Borderlines: incurable demons or trauma victims?

complex_ptsd
The symptoms of Complex PTSD are almost identical to those of BPD.

Something has come to my attention during the time I’ve been blogging, which I think is important enough to merit another post about it.

Borderline Personality Disorder (BPD, DSM code 301.83) is classified by the Diagnostic and Statistical Manual of Mental Disorders as a Cluster B (emotional/dramatic/erratic) personality disorder having many similarities to character disorders like Narcissistic Personality Disorder (NPD) and Antisocial Personality Disorder (ASPD). Both NPD and ASPD are characterized by a lack of empathy, entitled behavior, and disregard for the rights or feelings of others. It’s also true that some Borderlines act out in ways harmful to themselves and others. Hence, “Cluster B” has become a pejorative category and some ACONs (adult children of narcissists) and others have demonized people with BPD as being amoral, immoral, and almost inhuman, nearly or as bad as as people with NPD or ASPD. Some even go so far as to lump all borderlines in with the “narcs” and barely make a distinction between them. In their minds, if you’re a Borderline, you’re no better than a “narc” and that’s all there is to it. You’re a bad person and to be avoided.

To make matters even worse, many mental health professionals refuse to treat people with BPD, believing them to be troublemakers, incurable, or both. I remember one therapist I saw years ago for an intake session and seemed to connect well with, called me a few days later after he received my psychiatric records, and told me he couldn’t take me on as a patient. “I don’t work with borderlines,” he said.

It’s true that there are some similarities between the Cluster B disorders, and both BPD and NPD/ASPD have roots in childhood abuse or neglect. But the similarities don’t run very deep. What I mean by that is while both a borderline and a narcissist cn be manipulative or abusive to others, the reasons are very different. There’s also the matter of intention. Borderlines, if they act out against others, aren’t usually aware they’re being abusive and/or manipulative. If their bad behavior is brought to their attention, they normally become very upset and feel terrible about it (unless they have a comorbid NPD or ASPD diagnosis). They act out because of overpowering emotions that they haven’t learned how to control. In contrast, a narcissist or person with ASPD acts out because they can. If their behavior is brought to their attention, they’re likely to become angry and rage against the accusation, make excuses, blame-shift it onto someone else, or deny it.  Unlike most borderlines, they don’t feel remorse, guilt or shame for hurting others.

In addition, many borderlines are much more harmful to themselves than to other people. If they do act out against others, most are as frightened by their own outbursts as others are and sometimes more so. In a nutshell, people with BPD know they have a problem and wish they could be different. Untreated BPD makes a Borderline’s life miserable, while people with NPD or ASPD are usually not bothered by their disorder. That’s why, even though Borderlines can act “crazier” than narcissists, they can get better and are much more responsive to therapy or behavioral treatments such as DBT or CBT.

But we’re still caught in a gray zone, neither here or there.   The stigma against borderlines (in my observation) has grown worse, and most narcissistic abuse sites pretty much regard people with BPD  as the “female or over-emotional version of NPD.”  (actually, Covert/Fragile NPD or Histrionic Personality Disorder would come closer).   If we’re narcissistic abuse victims suffering from complex PTSD, it takes a great deal of courage to admit you also have a BPD diagnosis.  It took me a few months to come out about it on this blog. Fortunately,  I haven’t received too much (or really, any) flack about it.

complex-ptsd-and-bordeline-personality-disorder-36-728
Click to enlarge graph.

The good news is, a number of BPD bloggers are helping to reduce the negative stigma that we’re “bad seeds” with an untreatable disorder just because we’re OMG “Cluster B.” Think about this: have you ever noticed that there aren’t too many people with NPD (or ASPD) blogging about their challenges and insecurities, or fighting to reduce the stigma against their disorder? If they blog about their narcissism or psychopathy, it’s usually to brag about how NPD/psychopathy makes them superior or allows them to have control over others and be successful in the world. That’s because they don’t think they have a problem (They just cause others to have problems). Most Borderlines know they have a problem and struggle with it constantly, since it makes them feel so crazy and lowers their quality of life. I can only think of ONE blogger with NPD who was unhappy with his disorder and successfully treated for it (or so he says). That man probably had low-spectrum and probably covert NPD; a person with malignant or high spectrum grandiose-type NPD will never have enough insight or willingness to admit that THEY are the ones with a problem. In contrast, I can think of about 20 bloggers with BPD who are in treatment or therapy or have even been healed! I’m sure there’s many more that I don’t even know about.

BPD also seems to co-occur a lot with complex PTSD or PTSD. Most BPD bloggers I can think of also have complex PTSD or are in treatment for it. The symptoms of BPD and Complex PTSD are almost the same. The DSM does not recognize Complex PTSD as a diagnosis; it only recognizes PTSD, which is not caused by chronic trauma over a long period of time (such as having been abused as a child), but by one traumatic incident (such as fighting in a war or being raped). Therapeutic treatments for complex PTSD and BPD are also almost the same (for that matter, NPD and other personality disorders are treated almost the same way). Both BPD and Complex PTSD have a higher cure rate than NPD. Since Complex PTSD isn’t recognized as a valid diagnosis, I think a lot of people (especially women) who might have been diagnosed with complex PTSD if it was recognized get slapped with the “Borderline” label instead. Although I accept my BPD diagnosis (and have even become a little attached to it), I wonder if I might never have been diagnosed with it at all had Complex PTSD been recognized by the psychiatric profession. I think in some cases, BPD may not really be accurate, or could even be the same thing as C-PTSD due to their many similarities. At least one blogger (BPD Transformation, who used to comment here but stopped for some reason), doesn’t even think BPD is a valid diagnosis and shouldn’t exist at all.

Further reading:

Are BPD and Complex PTSD the Same Disorder?

Is BPD a Real Disorder or Should it Be Eliminated as a Diagnosis?

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How does avoidant PD differ from covert (vulnerable) narcissism?

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Covert (vulnerable or fragile) narcissism (cNPD) can, on the surface, look an awful lot like Avoidant Personality Disorder (AvPD–not to be confuse with AsPD!), which I have been diagnosed with, along with BPD.

But appearances are only skin deep.

I found an article on Psychforums (in the Avoidant PD forum) that describes the differences very well. Because covert/vulnerable narcissism is not an officially recognized diagnosis, and is not included in the DSM (yet), covert narcissists are frequently (if not almost always) diagnosed BPD comorbid with AvPD, as I am. Aspergers can also be easily confused with cNPD, and has been by many. But this article focuses on Avoidant PD, not Aspergers.

“Vulnerable narcissism could be misdiagnosed with at least two other distinct DSM personality disorders: Avoidant Personality Disorder (AVPD) and Borderline Personality Disorder (BPD). In the diagnosis of AVPD, there are several criteria that may overlap with vulnerable narcissism. First, avoidant individuals are observed as appearing shy and being fearful of developing close relationships with others. Second, individuals with AVPD may meet criteria for experiencing fears of feeling humiliated, rejected, or embarrassed within individual relationships. Finally, Millon (1996) proposes that the use of fantasy in individuals with AVPD is a major element in the presentation and perpetuation of this disorder. This is striking in the fact that the use of fantasy has long been denoted as primary to the realm of narcissistic pathology.The vulnerable narcissist will likely exhibit significant interpersonal anxiety, avoidance of relationships, and use of fantasy, but this is guided by a core of entitled expectations. That is, vulnerable narcissists may avoid relationships in order to protect themselves from the disappointment and shame over unmet expectations of others, in contrast to fears of social rejection or making a negative social impact typical of AVPD.

Another false positive diagnosis that may occur as a result of misinterpreting vulnerable narcissismis in the diagnosis of BPD. Masterson (1993) forwarded this issue in an elaborate discussion about the potential for misdiagnosis of the closet narcissistic personalitywith BPD. Misdiagnosis can occur because of a clinician’s attention to the overt presentation of the emotional lability in the individual to the exclusion of an understanding of the cognitive and socio-emotional experience that guides the lability. As with social avoidance, the emotional lability of the vulnerable narcissist is influenced by his or her covert entitlement and difficulties managing disappointment and self-esteem threat. In contrast, the emotionally lability of the individual with BPD is a byproduct of unrealistic anaclitic needs (e.g., the need for a strong caretaker to manage his or her fears of being independent).

avoidant personality

Both the AVPD and the vulnerable narcissistic character will likely report difficulties with feeling self-conscious in interpersonal situations, along with the tendency to avoid situations in which they expect to be ridiculed. The difference between AVPD and vulnerable narcissistic characters lies in their expectations for themselves and others. Individuals with AVPD have needs to be liked and accepted by others, but fear they will fail to be acceptable to others. In contrast, vulnerable narcissistic characters need others to respond favorably to them and to admire them regardless of their behaviors, beliefs, skills, or social status, but fear that others will fail to provide them with narcissistic supplies. For vulnerable narcissistic characters, it is not mere concern about being liked or not. Rather, the vulnerable narcissist’s fear is that he or she will not be admired. Furthermore, vulnerable narcissistic individuals experience significant injury and anger in response to perceived slights. Their avoidance of relationships is based upon their fear of not being able to tolerate the disappointment of their unrealistic expectations.

The assessment of entitled expectations and exploitative motivations are important variables that would guide how an individual approaches and experiences relationships, including a therapeutic relationship. Not acknowledging narcissistic entitlement when it is present could lead to important misinterpretations of clients’ experiences that either reinforce their sense of entitlement or lead to unrecognized self-esteem threat in the therapeutic relationship (Gabbard, 1998).”

From “Interpersonal analysis of grandiose and vulnerable narcissism” Dickinson, Kelly A; Pincus, Aaron L

Are BPD and complex PTSD the same disorder?

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Me at age 3 in the zone. Was the template for my BPD already laid down?

Ruji, a new commenter on this blog, made an interesting observation–that BPD should be divided into at least two subtypes: Empathy Challenged/Character Disordered (closer to NPD/ASPD) and Highly Sensitive Person with Emotional Dysregulation (closer to the type I have, although at different times in my life or when extremely stressed I have displayed the more character-disordered subtype). I agree with her. Ruji’s idea is remarkably similar to The World Health Organization’s two subtypes of BPD:

1. F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):

–marked tendency to act unexpectedly and without consideration of the consequences;
–marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
–liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
–difficulty in maintaining any course of action that offers no immediate reward;
–unstable and capricious (impulsive, whimsical) mood.

2. F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

–disturbances in and uncertainty about self-image, aims, and internal preferences;
–liability to become involved in intense and unstable relationships, often leading to emotional crisis;
–excessive efforts to avoid abandonment;
–recurrent threats or acts of self-harm;
–chronic feelings of emptiness.
–demonstrates impulsive behavior, e.g., speeding, substance abuse

Psychologist Theodore Millon has gone even further, proposing that BPD should be divided into four subtypes:

1. Discouraged (including avoidant features): Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.

2. Petulant (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.

3. Impulsive (including histrionic or antisocial features) Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.

4. Self-destructive (including depressive or masochistic features) Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.

Millon’s Types 1 and 4 would correspond to the Highly Sensitive Person/Emotional Dysregulation type mentioned above (and therefore closer to the Avoidant/Dependent PDs); Type 2 sounds very much like NPD; and Type 3 seems closer to ASPD or Histrionic PD.

complex_ptsd
BPD symptoms are almost identical to those of Complex PTSD.

There are so many diverse–almost opposite–symptoms that can appear with this disorder that one person with BPD can be very different from the next. In fact, you can take 10 borderlines and they will all seem very different from each other, with barely any similarities in their behavior at all. One will be shy, fearful and retiring, never making waves, acting almost like an Aspie or an Avoidant; while another may break the law, lie constantly, and act obnoxious and rage whenever things don’t go their way. A borderline could be your raging boss who drinks too much and ends every annual Christmas party with one of his infamous rages, or it could be the sweet and pretty schoolteacher who goes home every night and cuts herself. She could be the come-hither seductress or the nerdy computer programmer. He may have few or no friends or a great many.

This diversity is not the case with the other personality disorders, which have more cohesiveness in the symptoms their sufferers display. So I wonder–is BPD really a personality disorder at all? Does it even exist, or is it really just a group of trauma-caused symptoms the experts in their ivory towers stuck in a single box called “BPD” because they didn’t know how else to classify them?

In fact, all these diverse subtypes have one thing in common–they are all very similar or identical to the symptoms of someone with complex PTSD (C-PTSD). People with C-PTSD are often misdiagnosed as Borderlines because their behaviors can be just as baffling and manipulative, and both disorders also include dissociative, almost psychotic episodes. Extrapolating from that, I wonder if ALL borderlines actually have C-PTSD.

Earlier today I posted an article outlining 20 signs of unresolved trauma, and I was struck by how similar these were to the symptoms of BPD. And there is also this article that Ruji just brought to my attention that also describes how remarkably similar the two disorders are, but that the idea of fear of abandonment (which is recognized as the root cause of BPD) is not recognized as a factor in causing PTSD and that may be part of why they have been kept separate.

The BPD label, like any Cluster B label, is very damaging to its victims because of the “evil and character-disordered” stigma it carries. One psychologist has even included us, along with narcissists, among the “People of the Lie”!

Yes, it’s true some borderlines do act a lot like people with NPD or even Malignant Narcissism or ASPD, but most probably do not, and are really much more similar to people with Avoidant or even Dependent personality disorders, which hurt the sufferer more than anyone else. But if you have a BPD label, people start backing away from you slowly due to the stigma. Therapists are reluctant to treat you because they assume you will be either difficult and hateful in therapy sessions, or will never get better. Insurance companies won’t pay claims where there is a BPD diagnosis, because it’s assumed there is no hope for you. I’ve had this problem when I’ve tried to get therapy. I remember one therapist who I had seen for the intake session, who told me he needed to obtain my psychiatric records before we could proceed. The session had gone smoothly and I felt comfortable with him. A few days later I received a phone call and was told he did not treat “borderline patients” and wished me luck. So that’s the kind of thing we’re up against if we’ve had the BPD label slapped on us.

Also, as an ACON blogger who works with a lot of victims of narcissistic abuse, my BPD label sometimes makes people wary of me and they begin to doubt that my motives here are honest. At first I was reluctant to talk about my “Cluster B disorder” here, because I knew it might be a problem for some ACONs, who think borderlines are no better than narcissists. But I eventually decided that to hide it away like an embarrassing family secret would be misleading so I “came out” about having BPD (I never actually lied about it, but played it down in the beginning and rarely mentioned it). I’m glad I fessed up, but there have been a few people who left this blog after I came out about it or began to doubt my motives. So there’s that stigma and it’s very damaging.

Both C-PTSD and Borderline PD are caused by trauma. Both are complex defensive reactions against future abuse and both involve things like splitting, dissociation, psychotic episodes, self-destructiveness, wild mood swings, and behavior that appears to be narcissistic and manipulative.

The way I see it, the only real difference between C-PTSD and BPD is that the traumatic event or abuse happened at an earlier age for someone with BPD, perhaps during toddlerhood or infancy, while all forms of PTSD can happen at a later age, even adulthood. But the symptoms and defense mechanisms used to avoid further trauma are the same for both.

What’s up with this crazy idea that narcissism and Aspergers are the same thing?

aspie_narcissist

As a person with Aspergers who has been a victim of narcissists all my life, the difference seems pretty clear to me, but to some people, including mental health professionals, high-functioning autism (Aspergers) and narcissism are seen as the same disorder!

A thread on Wrong Planet, a forum for people with autism and Aspergers (a high functioning form of autism) discusses the confusion, with people on both sides of the Aspergers=Narcissism fence. Cited there is an article from Psychology Today, which quotes Sam Vaknin who believes narcissism is an autism spectrum disorder! The British psychiatrist Dr. Khalid A. Mansour concurs.

Clearly, some people don’t understand much about high functioning autism/Aspergers. Yes, I believe it’s possible for a person to be both a narcissist AND on the autism spectrum (an example might be Mark Zuckerberg, creator of Facebook, especially as he was portrayed in the movie “The Social Network“), but they are two vastly different disorders.

Appearances are only skin deep.

aspergers_narcissism

I understand where the confusion comes from. On the surface, the two disorders can appear similar. People on the autism spectrum may seem as if they lack empathy because they do not express their emotions well, which of course includes showing empathy. They also sometimes blurt out inappropriate or hurtful things, not because they mean to, but because they honestly don’t know any better: they have great difficulty reading social cues. They can appear selfish and sometimes get angry or upset when their routines are interrupted or they are forced to pull themselves away from their solitary pursuits to engage with others. They can also violate the boundaries of others. All of these surface behaviors may look a lot like narcissism.

But appearances are only skin deep, and this is where any similarity ends. Lack of empathy seems to be the most commonly mentioned “characteristic” of both Aspies and narcissists. But in actuality, as far as empathy is concerned, a person with autism/Aspergers is the polar opposite of a narcissist. A narcissist cannot feel empathy, but can act as if they do. They are good actors and can fake emotion they do not feel. They can lie well; Aspies cannot lie or lie very badly. People with Aspergers and high functioning autism are great at picking up the emotions of others around them and are even sometimes overwhelmed by other people’s emotions (which sometimes makes them withdraw and that can make them seem like they lack empathy). They can be bad at expressing empathy because of their inability to read social cues or know what to say and do. Therefore, Aspies can feel empathy but often act as if they do not.

autism

Narcissists can say hurtful or damaging things because (a) they don’t care how you feel; or (b) because they want to hurt you. People with autism/Aspergers say hurtful things too sometimes, but it’s never intentional and they do care how you feel. If they are told they said something hurtful, most autists/Aspies are consumed with guilt and will sincerely apologize. They blurt things out because they sometimes do not know it’s not appropriate to do so.

Aspies and autists hate to have their comforting routines interrupted because repetition is something that grounds and relaxes them. A low functioning person with autism will sometimes perform repetitive movements or repeat a phrase over and over. This is how they cope with too much stimuli coming in. If they are interrupted, a low-functioning autist may fly into a rage or have a temper tantrum. Disengaging and switching gears is impossible for them.

At the higher end of the spectrum, an Aspie or high functioning autist may not repeat the same word or action over and over, but they have their hobbies and obsessions which they pursue with a single-minded intensity. They tend to hyper-focus on whatever interests them. If they are interrupted from whatever their mind is focused on, they may snap at you or become very annoyed. They can switch gears if they must but they hate doing it.

A narcissist may also snap or become annoyed, but not because they have difficulty switching gears but because they are just plain selfish and don’t want to do something that might please someone else besides themselves. Think of the narcissistic husband playing a video game. His wife comes into the room and asks for some help opening a stuck window. The husband flies into a rage and tells her he’s busy and to do it herself. It’s not because he’s that engrossed in the game or even cares about it that much, it’s because he doesn’t want to put himself out for his wife. For an Aspie or autist, the game engages all of their senses and their mind is extremely focused. They simply can’t pull away from it.

aspie_misdiagnosis

A person with autism or Aspergers can and do violate the boundaries of others. Again, this is because they can’t read social cues well enough to know when they are violating someone else’s boundaries. A narcissist knows full well when they are violating boundaries, but they simply do not care.

A forum member on Wrong Planet sums up the confusion this way:

To me it’s as absurd as comparing the small narcissistic child recklessly driving a car, to a person trying to cross the street in a wheelchair, and saying they have a lot in common because they both have a set of wheels.

I think mental health professionals and others who believe narcissism and Aspergers are on the same spectrum need to dig a lot deeper before they make such sweeping generalizations. They are not the same disorder at all and are certainly not on the same spectrum. Aspergers/high functioning autism is a neurodevelopmental deficit and really a type of learning disability; narcissism is a moral deficit.

For further reading, please see my article, People with Autism Do Not Lack Empathy!
Also see The Spectrums of Autism and Narcissism.

Narcissists with Aspergers?

lonely_guy

There’s been much written about the relationship between Aspergers syndrome and narcissism, mostly about the way they are often confused with each other (or misdiagnosed as the other disorder) due to the belief that people with Aspergers lack empathy (which is not true). I wrote about this false belief in my article, “People with Autism Do Not Lack Empathy!”

People with Aspergers may SEEM unempathic, because they are not always very good at expressing emotions or knowing how to react when other people share their emotions with them. But an Aspie’s lack of appropriate social reaction to the emotions of others doesn’t mean they can’t FEEL the emotions around them. In fact, some may feel other’s emotions MORE keenly than neurotypicals, and they can be easily overwhelmed, which may cause them to withdraw from the situation and partly account for why they may seem less engaged emotionally or uncaring about the feelings of others.

aspie_misdiagnosis

Narcissism as an Autism Spectrum Disorder?

question2

Psychology Today had an interesting article comparing narcissism to high functioning autism (Aspergers) and at least one psychologist thinks they may be the same disorder!:

Khalid A. Mansour (the British Arab psychiatrist), has proposed in an article in the Pan Arab Journal of Psychiatry (link is external) that narcissistic personality may merit classification as an autistic spectrum disorder.

Dr. Mansour writes, “There is now significant level of agreement that emotional processing problems like: lack of empathy, poor self-awareness, self-centredness, poor reciprocation of emotion, poor ability to maintain emotional relationships, anxiety and anger outbursts are more or less central features of autism (10, 50,51).”

Interesting. When I first read the above paragraph, I though Dr. Mansour was writing about severe narcissism. His description fits both narcissism and autistic spectrum disorders. Hmmm.

Dr. Mansour similarly quotes from the ICM-10 listing these features of autism:

–Self-centeredness; inappropriate to developmental level and cultural expectations
–Poor self-awareness, poor ability to develop remorse or learn from mistakes
–Poor empathy or appreciation of others feelings
–Poor ability to reciprocate emotions.
–Hostile dependency on safe relations.
–Failure to develop emotional relationships appropriate to developmental level and social norms
–Treating people as objects or preferring objects over them
Again, this list certainly sounds a lot like narcissism.

Dr. Monsour concludes: “… it is noticeable that people with NPD, do not show a major degree of functioning problems in stress free environment or when they are supported (except that they are perceived as “not pleasant characters” to deal with). However under stress and without support they can become quite dysfunctional in a way not far from what we usually see in Asperger’s syndrome. “

I don’t buy it. This is the opinion of one psychiatrist. While it’s true that on the surface these two disorders may appear similar, the mechanism behind the behaviors are vastly different–in fact, almost the opposite. For the narcissist, their lack of empathy and failure to engage the emotions of others is due to their inability to feel the emotions of those around them, but they can FAKE empathy fairly well, even if they choose not to. If they are trying to obtain supply, they can be pretty good at it. Their social skills are not the problem–their inability to feel other’s emotions are. They are like actors in a play. In contrast, a person with Aspergers or high functioning autism DOES feel the emotions of others around them strongly, but lacks the social skills necessary to be able to convey this to others effectively. Unlike the narcissist, people with Aspergers are very bad actors.

But the question was, can Aspergers and narcissism occur together?

aspie_narcissist

But we’re talking here about comorbidity. The question I’ve raised is whether Aspergers and Narcissism can be comorbid with each other–that is, can someone have BOTH disorders?

The answer appears to be yes. I found this on Yahoo Answers, from a man who claims to be both a high functioning autistic AND a sociopath:

[…] people with Asperger’s can be sociopaths and or narcissists as well. “CO-MORBID” is the medical term used to describe a disability or group of disabilities that exist another disability in a single individual at the same time. It is possible to be autistic and have cerebral palsy or have aspergers and diabetes. Likewise it is also possible to have both Aspergers and mental disorders including sociopath and narcissism. Asperger’s does not exist in a bubble that protects it from co-morbid disabilities and mental defects.

I have High Functioning Autism and I also have antisocial tendencies I must always keep properly managed. I see my psychiatrist regularly. I take my medications as needed and I have trained myself to always be mindful of my darker instincts to insure they do not express themselves in disastrous ways. I have high functioniong autism but; thanks to early intervention by family, doctors and others I was made keenly aware of my antisocial ways and taught how to manage them in ways that kept everyone safe. It is the single most difficult thing I do in life to keep my antisocial ways well managed but; having seen the monster I become when enraged is motivation enough to keep me always vigilant.

There’s no reason why the disorders couldn’t exist together. Personally, I’ve never known anyone with both disorders, but that doesn’t mean they don’t exist. Using a fictional example, I’m going to speculate here what the behavior of a narcissist with Aspergers might be like.

The Case of Mark F.

Depressed Forty Year Old Man Drinking Alone

Mark F. always had trouble making friends. In grammar school he was bullied due to his inability to fit in with others or show empathy. He was socially awkward and never seemed to know the right thing to do or say. Mark not only was unable to show appropriate reactions in social situations, but rather than suffer in silence and wonder why others didn’t understand or like him (as most Aspies do), he didn’t care about the feelings of those around him. He was easily hurt by the bullying, but reacted in rage due to these narcissistic injuries to himself. He’d lash out at those who injured him and didn’t care if he hurt someone else.

As Mark grew older, he had difficulty keeping a job, not only because of his inappropriate, almost schizoid affect that was very offputting to those around him, but also because he deliberately caused pain to others with his frequent insensitive insults. Due to his Aspergers, Mark lacked the social skills to be able to effectively use the more subtle narcissistic “tools” such as gaslighting or triangulation against others, but he was very good at blame-shifting and projecting his character defects onto those around him. Lacking the social skills to know what behaviors were appropriate, he’d “go off” on those in authority, and was frequently fired from his jobs for insubordination, gossiping openly about his coworkers, missing work due to debilitating hangovers (more about this in the next paragraph), and starting fights.

Mark never married. Though good looking, due to his poor social skills and openly hostile attitude (he was unable to mask his anger, resentment and envy of others), his dates never developed into relationships. No woman would stay with him longer than a few weeks. He had no friends and resorted to frequent drinking to cope with his loneliness.

As you might imagine, Mark was miserable. He constantly felt victimized. He was frequently depressed and wondered why he couldn’t get others to cooperate with his need to use them for supply. In his frustration and envy of all those around him for their “better social skills,” Mark tried to self-medicate by drinking heavily and his frequent drunkenness only served to exacerbate his rages and cause his work attendance to be poor.

Having both disorders would be a recipe for extreme misery. Mark’s behavior is just one way narcissism comorbid with Aspergers could manifest itself. An effective narcissist must possess good social skills to be able to charm others into trusting them and to use their “bag of tricks” in an effective way, and therefore an Aspie with narcissism wouldn’t be particularly dangerous, just very unlikeable. Therefore, I don’t think it would be probable that an Aspie could be a “malignant narcissist” but they certainly could be suffering from NPD. A person with both disorders would have zero charm and therefore not have many opportunities to use others the way a narcissist with good social skills could. My feeling is substance abuse would be a huge problem for such a person, in their attempt to make life more bearable. For those not resorting to substance abuse or alcoholism, severe depression or even suicidal ideation could result.