Understanding the Comorbidity Between Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD)
Borderline personality disorder (BPD) and narcissistic personality disorder (NPD) are two conditions that are characterized by difficulties with emotion regulation, impulse control, interpersonal functioning, and sense of self.
Defining BPD and NPD
People with BPD often struggle with unstable emotions, relationships, self-image, and behavior. Impulsive and reckless behavior is also common. Meanwhile, the hallmark signs of NPD include grandiosity, need for admiration, and lack of empathy.
Despite some clear differences, BPD and NPD have a high rate of co-occurrence or comorbidity. Up to 47% of people with BPD also meet criteria for NPD and vice versa.
Understanding Comorbidity
When two disorders or conditions occur together at a rate higher than chance, they are called comorbid. The reasons for comorbidity can include:
- Overlapping symptoms
- Shared risk factors
- One disorder increasing risk for another
- Incorrect diagnosis
Overlapping Signs and Symptoms
BPD and NPD overlap most prominently around instability of self and relationships. Both involve intense emotions, impulsivity, and vulnerability around perceived rejection.
Unstable Sense of Self
Both BPD and NPD involve a fluctuating self-image and shifting sense of identity. BPD causes rapidly changing feelings about oneself. NPD involves vacillating views of self-importance.
Tumultuous Relationships
Those with BPD and NPD tend to have intense but unstable relationships. BPD causes fear of abandonment and rejection sensitivity. NPD involves love-hate relationships and lack of empathy.
Impulsivity
Impulsive and self-destructive behaviors are common to both BPD and NPD as part of poor emotional control. This includes areas like substance abuse, eating disorders, financial issues, and reckless driving.
Extreme Reactions to Rejection
Perceived rejection elicits extreme emotional reactions in those with BPD and NPD, though for different reasons. BPD involves frantic efforts to avoid abandonment, while narcissists display rage or humiliation.
Shared Risk Factors and Developmental Pathways
BPD and NPD also share similar childhood risk factors that shape personality and self-concept.
Trauma and Invalidating Environments
Experiencing childhood emotional, physical or sexual abuse is strongly linked to both BPD and NPD. Invalidating home environments also contribute for both conditions.
Insecure Attachment Patterns
Insecure attachment styles involving preoccupation/anxiety or dismissiveness are common precursors for BPD and NPD. Troubled relationships with caregivers undermine stable sense of self.
Hypersensitivity to Emotions
People predisposed to BPD and NPD often have intense emotional reactions starting early in life, though they manifest differently. One involves emotional flooding, the other defensive emotional detachment.
Bidirectional Risks and Cyclical Interactions
The overlapping symptoms and shared vulnerabilities indicate some bidirectional risks where BPD and NPD exacerbate each other in cyclic fashion at times.
Rejection Sensitivity Spurring Ego Injury
The profound rejection fears in BPD may elicit narcissistic rage and ego injury in response. Their extreme emotional displays can further alienate others.
Narcissistic Wounds Fueling Abandonment Crisis
When feeling rejected, those with NPD may experience intense shame, humiliation or emptiness similar to borderline abandonment fears. This can spur self-harming behaviors seen in BPD.
Underestimating Common Ground
Lack of insight about areas of shared struggle can also impede progress. Narcissists may dismiss recognizing borderline emotional pain. People with BPD may not appreciate narcissistic vulnerabilities.
Accurate Diagnosis is Essential
Due to the symptom overlap between BPD and NPD, it can be challenging to differentiate the conditions. Getting an accurate diagnosis is crucial for determining appropriate treatment strategies.
Hallmark Differences
While ego inflation typifies NPD, chronic feelings of emptiness and loneliness are more prominent in BPD. Shifting sense of self is also more central to BPD than NPD.
Awareness of Comorbidity Patterns
Diagnosticians need awareness of common BPD and NPD comorbidities to help identify subtle distinctions in underlying mindsets and behaviors that distinguish the two conditions.
Longitudinal Assessments
Getting a thorough history to evaluate long-term functioning patterns can reveal defining characteristics of BPD vs NPD. This clarifies appropriate diagnosis and priority treatment targets.
In many cases, the vulnerabilities of both BPD and NPD are at play to some degree. Appropriate therapy strategies involve addressing thought patterns, emotional skills, self-awareness, empathy and relationship dynamics specific to each set of symptoms.
FAQs
Why do BPD and NPD overlap so much?
BPD and NPD have significant symptom overlap due to shared instability of emotions, relationships, self-image and impulsivity rooted in childhood emotional vulnerabilities and trauma.
How can you tell BPD and NPD apart?
While chronic emptiness and abandonment fears occur in BPD, grandiosity and need for admiration are more defining of NPD. Getting a longitudinal history helps determine primary symptoms.
Can BPD and NPD make each other worse?
Yes, BPD and NPD can interact in destructive cyclic fashion at times. Rejection sensitivity in BPD may worsen narcissistic rages. Narcissistic wounding can intensify BPD emotional crisis.
Why is accurately diagnosing BPD vs NPD important?
Accurately diagnosing whether symptoms of emotional volatility stem more from BPD or NPD allows mental health professionals to select appropriate therapies to address the specific underlying mindsets and behaviors.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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