Borderline Personality Disorder and Narcissism

Table of ContentsView AllTable of ContentsBPD vs. NPD: Key DifferencesCo-OccurrenceHow NPD Affects BPDTreatment

Table of ContentsView All

View All

Table of Contents

BPD vs. NPD: Key Differences

Co-Occurrence

How NPD Affects BPD

Treatment

Borderline personality disorder and narcissism (more accurately, narcissistic personality disorder, or NPD) are bothpersonality 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 asymptom of BPDlisted 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.

1:24How to Identify a Malignant Narcissist

1:24

How to Identify a Malignant Narcissist

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, saysAvigail Lev, PsyD, founder and director of the Bay Area CBT Center.

Both narcissistic personality disorder (NPD) and borderline personality disorder (BPD) are categorized as Cluster B personality disorders. This means that they are ego-syntonic rather than ego-dystonic, like non-personality disorders.—AVIGAIL LEV, PSYD, FOUNDER AND DIRECTOR OF THE BAY AREA CBT CENTER

—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.

Cognitive Empathy vs. Affective Empathy

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.

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 ofself-worth.

What to Know About Narcissistic Personality Disorder

Borderline Personality Disorder (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:

Especially during times of stress, people with BPD can experiencedissociation. 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.

If you or someone you care about is having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

For more mental health resources, see ourNational Helpline Database.

What to Know About Borderline Personality Disorder

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.

A 2018 study that drew from a treatment-seeking sample rather than a community sample found that about 13% of patients with BPD also meet the diagnostic criteria for NPD.

Borderline Personality Disorder Statistics

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 moreemotional painto others than they cause themselves. This can mean that theirmotivationto change their behavior is very low.

Research supports the theory that when people have both borderline personality disorder and narcissism, their BPD symptoms are less likely to improve over time.

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

Therelationships of people with BPDare 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 withinterpersonal behaviorandmoral functioning.

In addition to the chaotic emotional life andfears of abandonmentassociated with BPD, a person with co-occurring NPD may also take advantage of or manipulate others whilehaving little empathyfor 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.

If you are in a relationship with someone with BPD, NPD, or both, encourage them to seek treatment. Individual therapy for each partner and couples' therapy may help you both cope with the symptoms of personality disorders that make relationships difficult.

The 10 Best Online Couples Therapy Services We Tried and Tested

Treatment for NPD and BPD

There are currently no empirically supported treatments for NPDand 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 modifiedpsychoanalytic techniquesand has recognized the challenges of successfully treating the disorder.

The clinical literature, in general, tends to regard NPD as very difficult to treat, particularly in its most severe forms.

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

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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.

11 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Grant BF, Chou SP, Goldstein RB, et al.Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.J Clin Psychiatry. 2008;69(4):533-545. doi:10.4088/jcp.v69n0404Volkert J, Gablonski TC, Rabung S.Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysis.Br J Psychiatry. 2018;213(6):709-715. doi:10.1192/bjp.2018.202American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association.National Institute of Mental Health.Borderline personality disorder.National Alliance on Mental Illness.Dissociative disorders.Hörz-Sagstetter S, Diamond D, Clarkin JF, et al.Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder.J Pers Disord.2018;32(4):562-575. doi:10.1521/pedi_2017_31_306Euler S, Stöbi D, Sowislo J, et al.Grandiose and vulnerable narcissism in borderline personality disorder.Psychopathology. 2018;51(2):110-121. doi:10.1159/000486601Zanarini MC, Frankenburg FR, Vujanovic AA, Hennen J, Reich DB, Silk KR.Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission.Acta Psychiatr Scand. 2004;110(6):416-420. doi:10.1111/j.1600-0447.2004.00362.xCaligor E, Levy KN, Yeomans FE.Narcissistic personality disorder: Diagnostic and clinical challenges.AJP. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723Dimaggio G.Treatment principles for pathological narcissism and narcissistic personality disorder.J Psychother Integr.2021. doi:10.1037/int0000263Dieckmann E, Behary W.Schema therapy: An approach for treating narcissistic personality disorder.Fortschr Neurol Psychiatr.2015;83(08):463-478. doi:10.1055/s-0035-1553484

11 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Grant BF, Chou SP, Goldstein RB, et al.Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.J Clin Psychiatry. 2008;69(4):533-545. doi:10.4088/jcp.v69n0404Volkert J, Gablonski TC, Rabung S.Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysis.Br J Psychiatry. 2018;213(6):709-715. doi:10.1192/bjp.2018.202American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association.National Institute of Mental Health.Borderline personality disorder.National Alliance on Mental Illness.Dissociative disorders.Hörz-Sagstetter S, Diamond D, Clarkin JF, et al.Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder.J Pers Disord.2018;32(4):562-575. doi:10.1521/pedi_2017_31_306Euler S, Stöbi D, Sowislo J, et al.Grandiose and vulnerable narcissism in borderline personality disorder.Psychopathology. 2018;51(2):110-121. doi:10.1159/000486601Zanarini MC, Frankenburg FR, Vujanovic AA, Hennen J, Reich DB, Silk KR.Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission.Acta Psychiatr Scand. 2004;110(6):416-420. doi:10.1111/j.1600-0447.2004.00362.xCaligor E, Levy KN, Yeomans FE.Narcissistic personality disorder: Diagnostic and clinical challenges.AJP. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723Dimaggio G.Treatment principles for pathological narcissism and narcissistic personality disorder.J Psychother Integr.2021. doi:10.1037/int0000263Dieckmann E, Behary W.Schema therapy: An approach for treating narcissistic personality disorder.Fortschr Neurol Psychiatr.2015;83(08):463-478. doi:10.1055/s-0035-1553484

Grant BF, Chou SP, Goldstein RB, et al.Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.J Clin Psychiatry. 2008;69(4):533-545. doi:10.4088/jcp.v69n0404Volkert J, Gablonski TC, Rabung S.Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysis.Br J Psychiatry. 2018;213(6):709-715. doi:10.1192/bjp.2018.202American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association.National Institute of Mental Health.Borderline personality disorder.National Alliance on Mental Illness.Dissociative disorders.Hörz-Sagstetter S, Diamond D, Clarkin JF, et al.Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder.J Pers Disord.2018;32(4):562-575. doi:10.1521/pedi_2017_31_306Euler S, Stöbi D, Sowislo J, et al.Grandiose and vulnerable narcissism in borderline personality disorder.Psychopathology. 2018;51(2):110-121. doi:10.1159/000486601Zanarini MC, Frankenburg FR, Vujanovic AA, Hennen J, Reich DB, Silk KR.Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission.Acta Psychiatr Scand. 2004;110(6):416-420. doi:10.1111/j.1600-0447.2004.00362.xCaligor E, Levy KN, Yeomans FE.Narcissistic personality disorder: Diagnostic and clinical challenges.AJP. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723Dimaggio G.Treatment principles for pathological narcissism and narcissistic personality disorder.J Psychother Integr.2021. doi:10.1037/int0000263Dieckmann E, Behary W.Schema therapy: An approach for treating narcissistic personality disorder.Fortschr Neurol Psychiatr.2015;83(08):463-478. doi:10.1055/s-0035-1553484

Volkert J, Gablonski TC, Rabung S.Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysis.Br J Psychiatry. 2018;213(6):709-715. doi:10.1192/bjp.2018.202

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association.

National Institute of Mental Health.Borderline personality disorder.

National Alliance on Mental Illness.Dissociative disorders.

Hörz-Sagstetter S, Diamond D, Clarkin JF, et al.Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder.J Pers Disord.2018;32(4):562-575. doi:10.1521/pedi_2017_31_306

Euler S, Stöbi D, Sowislo J, et al.Grandiose and vulnerable narcissism in borderline personality disorder.Psychopathology. 2018;51(2):110-121. doi:10.1159/000486601

Zanarini MC, Frankenburg FR, Vujanovic AA, Hennen J, Reich DB, Silk KR.Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission.Acta Psychiatr Scand. 2004;110(6):416-420. doi:10.1111/j.1600-0447.2004.00362.x

Caligor E, Levy KN, Yeomans FE.Narcissistic personality disorder: Diagnostic and clinical challenges.AJP. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723

Dimaggio G.Treatment principles for pathological narcissism and narcissistic personality disorder.J Psychother Integr.2021. doi:10.1037/int0000263

Dieckmann E, Behary W.Schema therapy: An approach for treating narcissistic personality disorder.Fortschr Neurol Psychiatr.2015;83(08):463-478. doi:10.1055/s-0035-1553484

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How to Identify a Malignant Narcissist#

Differences Between Borderline Personality Disorder and Narcissism#

Narcissistic Personality Disorder (NPD)#

Borderline Personality Disorder (BPD)#

How Often NPD and BPD Co-Occur#

NPD and BPD in Relationships#

Treatment for NPD and BPD#

Get Help Now#

A Word From Verywell#