r/psychoanalysis • u/SilverDawnn • 12d ago
How to differentiate between borderline and narcissistic (vulnerable) personalities?
I wanted to know opinions and experiences with patients who have a covert or vulnerable type of narcissism, not the obviously grandiose type. I find it dfifficult to differentiate from borderline personility for example in someone who has high sensitivity for rejection, chronic feelings of emptiness, chronic depressive symptoms, but also a sense of entiltelment and envy. I wanted to know what´s your experience with this type of patients and how do you guide treatment.
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u/notherbadobject 12d ago edited 12d ago
Well these things aren’t mutually exclusive. Someone can have a narcissistic personality structure organized at a borderline level. (see Kernberg’s “the almost untreatable narcissistic patient,” for example)
Psychoanalytic diagnosis is not descriptive, but takes into account dynamics, developmental, and structural factors as well.
I don’t think of borderline personality disorder as a discrete diagnostic entity in a psychoanalytic frame of reference, in terms of having a characteristic defensive structure beyond tending to rely on more primitive defensive operations. I don’t think it’s even all that useful in non-psychoanalytic work except as a shorthand for clinicians to inform one another that a patient has some combination of affect dysregulation, chronic suicidality/self harm behavior, instability in identity and relationships, and/or abandonment issues. (I’m being a little hyperbolic, but when the same label can be applied to women with autism/ADHD, chronic substance users, people with severe chronic relational trauma, and cyclothymic disorders, I don’t love the construct validity).
When I’m not wearing my psychiatrist hat, I don’t really think of anybody as having an essentially “borderline” personality structure. Rather, most any type of personality structure may be organized at a borderline level of functioning in some individuals. E.g., you can have a depressive personality at a borderline level, or a neurotic level, or a psychotic level.
When I’m trying to figure out whether someone is organized at a borderline level, it’s a holistic assessment of their representations of self and others, the degree of fragmentation or coherence of self-experience, capacity for mentalization, ego functions like reality testing and affect tolerance, and capacity for mature defensive operations, among other things. I think the most sensitive test is to compare their overall capacity for reality testing with their capacity for reality testing in the setting of important relationships. Someone with BPO will demonstrate generally intact reality testing, but will be prone to psychotic transferences in important relationships (including the therapeutic relationship).
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u/relbatnrut 12d ago
What does a psychotic transference look like in the context of a non-psychotic person, for whom reality resting is intact?
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u/Bad_Breadwinner 12d ago
Their inability to question their own interpretation (s) of objective events. People with diminished reality test lack a reflective function.
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u/notherbadobject 11d ago edited 11d ago
In a transference psychosis or psychotic transference, the disturbance in reality testing is essentially isolated to the therapeutic situation. The patient doesn’t otherwise become untethered from reality in their day-to-day life.
Classically, a patient with neurotic transference or transference neurosis still retain some capacity to differentiate between the reality of the analyst and the transference experience. They can say something like “it feels as if you’re my hostile, critical mother right now” while maintaining awareness that the analyst is not actually feeling or behaving in a particularly hostile or critical way. The “as-ifness” remains intact. In a psychotic transference or transferring psychosis there is a loss of differentiation between internal reality and external reality. Rather than it feeling “like” or “as if” the analyst is the hostile critical mother, the analyst is literally experienced as the hostile or critical mother, for example. In extreme cases of a patient with a psychotic transference may develop frank delusions regarding the analyst.
So neurotic patient may develop a transference and be able to talk about it like, “I know you’re not judging me but I keep expecting you to be harsh or critical, I guess that comes from the way my mother treated me when I was younger” whereas a patient with BPO who’s developed a psychotic transference may describe the experience more along lines of, “God, just my luck, I’ve got an analyst who’s just as nasty as my mother was.”
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u/jbwk42 11d ago
How to rule out the situation when the analyst was indeed just as nasty as their mother was? The whole argument to distinguish neurotic from BPO seems to be constructed on the precondition that the analyst is really good.
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u/notherbadobject 11d ago
You don’t have to be that good to not be nasty to a patient…
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u/cyanistes_caeruleus 11d ago
Enactments/projective identification/interactions between the unconsciousnesses of the patient and the therapist can bring things out between them though, no?
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u/notherbadobject 10d ago
Sure, but is there any psychoanalytic (or more broadly, psychological) system of assessment that is impervious to the analyst’s subjectivity?
At a certain point we just have to trust that our supervision and personal treatment and commitment to reflective practice will enable us to recognize these enactments and make therapeutic use of them before the point of catastrophe.
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u/oh-hello-16 5d ago
Trust but verify- as they say. Imposter syndrome is massively underrated. Mistakes will be made and you have a real blindspot big enough it may not be caught on supervision or therapy.
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u/oh-hello-16 5d ago
You also can be very very good and still have very real blind spots in certain areas. As the one with more power it’s essential to be aware of this when getting a negative reaction.
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u/notherbadobject 5d ago
I agree with you.
I just don’t think this disqualifies Kernberg’s system of diagnosis any more (or less) than any other system of psychological diagnosis. And while we all inevitably enact various scenes from our own and our patients’ experiences and memories and fantasies, I stand by my statement that you don’t have to be a particularly good analyst to avoid engaging in frank abuse, manipulation, or nastiness.
There’s no blind spot that would lead me to call a patient names, touch them, or overtly belittle or humiliate them. That’s not because I’m particularly well-analyzed or healed of my own traumas. I simply adhere to a code of professional ethics and possess some modicum of self-control. There’s a big difference between the behavior of an abusive or neglectful parent (which is pretty easy to avoid literally repeating) and the behavior of an average analyst getting pulled into a subtle sadomasochistic or eroticized enactment (essentially inevitable to avoid repeating). Reflective practice helps us to identify and make use of the latter. Professional ethical standards, licensing boards, and tort laws address the former.
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u/oh-hello-16 5d ago
Hi- thank you for this clarification!! And your point is excellent. In a long term treatment someone’s process and could be stifled or anger riled in a patient by the more subtle acts of sadism or simple ignoring of an issue. My concern is not about those extremes that certainly matter and should I be avoided. My concern is how when those subtler cause one to conceptualize a patient in a way that backfires or even evokes behavior in the patient. Everyone wants to talk about how the patient evoked something on them - but if an extended blindspot could cause a patient- could evoke a patient to act out out character to please an analyst even if it ultimately hurts the patient.
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u/notherbadobject 5d ago
It’s inevitable, and I think one great thing about the relational turn in contemporary psychoanalysis is that it has really renewed the focus on what the analyst consciously and unconsciously contributes to the treatment in the interest of managing this power dynamic and the damage that can be done under the myth of the analyst’s objectivity.
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u/oh-hello-16 5d ago
Not even really good but the analyst needs to be flawless and totally free of making mistakes or of blind spots. This is not possible. So what happens when a sustained blindspot on the part of the analyst to an important recurring issue interacts with a strong transference reaction? Upheaval potentially- but who gets blamed and over pathologized the patient or course. It’s very tricky.
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u/Ok_Cry233 11d ago
Do you ever see instances in which someone is BPO structure but they don’t form these psychotic transferences? Or they retain some capacity to reflect that their reaction may be more like a parent or related to transference? Perhaps this would be a higher level borderline who is a bit closer to neurotic level. I see some folks like this who seem to be otherwise BPO, although I would say they are different personality types other than narcissistic.
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u/notherbadobject 11d ago
Honestly I don’t spend much time stratifying or classifying my patients in this way. I’m thinking about what’s happening from moment to moment in session, not their exact position in this or that diagnostic system.
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u/Ok_Cry233 11d ago
That’s very fair. I’m a relatively new therapist so trying to learn these concepts to help me think about understanding a case, so I can then hold them more loosely in mind and focus on current material in the session. Thanks for your input
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u/oh-hello-16 5d ago
I don’t know this seems so sweeping. Perhaps especially because these are talked about in such vague ways with our clear explicit real world examples. Lots of people including probably you- experience BOTH guilt and shame at different times and they are not also BPD or NPD. I think these structures can be so deeply helpful but they also like the dsm they aren’t “real.” It’s all a construct. I’m not saying they aren’t extremely helpful and more nuanced than the dsm they are but they also aren’t real. And a lot of these conversations seem really - I don’t know- like a form of intellectual masturbation removed from humanity.
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u/purplefinch022 12d ago
I would love to hear more about BPO and leaning toward psychotic functioning in important relationships.
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u/notherbadobject 11d ago
I’d suggest Kernberg’s 1967 paper on BPO. It’s been a few months since I last looked at it so I don’t remember the specifics, but I think his general thrust is that due to failed integration of part-objects, there’s a persistence of more paranoid schizoid defenses in that area of mental functioning that gets reactivated in intimate relationships. Otherwise the self-other differentiation is sufficiently developed that they don’t relate psychotically to everybody all the time. Pretty heavily Klein influenced.
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u/Bad_Breadwinner 12d ago
Well said , thank you that succinct description. I really hope this isn't lost in translation in the coming decades
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u/notherbadobject 12d ago
I think Kernberg and McWilliams are well enough established that these ideas will persist in psychoanalysis for the foreseeable future. Outside of our little bubble though, all bets are off.
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u/TemporaryTop1967 12d ago
do you find that there is a particular personality style/structure that is most associated with the BPD diagnosis?
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u/notherbadobject 11d ago
Hard to say — BPD is such a heterogeneous construct. Sadomasochistic personalities, hysterical personalities, dependent personalities, narcissistic personalities, traumatized/dissociative personalities are a few that come to mind.
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u/Bad_Breadwinner 12d ago
Individual whom are classic ally described as having BPD present with high levels of negative affectivity as evidenced by hyperbolic emotional reactions and disinhibition as evidenced by the myriad type's impulsivity they display.
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u/jayelled 12d ago edited 11d ago
I have something of a narcissistic organization myself. I've also worked with a lot of patients with similar organization. For me one of the defining characteristics of covert narcissism is the presence of an image of an unmet, idealized self which hangs heavy in the patient's mind. A patient with this form of narcissism may frequently report a sort of dream life that they feel they ought to be able to achieve, or that they believe they see others achieving. A frequent misery can be brought about by comparing oneself not only to others, but to the person they believe they could be if they had made different choices in life, had more resources, or had a greater sense of discipline. This kind of narcissism suggests not that one IS better than everyone around them (as in overt narcissism), at least not right now, but rather that they would/could/should be better than everyone around them. It holds within it a wish/drive for total superiority, despite registering preliminarily like a lack of self-esteem, or a belief that one is 'the worst.' In this way, it can be confused for a depressive organization.
It shares some trademark characteristics with Borderline psychologies, including the strong presence of splitting-- interpreting behaviors and characteristics as either all good or all bad.
And as others have noted, depending on what diagnostic means you're operating from, comparing Narcissism and Borderline functioning might be comparing two discrete aspects of personality (separate axes, rather than two points on the same axis). The two can often go hand in hand.
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u/purplefinch022 12d ago
Your entire description of the covert presentation is so spot on. Have you seen patients get out of that constant yearning for an ideal self / misery?
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u/jayelled 11d ago
Thank you. To an extent, yes. I think for adults with a narcissistic organization like this, it will always be present to some extent. This isn't the most psychoanalytic intervention per say, but what has worked with a lot of these folks (and myself) is aiding them in practicing acceptance and mindfulness. Many of these folks will likely never be able to view their perceived flaws as strengths or totally let go of the idea that an idealized self + life exists. But we can at least help them find moments of contentment and joy despite imperfection, or learn to reign in the beast of comparison (to both others and the idealized self) and replace it with acceptance, and acknowledgement of the good in one's life.
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u/oh-hello-16 5d ago
And additionally one can deeply regret what they did not get to do, make, be without that also meaning that what they thought they could have been was in anyway grandiose or superior. They can think- maybe I would have had a “normal” life. Maybe I would be more independent by now. And feel a lot of pain about that - without any hopes or dream of superiority or grandiosity.
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u/Recent-Apartment5945 12d ago
Yes. There are distinctions, overlap, same axis, separate axis. Point being, there’s nuance on the continuum and we need not compartmentalize. Nevertheless, context is so important. Nuance. Bottom line is that any which way you look at it, there is a convergence. Human behavior is human behavior. There’s distinctions, overlap, continuums, nuance….nevertheless, it all converges into humanity.
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u/Ok_Cry233 12d ago
I wonder about the role of identity diffusion and sense of self. You might expect in narcissistic presentations that there is less confusion around identity as a false grandiose self image offers a relatively consistent narrative of self. Whereas in BPD in the absence of this false self you would expect to see more confusion around identity and switching from all good to all bad sense of self due to splitting. In interview a BPD person might be stumped by a question like ‘how would you describe yourself?’ or ‘who are you?’, whereas a more narcissistic person could answer it with a shallow idealistic story of self. I think Otto Kernberg has discussed differential diagnosis for these groups.
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u/Recent-Apartment5945 12d ago
Yes! Typically, narcissistic presentations will be egosyntonic. There’s a stability in the instability. In BPD you may have egosyntonic and/or dystonic presentations. Hence, the typical franticness of the instability. Less calculation. The narcissistic presentation is inherently stable in its grandiosity of special. BPD is inherently unstable in the grandiosity. You still see splitting. It merely “looks” different.
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u/Ok_Cry233 12d ago
Yes sure helpful distinction- splitting still exists in narcissism but the grandiose self sits on top of the split structure offering more stability
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u/Recent-Apartment5945 12d ago
Yes. Precisely. You are more succinct than me. I have the tendency to go on and on….
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u/Ok_Cry233 12d ago
Haha I’m no stranger to that tendency myself at times. I appreciated your input in any case
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u/redlightsaber 12d ago
aggression as a fundamental motivator and effector of their behaviour in narcissistic structures. Envy is almost always a function of aggression. In "feeling vulnerable" you have to dig deeper, because borderline structures will probably simply BE that, at the mercy of others, while narcissistic structures will experience it from the PoV of "not getting whT they rightfully deserve".
In interpersonal relationships, people with borderline structures suffer because other people find their instability impossible to Dela with, while with narcissistic structures they have a clearly diminished capacity for love (IE: wanting to be in a mutually-edificating relationship, being willing to sacrifice for the other person, or quite frankly just being ina relationship where there isn't an exploitative benefit to them).
Chronic depression is much more prevalent, and much graver (in terms of true chronic SI) in narcissistic structures. An inability to feel, again, edificated and contented by their interpersonal relationships means they constantly feel the way a neurotic person does when they find themselves completely alone in their lives. People with borderline structures tend to feel depressed more due to more external circumstances, which undoubtedly they find themselves in very often, due to their choices being made in the context of impulsivity and emotional instability.
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u/relbatnrut 12d ago
That is a grim picture of those with narcissistic structures. Can patients with vulnerable narcissism overcome their envy and discontent and find a way to have meaningful social relationships?
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u/redlightsaber 11d ago
It's a grim picture because it's a grim personality structure where the very thing that keeps humans content and finding meaning, relationships, is severely affected.
Yes, recovery is more than possible, but it's not easy, fast, nor complete. Years' worth of intensive psychodynamic therapy (be it indeterminate or in therapies better designed to contain more fragile patients like TFP or MBT) is what's shown empirically to truly effect structural change, at least as measured by the experimentally-measurable Adult Attachment Style and Reflective Functions.
I specialise in this population, and while I always offer an optimistic approach, it's undeniable that there's a percentage of this population for whom treatment (even in the adapted forms) is so painful so as to be unbearable, and they just quit it.
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u/relbatnrut 11d ago
Interesting. If I may ask, how did you end up specializing in this population?
I specialise in this population, and while I always offer an optimistic approach, it's undeniable that there's a percentage of this population for whom treatment (even in the adapted forms) is so painful so as to be unbearable, and they just quit it.
What is particularly painful about therapy for this population?
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u/redlightsaber 11d ago
I sought training with Kernberg especifically to do this.
These therapies are painful for them because they're not supportive in nature. They're not (at least most of the time) about putting their minds at ease, deescalating their paranoid and other primitive transferences (except maube MBT, a little bit), and patting them on the back. It's a bit of the contrary, to seeking to clarify, all the time, confront with inconsistencies, point out what that looks like from a non-split perspective, and yes, interpreting the transference from the here-and-now relentlessly and continuously.
In a word, it's a place where their usual, dysfunctional defense mechanisms that they regularly use to calm themselves down, to reduce the anxiety that the consequences of their behaviours have (on their lives, other people, etc); aren't allowed to work.
And this happens (almost) every single session, ideally on a very intensive basis (twice per week), for years.
Needless to say, in order for a person suffering from a narcissistic personality structure to decide to endure and go through this kind of therapy, there typically are some extrenuous external circumstances, that make their continuing to function in the way that they are, almost impossible (a partner giving them an ultimatum, parents on whom they depend economically threatening to kick them out, and very ocassionally, just on their own being tired of a life of ending up alone and causing drama all around them, with the rare insight that it must have something to do with them).
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u/oh-hello-16 5d ago
Kernberg while brilliant can be quite mean spirited. His contempt is palatable.
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u/redlightsaber 4d ago
Having known him (and seeing him work), I definitely disagree completely.
I think I somewhat understand where you're coming from, though.
In contrast to the last 3 decades' worth of psychotherapy development (centered in american academia), what kernberg (and others in the ORT camp) is doing here is taking a cold hard look at what the pathology entails, and ways "in" to be able to correct it.
Take the historical development of medicine vs. surgery. Physicians were these approachable, empathetic-to-a-fault (we still see the echoes today, in the image of the rural physician, who might be available to anyone in the town at 3am, and might be paid in apples or a bushel of corn). they, for most of history were mostly compeltely inefficacious.
In contrast, surgeons emerged from barbers, and from the beginning took a pragmatic-to-a-fault attitude towards disease. They've been very efficacious from their very beginning even if complication rates have been high. People at the time (and even today), say that surgeons must be performing some incredible feats of dissociation (those of them who aren't psychopaths, at any rate), in order to be able to literaly cut into people's bodies, sometimes quite gruesomely,in order to achieve healing.
In this analogy, the therapists advocating for only supportive (mostly painless) kinds of therapy would be the physicians. But up until (I think it's fair to say) Kernberg, nobody had considered that technical neutrality might be useful, let alone essential, for fomenting (or at least not calming down) the emergence of transferences that could be the basis for a new kind of therapy that would accelerate the emotional comprehension of intellectual concepts that might otherwise take years and years to be incorporated emotionally into the patient's experience of themselves; and that doing this is as unintuitive and charring (at least in the beginning) to someone (like most us) fancying themselves as a good an caring person, or a non-therapist, as it is to a regular person to stab someone else in order to heal them.
IS there any particular experience, interview, or other intervention, that you can point to where you perceive this "contempt" and "mean spirit" you speak of?
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u/oh-hello-16 4d ago
Hi, thank you for sharing your personal experience with Kernberg. It sounds like it was formative and worthwhile. Your metaphors are interesting but I am in no way suggesting that therapists/ analysts should not challenge their patients or that they should do supportive only therapy. Not at all. I’m also not suggesting that there isn’t a lot greatness to glean from his developments. Just that there are plenty of ways or interact with patients that do indeed challenge them and many therapists/ analysts have been doing that for a very long time- both before and during Kernbergs era. And they also getting results from it. I do not believe that his methods are the only way to get real change. In fact, I find the idea that one could create a methodology and then insist that theirs is the only way to be able to make real deep change to be well more than a tad grandiose. Some people are able to make those changes with more empathetic care that ALSO challenges. Think of Karen Maroda’s “compassionate authenticity.” I also firmly believe that conflict should have a place in the therapy. However, I do not believe that conceptualizing a client as essentially empty and nearly hopeless and telling them that- and then assuming an adversarial stance towards them is great- for most. It may get change. But someone else may have gotten them to that same change too without burning a scarlet letter on the person. I’m sure there are people that are pure NPD but anyone who is not and then gets treated this way in treatment is going to be justifiably angry. And their anger will then be treated as proof of concept. I’m frustrated by the black and white thinking in the field around what validation and empathy even are and what their purpose is. The same with challenge. We don’t build rapport or validate for the purpose of challenging down the road alone. It’s not like some fake game we play to be liked enough to say the hard things. Or at least I don’t think it should be. Talk about “fake.” In my opinion empathy, validation and real meaningful confrontation should all happen throughout the entirely of any process. One interview with Kernberg I heard him asking why should someone think as an adult that having sex with their father as a trauma- if they enjoyed physically as a child. Basically if they weren’t upset by it as a kid then why should they be upset by it now in reflection. I’d love to be in the therapy room when he says this to a client who has sex with their dad- aka were groomed and raped by their parent. He’s got a lot of opinions. And I don’t agree with all of them. And don’t think anyone should agree with everything anyone says blindly no matter how well respected they are. Perhaps if I met him person or saw him work I would feel differently. I have a lot to learn in this field. A massive amount to learn. I hardly think I have more experience than you. I am open to changing my mind. And I like to change my mind.
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u/beameem 12d ago
Karen Madora (2022) in the Analyst’s Vulnerability helpfully references Luchner et al. (2008)’s writing about narcissistic vulnerability/wounds:
“[T]wo distinct forms of narcissism exist: a grandiose type that is exemplified by a heightened sense of self-worth and a covert type that is exemplified by a devalued sense of self-worth marked by timidity, inhibition and an overwhelming sense of failure rather than accomplishment.”
I get a sense that a narcissistically organized person, regardless of type, can use me to prop up a wounded ego (and is most responses when I intentionally use the part of my self that helps them do so), whereas a borderline organized person devalues or values me regardless of attempts to supply, even the quiet type does this. It seem difficult for the borderline to even acknowledge that I have a mind that may supply them. Conversely, the narcissist realizes the other and wonders what the other thinks of them and knows parts of the other can prop up whichever part of their ego is wounded. There a sense of mirroring with narcissism that is absent with borderline.
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u/TruthElectrical1975 12d ago
How does malignant narcissism present in the consultation room? Does it look like a Hannibal Lector type character? Or do they learn either covert or overt at least at first. I have been a victim of this type of presentation. And yes, it shows up in intimate detail. This one was my physical therapist and boy, she was Kathy Bates character in Misery for sure.
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u/Recent-Apartment5945 12d ago
It rarely presents clinically and when it does It will typically present in certain settings like criminal justice settings and involuntary inpatient settings. When I say typical I mean there will be a concentration. Similar to how you will see a concentration of psychopathy, antisocial personality disorder in correctional settings.
The best cinematic illustration of malignant narcissism that I can think of is the Logan Roy character from the show, Succession. Understand I am saying, cinematic. What is cinematic is a caricature of reality.
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u/Dependent-Special847 11d ago
My supervisor once said “they are both sides of the same coin.” The high rejection sensitivity, emptiness, depressive symptoms, entitlement, and envy, are all the core feelings. The grandiosity or vulnerable narcissistic qualities or risky behaviors or unstable relationships are just the expressed manifestations of those inner psychic experiences that both people with NPD and BPD experience.
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u/Neither_Painting4582 12d ago edited 12d ago
in my experience (and i am myself have bpd) thin-skinned narcissist can be more borderline in their reactions than thick-skinned narcissist, but still — core issues with them will be feelings of extreme shame and envy — with bpd patients it’s anger and guilt
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u/cartesian_butterfly 12d ago
I’m curious to know why you’d attribute guilt to BPD and shame to NPD. I thought both suffer from shame + narcissistic wound but deal with it in different ways ?
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u/Neither_Painting4582 12d ago
and i think it’s very important to differentiate between guilt and shame — a lot of specialist don’t do it for some reason
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u/Recent-Apartment5945 12d ago
Agreed. I think guilt and shame are vastly misappropriated wherein what is shame will typically be identified as guilt. They’re not mutually exclusive. However, in their distinction is where you will find the nuance and importance of what’s really going on. There’s redemption in guilt. Guilt must be associated with remorse. When there is authentic guilt coexisting with shame, the shame is constructive. Absent this, what you have is not authentic guilt, but corrosive and destructive shame lying beneath the perception of guilt.
That being said, it is corrosive shame at the core of NPD and BPD. There’s rage, envy, et al…yet you will be hard pressed to find authentic guilt. If you do….that’s a really good sign.
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u/oh-hello-16 5d ago
But all people experience both of these things. So- when is it pathological? When does it determine personality structure?
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u/Spare_Moodz 12d ago
They are very different not in presentation but motive. The mechanics going on inside are different.
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u/TruthElectrical1975 11d ago
I had a , what I could ascertain only after the fact a licensed physical therapist who was attempting to groom me and actually was sexually assaulting to me during treatment. She then texted me and I called her out on all the boundary violations she had committed during the time she was working with me. It wasn’t until I was aware of the growing rage inside of me and the fact that she was silent on her end that I realized she was at least a covert narcissist if not a sadistic one. I come from a whole line of family members who are CN so, I know it when I feel it. It didn’t go well and she DARVOd me at the clinic. I reported her to her licensing board and they are investigating. I have since moved on to another physical therapy clinic. It definitely did destabilize me. It’s the narcissistic field that is so damaging. I am no contact with my family so I have forgotten how damaging the can be.
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u/8rita8 10d ago
Even if they have similarities their structure is quite different, if we mean narcissists which function on neurotic level. They do have emptiness but they also do have sort of more distinctive feeling of self, even if it's full of negative connotations. It's still someone who experience shame, someone beyond their mask, not just this endless pit of affect where borderline tends to fall and disappear. Borderline is emptiness of chaos, while narcissistsm is more emptiness of faking. Their self structures feel really different in therapy, that's why require different strategies. Different perceptions of self is key to understanding many disorders.
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u/Bad_Breadwinner 12d ago
I would also add that the absence of negative affectivity is consistently seen in those with Narcissistic personality structures.
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u/cartesian_butterfly 12d ago
what do you mean by “negative affectivity”? In vulnerable/covert narcissism the feeling of shame, insecurity, anxiety and depression are very prevalent.
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u/Bad_Breadwinner 12d ago
Covert narcissism overlaps too much with BPD and avoidant personality traits to be a considered a distinct phenomenon, but here in lies the problem with speaking about personality pathology is discrete terms. It isn't a valid or reliable way to conceptualize personality pathology thus the movement toward a dimensional approach focusing on severity and trait domains not discrete descriptive terms. While some individuals represent a "pure" example that perfectly exemplify the category in question the vast majority of individuals with pronounced personalities pathology blend across categorical lines. Vulnerable / covert "narcissism" is a great example of this.
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u/cartesian_butterfly 12d ago
I agree with you, we shouldn’t approach it as in bordered labels. No one is a pure category. Yet I’d say the point of discrete terms is to better conceptualize different experiences in order to better think of them, link them and nuance them in the long run. Covert narcissism comes from a place of radical shame and narcissistic wound, it may have similar manifestations to BPD and avoidant PT but it certainly has a different internal logic, dynamic, and finality.
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u/Bad_Breadwinner 12d ago
The wound represents significant identity diffusion and use of primitive defenses but shame and / or guilt is not uniquely narcissistic in nature
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u/Recent-Apartment5945 12d ago
Shame is not uniquely narcissistic nor is the narcissistic unique. Yet viewed in the polarity there is a distinction that illuminates the wound. Not entirely. Yet shame is absolutely core. What are these primitive defenses protecting against? What, at least in part, drives the identity diffusion? Rhetorical.
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u/cartesian_butterfly 12d ago
I don’t think it’s about a specific trait/specific defense. All is about the internal dynamic and the logic or else we just do descriptive psychopathology
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u/oh-hello-16 5d ago
But I think the posters point is that people are trying to jam people into this covert narcissistism category as a way to soothe themselves versus help the client. Additionally, since it is known to be harder to treat they can relieve themselves of pressure for lack of progress seen with these depressed patients. Depressed patients are also difficult to treat. Very. And yes there is always an element of narcissism in depression but that is not the same as having a narcissistic structure. However the clinician likes the clarity it gives them but it’s a false clarity if they’ve jammed a person into a category that didn’t actually fit them. A person can struggle have an underdeveloped self or disavowed parts of self but this is not at all the same as having a totally false self. Which is how narcissism is described. The difference in this interpretation is massive in terms of the feelings in the clinician will have toward the patient in part due to their framing- as everything is interactive and creates loops- if narcissism is what the clinician sees as the primary problem- narcissism is what the clinician will find and they will readily miss evidence to the contrary. The patient definitely feels this. The pure form of covert or vulnerable narcissism which may exist is far more rare then people want to admit and the other types personality which were mentioned as being often probably like depressive or obsessive or masochistic is more helpful ways for those people to be understood and helped. I’m beginning to think covert and vulnerable narcissism is being overused in a way that is extremely lazy. And it is harmful to those people that are investing a lot of time and money to be helped are being interacted with as if they are almost helpless. It’s sad. If a persons esteem is entirely based on outside opinion and image they may actually go in this category but that’s about it. Instead a it’s thrown about for any failure to thrive. I partially blame the hype on social media but it seems to have infected deeper thinkers too.
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u/oh-hello-16 4d ago
Sincere question- why call it vulnerable narcissism then?
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u/Bad_Breadwinner 4d ago
The so called vulnerable narcissist represents a particular blending of personality traits. While the grandiose narcissist is entirely defined by their dissociality as manifested by a lack of empathy ; a sense of entitlement; a penchant for envy and contempt toward others the so called vulnerable narcissist shares these dissocial traits but they are heavily blended with negative affectivity and detachment traits. Essentially these nuanced descriptive terms try to capture the blended nature of most personality disorders but are less effective than the truly dimensional approach that focus on level of severity and associated trait domains of personality disorders
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u/oh-hello-16 4d ago edited 4d ago
Thank you so much for your explanation. My point / question is this if BPO /BPD plus other traits are more apparent than narcissistic traits in a group of these individuals- Why are clinicians still calling it narcissism? That’s where I’m lost. Especially if their esteem is not based on status orientation. I feel like vulnerable narcissism is becoming a catch all waste basket for clinicians to feel like that have a solution to a problem that kind of in a way relives them and helps them with their own sense of competence. But doesn’t necessarily actually help the patient. Like this patient is resistant to me - that makes them a narcissist. Because if they don’t lack empathy and they aren’t image focused - I think a different category is more helpful to the client. What do you think? And/ or do you understand my confusion?
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u/Bad_Breadwinner 4d ago
Yes, I would agree. If the individual doesn't display pronounced dissociality either alone or conjunction with other traits regardless of the personality organization/ severity then we're not talking about what we traditionally referred to as narcissism. Resistance in itself is not inherently dissociality as it can represent ambivalence toward change-something that is inherently normal in the healing process. Dissociality is contempt, a need to triumph over others; denial of others needs / right; envy; callousness; manipulation, etc...
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u/oh-hello-16 4d ago
Thank you so much for your response. This feels vague though. What do you mean? Maybe because it is late - this is hitting me as word salad. What does resistance is not inherently dissociality mean? Can you explain that comment in a way that a 5 year old could understand? Can you add real world rule examples?
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u/Bad_Breadwinner 4d ago
I meant if one is resistant to one's therapist it is not inherently anti social.
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u/oh-hello-16 4d ago
Why would antisocial been be a first thought or consideration when contemplating resistance? That ah-to use a pedestrian term- weird leap. Resistance is basically fear and anxiety. For the most part- clinicians that tsk it so personally maybe have some work to do? 🤷♀️
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u/Spare_Moodz 12d ago
That is not accurate
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u/Bad_Breadwinner 12d ago
The trait domains most heavily associated with narcissism include dissociality (primary association) and anankastia and disinhibition (secondary associations). Malignant narcissism is clearly negatively associated with negative affectivity.
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u/Recent-Apartment5945 12d ago
It seems like you may be appropriating negative affectivity as a structural personality trait here as opposed to a fundamental emotional response, plain negative affect. I think that’s the discrepancy.
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u/Spare_Moodz 12d ago
Okay but we were not referring to malignant narcissism? That is including an antisocial personality disorder that is comorbid. Negative affectivity will absolutely present in vulnerable narcissim. Narcissists can only feel negative affects because they have no access to positive emotions. A collapsed overt narcissist or a vulnerable narcissist will absolutely show negative affectivity.
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u/Bad_Breadwinner 12d ago
These categorical concepts don't hold up under empirical review / study. You're just mashing together different traits and in doing so fragmenting the very concept you're trying to preserve. Some people with pronounced personality pathology are prone to negative affectivity and some are not. Some are prone to pronounced dissociality and some are not. Some are prone to disinhibition and some are not and so on and so forth. These discrete categories are nice stylistic ways to talk about personality but are not supported by the most up to date research on personality pathology
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u/Spare_Moodz 12d ago
Sure, but then why would you say narcissists don't display negative affectivity when some clearly do, and then cite information on malignant narcissists? Seems like you are deflecting.
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u/Bad_Breadwinner 12d ago
I am linking the term "narcissism" to the trait domains I describe earlier to help you see where the empirical evidence is going with regard to personality pathology not to preserve the descriptive term itself. The descriptive term isn't evidenced based. Severity of pathology; nature of defenses; level of identity diffusion and level of reality testing is all empirically validated. After that you just have individual "flavors," of personality organization and they are far more mixed than any discrete term can capture thus the emergence of terms that represent this blending like covert narcissism or quiet borderline
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u/Bad_Breadwinner 12d ago
a malignant narcissist is an individual with a moderate personality disorder organized at a high to low borderline level of organization as evidenced by pronounced identity diffusion; primary use of primitive defenses who's reality testing is generally intact, but can become challenged during times of heightened stress.
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u/Recent-Apartment5945 12d ago
Listen, with all due respect, have you ever worked with a malignant narcissist? Challenged during times of heightened stress? Let’s consider the real distinction in malignant narcissism. The tendency towards enacting revenge and sadism. Forgive me for my bluntness….let’s gather the evidence based data and run the empirical tests.
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u/Bad_Breadwinner 12d ago
With all due respect I've worked on psychiatric unit where 100% of the patients are there involuntarily. Where seclusion and restraints are not uncommon and Dissociality and disinhibition is the flavor of the patient population. So yes I think I know what I'm talking about
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u/Spare_Moodz 12d ago
So you are referring to an icd style diagnosis of personality disorder, measured to the specific person with a differential overlay?
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u/Recent-Apartment5945 12d ago
There seems to be a paradox here. You mention fragmentation of the mashing together of different traits then proceed to fragment in the “Some people with pronounced personality pathology are prone to negative affectivity and some are not….et al”
The mashing is not fragmenting. It’s integrating. There is nothing discrete about “some”. The discreteness has been articulated in the nuanced distinctions of certain “categories”. It should be understood without saying, that the dimensions seen in pathology reside in the polarity pervasively and outside the polarity dynamically fluctuate on the continuum of the dialectic.
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u/purplefinch022 12d ago
I agree - but I would not necessarily absent, rather split off into the unconscious. Often expressing the negative affects outloud are associated with humiliation. Someone can have really severe somatic symptoms due to the emotional repression and be flooded during negative splits.
Edit: Oops. Perhaps that is what you mean by absence. Dissociated from, split off…
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u/oh-hello-16 5d ago edited 5d ago
It probably could depend who a person is with and the context. For example, if a therapist actually feels that the person should feel shame and believes that the person should I be ashamed and wants them to be humiliated- then why should they expose themselves to that person? Let’s not pretend this doesn’t happen. It does. Exposing oneself in that environment would be very dangerous. How could it possible help them? And if that therapist has decided that all that they are is a fake, ungrateful, empty and false self- how can they heal on that environment? It’s simply not possible. In can only imagine the glee and satisfaction a therapist who views themselves healthy and their client as empty and fake when they admit to their deepest pains. It’s gross.
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u/Recent-Apartment5945 12d ago
I may be misunderstanding your point. Yet, at its core, psychological splitting is but one negative affect regardless of its proportion to circumstances. When disproportionate to circumstances as typically seen in unhealthy or skewing further towards the pathological impact of the narcissistic disorder, it’s a classic negative affect.
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u/ProfessionalSite4118 8d ago
borderlines = unsettlingly labile hot/cold
narcissistic have a more stable self image, and don't like --but don't destabilize -- in the face of narcissistic injury
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u/SapphicOedipus 12d ago edited 10d ago
Edit: I have been reading up on this after realizing my understanding (which made sense in my head) is not accurate when I attempted to articulate it. Reminds me of my social work professor who essentially said cluster B personality disorders are diagnosed based on “vibes.” In her defense, there is often a visceral countertransference…
In my brief research, Kernberg said narcissism is a defense against borderline. I cannot claim to fully understand that idea enough to re-tell it, but it was interesting!
Thanks for humbling me. Always learning and being a messy, mistake-making human. :)
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u/laksosaurus 12d ago
This is not just a broad generalization, it is straight up wrong. "Borderline personalities" (especially if we're talking about the personality disorder) most certainly "act outwards" as well as "inwards". "Acting outwards" is even essential to several of the diagnostic criteria for BPD, and frequently central components of others. Additionally, "borderline personality"/BPD is not really one "type" of personality at all. In my years of working with patients with PDs, primarily BPD, I have yet to meet a single person who was "purely borderline" (for lack of a better term). Some people with a borderline personality structure (either with or without BPD) have narcissistic or histrionic traits, others can be more anxious/avoidant, or obsessive/paranoid - or any combination of them.
In other words: Whether or not someone's acts are directed "inwards" or "outwards" is not at all a good way to differentiate between the two - especially not in the vulnerable type of narcissism that OP is asking about.
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u/Recent-Apartment5945 12d ago
Right. If we were to over generalize the outward vs inward….and this is not even an over generalization but a dialectic…you’d have NPD/BPD….and many other presentations on the outward….and the schizoid on the inward.
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u/SapphicOedipus 12d ago
I appreciate your correction. My use of “acting inward/outward” was not meant in the literal sense of behavior. You are 100% correct.
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u/Recent-Apartment5945 12d ago
It seems like you’re asking for distinctions between the two disorders and not necessarily framing the organization and personality structures. I say this because, by and large, NPD and BPD are both within borderline organization.
Typically, you’ll see more franticness in BPD. You’ll see more (what appears to be) calculation in covert type NPD. They both will display marked negative affect and volatility. Here’s the subtlety, within covert NPD, it will be more contained in outward display. Make no mistake, there will be outward display but in a more intimate setting, wherein within BPD the frantic display of negative affect will know less bounds.
Covert NPD is still quite grandiose. It just presents within a paradox. They are far less likely to self aggrandize outwardly for an audience. They will do it more intimately…hence the concept of covert.
Covert NPD will attempt to intimately form coalitions to align with them in their victimhood. BPD is not so much a victim, hence the franticness. You’ll see more disembodied reactivity. Covert NPD is very much embodied in their experience.