unreliable and subject to bias. The case study literature on the treatment of NPD has primarily centered around the use of modified psychoanalytic techniques and has recognized the challenges of successfully treating the disorder.

Some researchers suggest that because there is some overlap between NPD and BPD symptoms (such as impulsivity and destructive behaviors), treatments designed for BPD, including dialectical behavior therapy (DBT), mentalization-based therapy, schema-focused therapy, and transference-based psychotherapy, may also work with NPD. However, more research on the topic is needed.

A Word From Verywell

Personality disorders, including borderline personality disorder and narcissistic personality disorder, can be difficult to cope with. Co-existing personality disorders or other psychological conditions make diagnosis and treatment more complicated. However, there are some therapies that can be effective. If you are living with NPD or BPD, or have a loved one who is, seek support to help manage the condition and its effects on both of you.