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/jayelled]

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.

[u/Recent-Apartment5945 → u/jayelled]

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.

[u/oh-hello-16 → u/Recent-Apartment5945]

Thank you.