NPD vs. BPD: they are not the same thing!

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BPD-Awareness

Articles like this one make me want to rage. The author, Doug Bartholomew, a licensed social worker, believes that people with Borderline Personality Disorder (BPD) are pretty much the same as people with Narcissistic Personality Disorder (NPD). He even goes so far as to say BPD’s, along with NPDs, fit the criteria for M. Scott Peck’s “People of the Lie.”

Wait just one second. Peck’s People of the Lie don’t even include all narcissists–his definition describes those with Antisocial Personality Disorder and malignant narcissism (there’s a huge difference even between MN’s and garden variety narcissists–a malignant narcissist has ill will toward others and decided antisocial traits while a “benign” narcissist isn’t necessarily ill-intentioned but is just self centered and doesn’t care about your feelings). Peck never said all manipulative people (people with one of the four Cluster B personality disorders) were by nature evil, but evil people is what his book is about.

At the same time I understand where Bartholomew is coming from. On the surface, people with BPD can be manipulative and even resort to some of the same unpleasant tactics and mind-games (gaslighting, etc.) that narcissists like to play. They can appear to lack empathy, because they get so caught up in their own drama that they can literally forget that others exist. They can be demanding, high maintenance and prone to irrational rages (just like narcs) but are far more likely than narcs to turn their rage inward and become self-destructive or even suicidal.

Narcissism Clinic.
Not much to do with this article, but I couldn’t resist.

Borderlines also usually regret their acting-out and selfish or manipulative behaviors when the crisis has passed or their bad behavior is called out to them. They may be self-centered and impulsive but are not lacking remorse or the ability to feel shame and guilt. The problem with Borderlines is they tend to act as they feel at the moment without thinking things through. They can get so caught up in their own fear of abandonment that they almost literally forget that you have feelings too. However, after the fact Borderlines usually will feel remorseful and ashamed of their behavior, and on top of that, realize that their offputting behavior may cause others to do what they fear the most–abandon them.

Bartholomew also states that all Cluster B disorders are characterized by a lack of empathy:

The overwhelmingly most commonly mentioned behavior or trait associated with all the Cluster B Personality Disorders is a lack of empathy or compassion. They seem unmoved by the effect their behavior has on their loved ones other than what is necessary to keep their loved ones engaged and around. It is as if they were tone deaf or color blind to the feelings and experiences of others.

While it’s true that people with NPD and ASPD are characterized by a lack of empathy, I disagree that this is true of people with BPD. I think this is a gross overgeneralization.

Borderlines can feel empathy, but due to their impulsiveness and fear of abandonment, they can act in selfish, defensive, and manipulative ways that may hurt others (but they hurt themselves even more so). However, unlike malignant narcissists and people with ASPD, Borderlines do not set out to hurt others and they do care how others feel. Unfortunately their good judgment is clouded by their disorder which makes it difficult or impossible for them to regulate their emotions. That’s why they act so impulsively and often fail to think things through before they act out. It’s also why their relationships tend to be stormy and short-lived.

BPD_cartoon

A person with BPD does not wear a mask or have a “false self” like someone with NPD–but their fear of abandonment can cause them to knowingly or unknowingly push others away. Their ambivalence in relationships can be very confusing to others–they can seem to adore you one moment, and then hate you the next. They can seem needy and rejecting by turns. When others grow tired of this crazymaking and confusing “I hate you, don’t leave me” behavior and finally leave them, the Borderline genuinely doesn’t understand what they have done to drive the other person away, and so they become even more fearful of being abandoned. Their behavior is maladaptive because it tends to cause the very thing they are trying so desperately to avoid.

63380797
We are just burning toasters.

A much better description of the similarities and differences between Borderlines and Narcissists can be found in “Borderline vs. Narcissistic Personality Disorder: How Are They Different?” from the Clearview Women’s Center’s website.

While the two disorders, both being part of the Cluster B group of personality disorders, do have overlapping symptoms and are often confused with each other and/or misdiagnosed as the other disorder (with males being far more likely to be diagnosed with NPD and females with BPD), this author, unlike Bartholomew, understands that both the motives and mechanics of the disorders are quite distinct from each other:

[…]both BPD and NPD deal with conflict in a way that is unhealthy to themselves and those around them. It’s the expression of the anger that results from the conflict that is different.

In her article “Blame-Storms and Rage Attacks,” Randi Kreger, co-author of Walking on Eggshells, points out the difference in how those with BPD and NPD express anger. While those with Borderline Personality Disorder may fly into a rage and push people away, they will often calm down, feel shame for their reaction, and promise never to do it again.

“Unless they’re in treatment, the underlying issues don’t go away. Some conventional [borderlines] do not get angry at all, but hold it in or express it inwardly through self-harm,” says Kreger.

“The anger of narcissists, on the other hand, can be more demeaning,” she continues. “Their criticism evolves from their conviction that others don’t meet their lofty standards — or worse, aren’t letting them get their own way.”

30 thoughts on “NPD vs. BPD: they are not the same thing!”

  1. Ah, I read this article today, coincidentally. Thank you for this. I’ve seen several with the same kind of gist: “Bipolar/Borderline,” “Asperger’s/Antisocial Personality Disorder,” etc. Usually from people with very bad experiences who tend to overgeneralize.

    Liked by 3 people

  2. Reblogged this on galesmind and commented:
    I don’t understand how those two could be considered the same from what I understand different areas of the brain misfire or don’t fire at all in the narcissist and the borderline. The narcissist is essentially one thing and the Borderline can be a combination. Great article as always.

    Liked by 1 person

    • There’s a lot of confusion because of outward appearances–the behavior of a BPD can be very similar to that of someone with NPD but the cause and the mechanics of the disorders are very different. Obviously Bartholomew doesn’t know a whole lot about BPD or hasn’t done much reading.

      Liked by 2 people

        • There is way too much confusion. Even the APA (American Psychiatric Association that puts out the DSM manuals can’t agree on what distinguishes some disorders from others–or even if some of them should be included as disorders at all. When you think about it, I think diagnostic psychology is more of an art form than a science.

          Liked by 1 person

  3. I think psychiatric labels can be useful. But I also believe that psychiatric labels can cause a lot of harm. I was diagnosed with schizophrenia more than 40 year ago when I was just 14. Many doctors and therapists have told me over the years that I was misdiagnosed. But as the family outcast scapegoat, I have never been able to live that label down.

    It’s sad. People who suffer from a psychiatric illness need compassionate help. But what we typically get instead is shaming and shunning.

    Liked by 2 people

    • It’s terrible what happened to you. But look how stronger you are now! I agree that psychiatric labels can be very damaging. I think there’s also a lot of misinformation and misunderstanding in the field.

      Liked by 1 person

  4. Isn’t it apparent that behind the confusion about what “BPD” or “NPD” are, is the looming fact that neither of them have ever been proven to exist in any scientifically validated way? “BPD” and “NPD” are fabricated, simplistic descriptions of behavior, that different human beings fit to a greater or lesser degree at different times. They are not valid medical disorders..
    The way of speaking about them as if they were concrete “illnesses” that people actually “have” – expressed in both the article you criticized, but also in your own writing – is simply not backed up by reality. I have to take you to task on that. Writing about them as if they were real illnesses – i.e. that they are categorical valid organizations – will not make it so.

    Liked by 1 person

    • The categories and criteria are always changing, and as I’ve said before, diagnostic psychology is more of an art form than a science. It’s not like math or physics, where there are natural laws that never change. Gravity and tconcepts like E=MC2 can be proven by empirical research; psychiatric categories cannot.

      You are aware of course that the DSM V–the Bible of psychiatric diagnosis, is used primarily for insurance and billing purposes. When a doctor submits a claim, they must include a diagnosis along with its billing code, whether it’s from DSM or the ICD-9 (which is for medical disorders) .

      Yet the categories do help the rest of us to better understand the disorders we see around us, even if they are only arbitrary constructs invented to put things into orderly categories. We humans like to categorize things.
      Perhaps people should be treated for their symptoms only, rather than for a “disorder.”

      But there is a such thing as NPD and it clearly falls on a spectrum that goes from low all the way to psychopathy (increasingly believed to be the same thing as ASPD).

      Whether or not related and similar disorders like BPD or HPD should actually be considered variations of NPD (because they all are characterized by a need for attention/supply and validation and all have their genesis from fear of abandonment/hurt caused by early abuse) seems to be a matter of opinion, like much else in psychiatric diagnostic “science.”

      As I said to Sammy (below) I think some Borderlines (the more extroverted “neurotypical” ones) are probably a lot more like narcissists than introverted Avoidant ones like myself. Not that I don’t have narcissistic traits, because I have plenty.

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      • Ok… this is always an interesting argument…. doesn’t the fact that the criteria and categories are always “changing”… and are “a matter of opinion” like you said… imply that there is something fundamentally mistaken with the system of categories that we have?”
        I assume your calling our categories of diagnosis a “science” was a joke 🙂
        You are absolutely right that humans have a need to create categories. It is adaptive to do so: early humans who could see things in an ordered way probably had an evolutionary advantage and could cope better with uncertain conditions. Unfortunately, the notion of rigid categories which can be “carved at the joints” not does like up well with the reality of mental distress.
        Interestingly, new research is showing that the more that people identify as having a mental illness/ psychiatric disorder (on average), the worse they tend to do on various outcomes like work capacity, social relationship satisfaction, etc – compared with people who have similar problems but who don’t identify with a label.
        This is very controversial, and does not apply to certain people. It appears that a minority of people do better when they identify as having a mental illness, but a majority do worse. In that regard, efforts to achieve “mental illness parity” and broad acceptance for “mental illness” are achieving the reverse of their objective: they are increasing stigma and worsening mental health outcomes.
        I am about to write an article about this which is probably not going to go over at all well with some well-intended fellow bloggers who are all about equality for “mental illness.”

        Liked by 1 person

        • Okay, no, I wasn’t actually calling diagnostic psychology a “science” because it isn’t. It’s a “social science” at best or even just an art form.
          But I have a serious question now, BPDT. Do you think we should just get rid of all psychiatric categories and scrap the DSM and only treat people for symptoms and not disorders at all?

          That could be one way to work things, but there is one big problem with that. I’ll give an example. Maybe it’s not a very good one, but here goes.
          Let’s say there are two people who suffer from severe depression and manic episodes. One of these people, a man let’s say, has a chemical imbalance in their brain (what we would call Bipolar disorder) and would be best treated through a combination of therapy and drugs (antidepressants or mood stabilizers). He can get better with careful monitoring of the combinations of drugs he is given and their dosages, and someone to talk to.

          The other person is a woman who has no chemical imbalance but goes into depressions when she is abandoned by other people or is not given what she wants. She has “manic” episodes when everything is going well (grandiosity). There is nothing wrong with this woman’s brain and drugs would not be of help, nor would the type of therapy given to a person with Bipolar disorder. This woman would be diagnosed with a Cluster B disorder such as NPD or BPD and cannot be helped by traditional means of therapy. Short term gains can be made through cognitive-behavioral treatments that would not work on a person with Bipolar.

          So if we just scrapped all the categories, how would we know how best to treat an individual, whose mood swings may be due to completely different factors?
          Or are you just saying that PD categories should be thrown out and replaced with a global “reactive attachment disorder of childhood” that led to an array of various ingrained behaviors we currently call personality disorders?
          I’m not trying to be funny here, but I am genuinely confused.

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          • Given several factors including:
            – Mental health outcomes are significantly better in poorer countries where mental health labels and medication are not heavily used (This may be related to other factors, but the stigma and pessimistic expectations related to “mental illness”, which are much less in poorer nations, is arguably one factor. Data for this are in studies like the World Health Organization’s psychosis studies, Ethan Watters’ Crazy Like Us, and Robert Whitaker’s Anatomy of an Epidemic);
            – That there is no conclusive evidence that “bipolar disorder” exists as a distinct category, or that difference in the brains of “bipolars” are caused by a biochemical imbalance (as opposed to caused by interaction with the environment). (And if you have this evidence, please share it… many people think that bipolar has a proven biological basis, but the evidence to my knowledge is not there; I have done a lot of research to try to find it. From my reading, no biological or genetic marker to date has conclusively established bipolar as a condition distinct from other psychotic or affective categories. This is reported in many books, for example Mad Science by Stuark Kirk or Rethinking Madness by Paris Williams).
            – Given that outcomes for people hospitalized for repeated severe manic-depressive episodes (bipolar) in the first half of the 20th century were much better than for bipolars today – a difference that is heavily correlated with overuse of lithium and other medications today (this data is reported in Whitaker’s Anatomy of an Epidemic)…
            – That much research from the last 5 years suggests that on balance the majority of people are harmed, rather than helped over the long term by identifying with a mental illness label. I am about to write about these studies and include citations…
            – Given all these factors, yes, it would be better to stop labeling people with illusory, unscientific words like bipolar, borderline, and schizophrenic.
            PD categories do not even need to be replaced with “reactive disorder of childhood.” There is no medical terminology needed. Just talk to people and understand their distress and what happened to them without diagnosing them with anything. Why is that not possible?
            Here is an example of a better approach:

            England is getting ahead of us here. American psychiatry is embarrassing to me as an American.

            Liked by 1 person

            • Wow, you sure have done a lot of research–I am impressed!

              I haven’t done a lot of research into bipolar disorder, but am going by the popular (not necessarily accurate) view that it is caused by chemical imbalances. Of course there are many things that lead to becoming bipolar, but in many cases chemical imbalances are a contributing factor (and respond to drug therapy). They are never a factor in PD’s which is why PD’s cannot be treated with drug therapy.

              Yes, American psychiatry is way too quick to label people and give them medication instead of insightful long term therapy. The labeling is done mainly because insurance companies need a label to pay a claim. So the labeling is done for economic rather than psychiatric reasons. As far as feeding patients drugs or quickie “treatments” instead of giving them long term therapy, again it comes down to money. It costs a lot more to give patients long term therapy-it’s more cost effective to give them short term treatments or drugs. In my opinion, that dehumanizes people in severe emotional pain and obviously most are not going to respond well to these treatments because they need so much more. But as mercenary as the American medical and psychiatric system is, it should not be a surprise that other countries are ahead of us this way. The whole medical system is like a giant pyramid scheme. In countries where money isn’t the primary motive behind treating mental disorders, more time will be taken to insure a patient gets better.

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            • I agree with a lot of this. But why do you think a chemical imbalance causes bipolar states? There has never been evidence for that that I’ve seen. From my research that is misinformation used by drug companies to promote lithium etc. Also, bipolar is not one unitary condition but rather a syndrome or range of related experiences. So, saying “it” is caused by some chemical misfiring is simplistic and mistaken.

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            • I can’t give you sources right now (I can work on this later when I have more time) but generally from my readings it seems many experts believe bipolar is caused, at least in part, by chemical imbalances. That doesn’t make it fact though.

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  5. Hello
    Thank you for a otherwise very good blog/information. I especialy liked your description in the blog”Letter from a narcissist true self”. But I have a comment to this blog.

    I think that new research in psychology has confirmed that bpd and npd comes from a severe attachment disorder/neglect or abuse in childhood. The different symptoms/ defenses – wether you call it bpd or npd traits, ,has developed as a response to the articular situation the child grew up in. So it’s hard to distinguish often between bbd and npd and make them clearcut different. I am not saying that you or all with bpd have narcissistic difficulties, it’s all on a scale, and people with bpd can be very different even they have been diagnosed the same. But some with bpd are have narcissistic difficulties.

    As you write yourself: “while a “benign” narcissist isn’t necessarily ill-intentioned but is just self centered and doesn’t care about your feelings”; that happens often with some borderliners too. And it’s logic because it stems from a lack of trust and an attachment disorder in childhood.

    Sorry for my english, I am from another country. Best wishes

    Sammy

    Liked by 1 person

    • Sammy, first of all your English is just fine.
      I’m also glad you like this blog and I’m glad you liked the “letter from a narcissist” I wrote today. I got very emotional writing that!

      What you say has much truth. Many BPD’s are very narcissistic, some more than others. Introverted ones like myself (I also have Aspergers and Avoidant PD) probably tend more to turn our anger inward and become self destructive. I think more extroverted BPD’s may act more narcissistically, that is, using manipulation tactics similar to what narcs do. Like NPD, perhaps BPD should be on a spectrum. But at some point would they merge?

      Generally I think BPD is less dangerous to others than NPD, but more dangerous to the person who has it. It’s less adaptive in a way, because in our society, narcissism can be very adaptive, while borderline traits are not very adaptive at all.
      I agree both stem from severe attachment disorders during childhood, as do most PD’s.
      Thank you for your comments.

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  6. thanks for your response. Yes, I think you are right.
    Personally I think that the different PD’s are just descriptions of symptoms stemming from an attachment disorder, they are not really disorders.. And thats why they can overlap, it can be hard to fit a person in to one PD. because people are different and have different symptoms depending on their specific story/upbringing.
    Best wishes and thanks for a very good blog

    Liked by 1 person

    • I’m not sure I would say PD’s are not disorders, because they are maladaptive ways of relating to people in the world (either hurting the sufferer or their “victims” in the case of ASPD/NPD/sometimes BPD/HPD) but yes, I would agree they are all stemming from childhood attachment disorders — and for that reason they are very difficult if not impossible to cure.

      I hope you decide to stick around.

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