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.

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 being very 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.

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.

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

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.