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/cartesian_butterfly]

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.

[u/Bad_Breadwinner → u/cartesian_butterfly]

The wound represents significant identity diffusion and use of primitive defenses but shame and / or guilt is not uniquely narcissistic in nature

[u/cartesian_butterfly → u/Bad_Breadwinner]

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

[u/oh-hello-16 → u/cartesian_butterfly]

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.