Is It Vulnerable Narcissism or BPD?

Dr. Ettensohn discusses the differences and similarities between vulnerable narcissism and Borderline Personality Disorder (BPD). 

References:
Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). New York: Guilford Press.

#npd #narcissism #mentalhealth #mentalhealthawareness #psychology #healing #vulnerable #covertnarcissist #bpd #borderlinepersonalitydisorder #psychologist #psychoanalysis

[healnpd]

I will remove comments that are abusive to any individual (including myself) or population. This includes comments that are abusive toward pwNPD.

[michellembarre]

Once again, you nailed it! Perfectly explained, and not overly dramatized or negatively pronounced as monsters but shown as real humans who were severely harmed by humans.

[cupoftea]

Thank you again for another great episode. Your voice is so calm and reassuring and despite it being a difficult topic to explore I feel so validated by your explanations.

[PasaulioValdovas]

Thank you for your content. I really enjoy jow relatable and understandable your videos are. However, I have a question:
When are you going to make a video about actually healing NPD? I understand that working with professional therapist is the preferred way, but I would be very grateful if there were more resources about how to recover for those of us who can't or are not willing to attend the therapy yet.

[neonnightrder]

thank you for this video Dr. Ettensohn. In the next video, could you please talk about the false/true self theory? I've read about Winnicott's theory and that seems fascinating. Also, on how treatment aims to unveil the authentic self of a person and lessen the false self. I'm diagnosed as NPD and frankly I'm not really sure what's my authentic self behind the defenses. I realize this worry might be because of my OCD as unfortunately I'm diagnosed with it as well.

[keksanimations-bpzb]

As someone with Bpd the either “too close” or “too distant” hit hard. I knew the symptoms were there, but I never really summarised it. That description was kinda on point. At first I was like: “what is he talking about?” But then I listened to it again and it was like “oh my god that’s so true it hurts.” But it’s true so now that I know it I think it will be easier to self reflect if something like that happens.

If someone is too close I am mostly just mildly annoyed at them and don’t show it, if I care about the person because I know the feeling will go away eventually (or I set some boundaries) and if it’s someone random at work or another person I barely know, I just take a step back.

I don’t know if it counts as Bpd or not, but most of the time if someone is too close and I am not angry, I’m scared. I’m scared that I might obsess over that person and idealise them. And that it might lead to me hurting that person and myself getting hurt (both emotionally).

But the “too distant” kinda thing is true all the way for me. If I wish someone to be closer and they are too distant (miscommunication in a relationship, no replies or no returned affectionate gestures and words) there is a spiral of self blame, self hate, overwhelming feelings, overthinking and all that stuff.

But of course there are times a relationship (family friends partners) is exactly right. Not too close and not too distant. I love those relationships (but of course everything can fluctuate, so nothing is set in stone).

[prant]

My take here is that occasionally narcissists act psychotic. My ex GF was clearly a narcissist but never dream of hurting herself. Abandonment? At least she acted like it never bothered her. But, she was a woman in her sixties who, every once in while, would have a, “tantrum, ” where she exhibited an anger that was psychotic in nature, directed (of course), at me. 1. The, “anger, ” had no rational meaning. A waiter could pour coffee at the wrong time and she would pack up and leave a Caribbean vacation. 2. Zero empathy. These anger episodes ruined vacations, ruined the relationship, could have gotten me arrested and thrown in jail. None of that mattered at all to her. My anxiety got so bad I actually went to the hospital a few times, and of course, (four therapists later), I left for good. My point is, we need another category. “Borderline Narcissism.” A person who is a genuine narcissist, but, (because of extreme lack of empathy and splitting), exhibits definable psychosis.

[brandonmcalpin]

Frank Yeoman’s and Otto Kernberg published a paper distinguishing the differences between NPD, BPD, ASPD and Bipolar. Apparently 50% of the patients coming into the personality disorder clinics were misdiagnosed with Bipolar. That’s wild. 😂 Anyway. The differences between BPD and NPD given are bizarre to me. I’ll show you what I mean.

“Patients with a severe narcissistic personality disorder may present symptoms strikingly similar to those of borderline patients: general impulsivity, severe chaos in relations with significant others, severe breakdown in their capacity for work and emotional intimacy, and parasuicidal and self-mutilating behavior.”
-Frank Yeomans, MD & Otto Kernberg, MD

Off to a good start. I agree. Here’s where they give distinct examples of how to discern the difference between the two. I disagree with all of them mostly. Wonder what your thoughts are? I’m just some dude on the internet, I don’t have MD after my name so.. 😂

1. People with NPD have difficulties accepting any sort of dependence on a relationship. They lack any real investment in relationships with significant others(except for the connections as described below) Their aloofness contrasts with the highly ambivalent and dependent relationships of patients with BPD.

Overlap: Both NPD and BPD patients may seem to have a strong dependence on those connections with others that may serve them personally, particularly parasitic relationships; ie. bumming off friends with no intention to pay them back, non-reciprocal relationships where the other does all the giving, attention/praise(NPD) and or emotional support(BPD), leeching off family members, living rent free, not paying bills.

*The differences described above aren’t as much of a variation in conditions, rather a distinction between attachment styles?*


2. PwNPD show extreme fluctuations between immense feelings of inferiority, failure, anxiety, depressive symptoms and anhedonia on the one hand. On the other hand, a sense of superiority and grandiosity that shows in their dismissing behavior toward others, including their therapist. PwBPD may alter their relationship between clinging dependency and idealization, on the one hand, and vehement devaluation and dismissal, on the other hand, but they do not show the chronically contemptuous attitude that Narcissists present.

*I see where Frank and Otto are coming from, but I mostly disagree with this statement. Both pwNPD and pwBPD idealize and devalue their partners, both of which look similar in their presentation. The chronic contempt shown by Narcissists seems to be more of a masculine trait, not so much the defining characteristic used to decipher two mental health conditions from each other. Even when the pwNPD is presenting as the overtly vulnerable, shy or fragile self state, the contempt remains chronic, all pervasive and ubiquitous. I call it a sullen superiority and a morose haughtiness. Lol. Men, not to mention grandiose men, tend to express their disdain more overtly, while women primarily conceal their scorn as to avoid escalating conflict, out of fear of being ostracized from the group(evolutionarily speaking), only for it surface later as passive aggression. This is a contrast in gender dynamics, not personality disorders*


3. PwNPD, who are on the more severe end, are usually isolated socially, even if they are part of a social network. They lose their friends and do not maintain relationships over an extended period of time, and their loneliness contrasts with the complex, contradictory yet enmeshed relationships of borderline patients.

*I mostly agree, but I’d also like to point out how pwBPD tend to isolate themselves just as much. Perhaps they can cling to relationships longer, but this also seems to be more of an issue with gender dynamics. Women in general, personality disordered or not, tend to keep old connections alive more frequently than men because they prefer not to end things on bad terms. They may be vague or lie about the reasons for breaking up, harking back to #2, not being direct, being passive to avoid confrontation and or to bypass hurting feelings. I’m fairly certain women end relationships significantly more than men do, granting them the power to hold on to exes as friends*

*Regardless, I’d even go as far as to suggest that pwNPD have occasional periods of Schizoid-like isolation, brought on by any number of things. For example, a pwNPD may face public criticism, but somehow the disparaging comment seem to thread the needle, slipping through a pin hole within his armor of grandiosity, resulting in devastating narcissistic injury. The criticism pierced through and hit a major artery, so the pwNPD can’t recover properly. For days, weeks, months, perhaps even years, the pwNPD ruminates incessantly about the humiliation, invoking a debilitating shame*

*This entices the pwNPD to become a recluse, to hide away from the world until the wounds heal, but there’s an internal dissonance that will not go away. The pwNPD becomes agoraphobic and the trepidation causes more narcissistic injuries. The malign superego chastises the Narcissist, dismembering every piece of self worth that remained. The consequential agony derives from the yawning disparity between the Narcissist’s projected image and the unforgiving reality that was publicly exposed. The pwNPD can’t cope with this, it’s as if life was an illusion and it was shattered without warning. Disoriented and forlorn, the Narcissist faces the inevitable horror of a collapsing false self*


4. In contrast to BPD patients who present different aspects of their internal world from one moment to the next, patients with NPD at the borderline level mask the fragmentation and weakness of their identity under a brittle and fragile grandiose self that they present to the world and to themselves.

*Yes and no. Just because Borderlines struggle to mask, doesn’t mean they don’t mask at all. Borderlines describe how exhausting and mentally draining it is, claiming they can only ever hold it together for a few hours at a time, if that. There’s still an attempt present, it’s like this repetition compulsory act of trying to prop up a false self, yet failing to maintain it. Every Borderline I’ve ever had the pleasure of dating(lol), we’re the MOST bubbly, lively, energetic, free spirited people I’ve ever known. How is that not a facade? Just like me, any criticism or slight, or perceived signs of hostility or abandonment, is met with a crumbling of this facade at free fall speed. To me, it’s as if they have a false self, but it’s (more) unstable, perhaps due to later trauma between ages 5-10, usually sexual abuse. This could have caused some sort of fracture of the false self? Idk. That’s just my observation. It’s like they’re in this repetition compulsory act of propping up a broken facade only for it to fail over and over*

*Hence the transient manic phase in BPD. It seems to me, that’s their attempt at trying on a false self outfit, but after a few hours or maximum, a couple of days, it invariably falls apart. Just a thought, I cannot provide evidence of this. Just my observation. Also, Narcissists don’t always mask behind a grandiose facade either, they often endure violent swings in self worth, between the self state of overt grandiosity, covert vulnerability then plummeting to the self state of overt vulnerability, covert grandiosity*

*All of that said, I often wonder if BPD and NPD are the same entity. While, what Otto saw mostly, the pure grandiose Narcissists, seem to me to be Primary Psychopaths, not Narcissists? Just my uneducated opinion*

Edit: Oh; I think we are on the same page, at the end you said they’re not really distinct diagnosis rather different expressions. I say it’s gender differences but who knows

[zaccameron]

Thank you. I feel like for the first time there is hope. The stigma is real. Thank you for understanding me as human and not a monster.

[moxiepooties]

I am so glad I found your videos! I have spent a couple years in confusion trying to understand what was going on with a sibling, and though I was following several of the most popular and qualified narcissism experts for a couple years, I didn't really understand the situation well enough to avoid feeling confused at times. Now I KNOW what really happened that turned a sibling into someone whose behavior towards me is unpredictable and confusing!!! In my sibling's case, I believe BOTH NPD and BPD are factors. I have another relative who has been diagnosed with BPD but doesn't accept this diagnosis as accurate. Is that typical? Is it rare for these people to actually see themselves, because of the self-esteem issues?

[AlastorTheNPDemon]

Huh. I seem to have all these borderline distortions infesting my mind, but I do have an academic understanding of self-other boundaries... even though it seems like everyone else's personal bubble is the size of Jupiter's orbit. So far as I know, I do not exhibit any of the ignited rage or wild behavior commonly seen in Cluster B, erroring more on the side of social withdrawal and a constant smoldering pain in my chest that drains all of my energy.

Most of my grandiosity is manifest in occasional performances and internet interactions, with the death stare being used for aggressive people. My ideal persona is fairly new to the public in IRL interactions, but I'm really intent on sculpting it into something truly amazing. Being what is called a "deep thinker" though (a polished turd of a term, if you ask me), I must bear the burden of knowledge that I can never be as good as I desire. I feel hobbled and strapped down, unable to release the beast within no matter how much I desire it.

[AndrewFosterSheff]

The love-bomb->devalue->discard cycle just comes round more frequently with a borderline due to their push-pull confusion LOL!
That and the fear of abandonment cycle.

[naetek]

the first explanation he means : borderline pathological organization
the difference is that in NPD you got a PATHOLOGICAL GRANDIOSE SELF that includes ( real self-ideal self-and ideal others)

[kianaleigh]

I’m curious which of the four presentations of BPD you’re referring to when relating it to vulnerable narcissism? I’m aware one type of BPD overlaps significantly with NPD, however not every individual with BPD externalizes rage or projects blame onto others as the cause of their distress or negative experience.

[esahm]

Ultimately BPD and NPD are constructs that should be taken with some grain of salt. The idea that a person either fullfils all of the criteria of clinical construct A or of construct B is flawed. Neurobiology doesn't adhere to our human made taxonomic divisions as expressed in (for example) the ICD-10. Yes, ICD-11 has made some progress, but still it's limited in it's capacity to describe and logically structure mental and psychiatric phenomena. So to ascribe someone as having NPD or BPD, that's a rather arbitrary process. One and the same person visiting different therapists or psychiatrists will possibly be diagnosed with different disorders. Yet we communicate and treat these clinical constructs as if they were definite, when reality is that they are not. I guess this is how Clinical Psychology attempts to maintain a facade of being a scientific discipline, when a lot of it's methods, models and approaches center around subjective philosophical interpretation of natural phenomena, not an exactly scientific, evidence based understanding.

[iamportersinger]

This was helpful. Thank you. I watched several other videos with similar titles before watching this one… yours was by far the clearest explanation. 🙏🏼✨

[d.finance]

If I have a loved one that is showing signs of either NPD or BPD, but they refuse to seek help. Is there a book or resource that might help them at least start learning about the impact of their childhood on them adulthood or something like that? Something that they might not immediately try to push away from because of their defense mechanisms kicking in against 'perceived' criticism.

[matyasvarga]

Thanks, it's a really interesting video!
Does it mean to say that people who have borderline personality organization are for sure to have a personality disorder or not?
As I understand it, people with neurotic personality organization can have OCD, GAD and so called neurotic disorders but they don't have full blown PD-s.
Could you help it to make this clear?

[MsMirror]

How common is self-harm and/or suicidality in vulnerable narcissists?

[gvid]

i would love to see an episode about helping those with NPD get help. as someone who is open about their NPD, i get a *lot* of questions from people saying "how to i make my x get help" but you cant just make someone do anything, and id like a video explaining it in more depth (what can be done, what cant be done) that i can listen to myself and send to those people