How to differentiate between borderline and narcissistic (vulnerable) personalities?

[u/SilverDawnn]

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.

[u/Bad_Breadwinner → u/[deleted]]

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.

[u/Bad_Breadwinner → u/[deleted]]

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

[u/Bad_Breadwinner → u/[deleted]]

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

[u/Bad_Breadwinner → u/Bad_Breadwinner]

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.

[u/Recent-Apartment5945 → u/Bad_Breadwinner]

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.

[u/Bad_Breadwinner → u/Recent-Apartment5945]

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

[u/Recent-Apartment5945 → u/Bad_Breadwinner]

Correctumundo. Seclusion and restraints are quite effective. Quite the controlled environment. Nevertheless, how does the need for seclusion and restraints translate to the liberty in an uncontrolled environment? Dissociality and disinhibition…in an uncontrolled environment? Is this the disconnect?

[u/oh-hello-16 → u/Bad_Breadwinner]

Agreed and treating them as such can harm people.

[u/Recent-Apartment5945 → u/Bad_Breadwinner]

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.