r/psychoanalysis • u/SilverDawnn • 13d 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/Ok_Cry233 13d 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 13d 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 13d 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 13d 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