#23 – The Borderline-Narcissistic Continuum: A Different Way of Understanding “Diagnosis”

This is more the sort of thing I want to blog more about. Here’s a somewhat scholarly but interesting and thought provoking article about BPD (borderline personality disorder) being on a continuum that ranges from psychosis (being totally out of touch from reality) to normal (neurotic) behavior (the idea being that everyone is neurotic to some degree, which is what makes us human).

Borderline Personality Disorder was originally given that name because mental health experts studying this disorder in the early years believed that borderlines straddled the line between psychotic and neurotic in their thinking and behaving patterns. For a borderline undergoing healing, NPD (actually functional narcissism, which includes developing self esteem) is the first step toward mental health.

According to the experts mentioned in this article and many mental health professionals, BPD is a less functional and more ego-dystonic form of NPD.

BPD Transformation

For the purpose of understanding psychiatric problems in a more nuanced and optimistic way, here is a diagram from Donald Rinsley’s book Treatment of the Severely Disturbed Adolescent:


Please click on the picture to see it larger. Each row corresponds vertically to the rows above and below in describing degrees of emotional development, and each row describes emotional growth over time from left to right. The majority of the text in brown is Rinsley’s own diagram; the bottom additions in white are mine.

Donald Rinsley was among the most respected authorities on borderline and narcissistic conditions in the second half of the 20th century. He was a psychodynamic therapist who ran a psychiatric hospital for severely troubled adolescents in Topeka, Kansas in the 1960s, 70s, and 80s. He later worked extensively with personality-disordered and psychotic adults in an outpatient psychotherapy practice.

I believe that much can be learned from studying Rinsley’s…

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