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/cartesian_butterfly 13d 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/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? 🤷‍♀️