Borderline personality disorder (BPD) is characterized by unstable emotions, relationships, and self-esteem, while narcissistic personality disorder (NPD) is marked by grandiosity, a need for admiration, and lack of empathy. Both may result from childhood trauma and have low self-esteem, but differ in how they present in therapy and react to disappointment. Treatment for both disorders is difficult and requires experienced doctors.
The core features of borderline personality disorder (BPD) are a dramatically changing degree of stability in emotional expressions, relationships, and self-esteem. This combines with a tendency to act impulsively. Those with a narcissistic personality disorder (NPD) are more known for grandiose or highly self-important thoughts and behaviors, a constant need to be admired by others, and an inability to empathize with others. Borderline and narcissistic personality disorder have other differences but also share many traits in common.
NPD and BPD may result from exceptional impairment to self-esteem development in childhood. People with NPD often have a pattern of neglectful parents who may also, in turn, lavish attention. Many of those with BPD are victims of physical or sexual abuse. This childhood disability results in very different behaviors in adults with either of these personality disorders.
One of the ways that borderline and narcissistic personality disorder differ is in how they initially present in a clinical setting. The person with BPD is likely to be friendly, cooperative, and willing to share. A client with NPD is likely to spend a lot of time trying to convince a therapist of her importance, which is usually accomplished with bragging and stories. The NPD client also wants to charm the therapist, but tends to spend more time exaggerating their own merits.
When the NPD client fails to command the therapist’s admiration, they may give up and move on to someone else. This differs profoundly from the scenarios that can occur the day the BPD client is disappointed in a therapist. The response may be disproportionate fury, which may include acting out, leaving therapy immediately, or refusing to cooperate. This response is characteristic of borderline personality disorder in most relationships.
A commonality in borderline and narcissistic personality disorder is a history of failed relationships, which differ in quality. Those with BPD usually have intense relationships that ultimately end due to failure of the other party. They might attribute it to a pattern, such as: “I always pick the wrong men.” An NPD client is likely to describe many sketchy associations without much depth. These often end when the other party fails to properly appreciate the person’s unique qualities.
Individuals with these conditions may also differ in their reactions to disappointment. In BPD, actions in response to perceived injury include actual suicide attempts, self-harm, and substance abuse. People with NPD may register shock and alarm, but their pattern is to move on to someone else who appreciates them better.
Both borderline and narcissistic personality disorder are characterized by extremely low self-esteem. People with these disorders don’t have a reliable means of feeling good about themselves. They look to others to fill their sense of extreme emptiness or inner disgust, and they don’t realize that their behaviors result in rejection. NPD and BPD sufferers lack the ability to self-assess and when problems do occur, it’s always other people’s fault.
Blaming others for self-generated problems makes these conditions difficult to treat. Proper treatment can take years and requires doctors with strong experience treating personality disorders. There are some treatment models that may be more successful with BPD and NPD. These include object relations and dialectical behavior therapy.
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