The “Four F’s” of C-PTSD

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I just began reading “Complex PTSD: From Surviving to Thriving” by Pete Walker. I can already tell I won’t be able to put it down (I will write a book review when I’m finished, which shouldn’t take long). I’m also going to bring this book to my next therapy session because I want my therapist to see it.

Walker, who is a therapist and also a survivor of narcissistic abuse and sufferer of C-PTSD, is an engaging writer and definitely knows his subject matter. In one of the first chapters, he discusses the “Four F’s”–which are four different “styles” of coping that people with C-PTSD develop to cope with their abusive caregivers and avoid the abandonment depression. Whatever style one adopts may be based on several factors–natural temperament, the role in the family the child was given (scapegoat, golden child, “lost” or ignored child), birth order, and other factors.

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Available on Amazon

The Four F’s are:

1. Fight (the narcissistic defense): often “golden children,” such children learn to project shame onto others; may go on to develop NPD
2. Flight (the obsessive-compulsive/anxiety defense): these children will grow up to become highly anxious, obsessive-compulsive, and avoidant.
3. Freeze (the dissociative defense): these children “protect” themselves by dissociating from others, themselves, and their environment.
4. Fawn (the codependent defense): the child learns to avoid harm by people-pleasing or siding with their abusers.

Walker speculates that if C-PTSD were recognized in the psychiatric literature, the DSM could probably be reduced to the size of a pamphlet, for many people diagnosed with other disorders actually have C-PTSD, which encompasses symptoms of many other disorders and have common roots.

What you may have been misdiagnosed with (or diagnosed yourself with) if you have C-PTSD (these are the most common):

Personality Disorders:
Borderline Personality Disorder
Narcissistic Personality Disorder

Dissociative disorders

Anxiety Disorders:
Generalized Anxiety Disorder
Panic Disorder
Social Anxiety
Obsessive-Compulsive Disorder

Mood Disorders:
Depression
Bipolar Disorder

Developmental Disorders:
Autism Spectrum Disorders
ADHD
ADD

Codependency

Addictive Disorders

While any or all of these diagnoses can be co-morbid with C-PTSD, they miss the mark or don’t tell the whole story. Personality disorders such as BPD can develop from severe, unrelieved C-PTSD and they do share many similarities, but personality disorder labels are stigmatizing and not very helpful for someone who has suffered prolonged childhood trauma and abuse. Labels like “panic disorder” or “depression” aren’t helpful because they only address one or two symptoms of C-PTSD and therefore can’t even begin to address the roots of the depression or anxiety. You can treat anxiety or depression with drugs or short term therapy, but you can’t cure the person of the C-PTSD that’s causing their chronic anxiety or depression. The same goes for labels such as alcoholism or codependency. These are merely symptoms. People with C-PTSD are also sometimes erroneously diagnosed with developmental disorders such as ADHD or autism, which not only don’t address the trauma that led to the ADHD- or Aspergers-like behaviors, but also have completely different causes.

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Guest Post #8 : Abusers break you–and then HATE you for being broken.

My dear friend and active participant on this site, Linda Lee, has written a wonderful and OMG SO TRUE post, which describes a lifetime of abuse, including incarceration in a state mental hospital, and being faced with unethical doctors and caregivers, including one who raped her. She was sent back home to a rejecting family–who had put her there in the first place! Linda Lee has Complex PTSD, a form of PTSD that’s often the result of chronic abuse during childhood, rather than an isolated traumatic incident later on in life. After describing the insane house of mirrors she had been thrusted into that seemed to have no way out, Linda lifts the reader out of the darkness with an uplifting message about Easter and the resurrection.

Linda Lee also has a blog about her Complex PTSD caused by prolonged, severe trauma called Surviving Trauma (formerly Heal My Complex PTSD).   (I got a little confused here because Linda recently changed her blog but the old one is still there too.  Her new blog is called A Blog About Healing From PTSD. )

I know the following story sounds so crazy, it’s hard to believe. But it is all true, so help me God… unless I really AM nuts, and the mental health professionals who have told me otherwise over the years were all wrong!

ABUSERS BREAK YOU — AND THEN HATE YOU FOR BEING BROKEN
By Linda Lee, Surviving Trauma and A Blog about Healing From PTSD

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The cover for Linda Lee’s future book, which she designed herself!

If you take a young puppy away from his canine family before he is weaned, yell at him, kick him, shake him, beat him, half-starve him, and leave him on a chain outdoors, exposed to every kind of weather without shelter, that poor little puppy is going to grow up to be a deeply disturbed dog – if he lives to grow up.

If you treat human children like that pitiful dog, they are going to have behavioral and emotional problems, too.

I grew up with parents who were normal and nice some of the time, and behaved like insane, demonically possessed monsters part of the time. I never knew from one day to the next whether my mother was going to be like June Cleaver in the TV show “Leave it to Beaver,” or Joan Crawford in the movie “Mommy Dearest.”

As for my dad, a fundamentalist minister whose episodes of violence led to his diagnosis of multiple personality disorder (now known as Dissociative Identity Disorder), some people believed that he actually was possessed by demons.

When I was fourteen years old, I began to have some emotional problems. Big surprise, right? I told my mother about the difficulty I was having, hoping she could help me. But, although my problems were mild compared to both of my parents’ history of extreme mental problems, my mother said “You are crazy just like your father!” Then she contacted my dad (my parents were divorced by then), and he agreed with her that I needed to be put in a state mental institution – against the advice of my doctor!

Of course, my dad said that I was “crazy like your mother.” He also told me he was GLAD I had psychiatric problems, because now I would understand what he had gone through.

But I did not understand. Almost fifty years later, I still don’t. Unlike both of my parents, my behavior was not out of control. On the contrary, although I wasn’t perfect, I was obedient, subservient, and eager to please. I had never been the least bit violent. I had never threatened or tried to harm anyone.

My dad, on the other hand, came so close to murdering my mom when I was twelve years old that for several terrifying moments I had thought she was dead. That’s when my father was arrested, then put in the psychiatric ward of a general hospital after the police took him to the emergency room because his insulin-dependent diabetes was out of control.

As for my mother, a few weeks after my dad tried to kill her, she did something even worse – she tried to gas us all to death while my four younger brothers and sisters and I were sleeping in our beds. Yet she never put herself under any kind of psychiatric care. With no other responsible adult living in the house at the time, there was no one to force her to get help. So now, because she has never been to a mental health professional and labeled with a psychiatric diagnosis, my mother thinks she is “just fine.”

When my dad’s medical insurance ran out and he was discharged from the psych ward, my mother dropped her charge of attempted murder so he could go back to work and provide financial support. Then my dad married the head nurse of the psychiatric ward whom he had met while he was a patient there (how unethical is that?), and my mother started dating a newly divorced man who had previously worked with my dad. She soon became pregnant (accidentally on purpose?), and quickly married the unborn baby’s father.

So now my parents were living happily ever after with their brand new loves while I, their eldest daughter, became the family scapegoat and “the crazy one.” And together my parents decided that I needed to be locked up in a state insane asylum, because: “she might become violent some day.”

Projection much?

About a year after my parents put me in the institution a new psychiatrist, Dr. Fenster, was hired to replace the rapist shrink who had been caught and fired the third time he drugged me unconscious and raped me. Lucky Otter posted this story for me almost a year ago. Here is the link: https://luckyottershaven.com/2015/04/12/have-you-ever-been-hurt-by-a-psychiatrist-guest-post-by-alaina-holt-adams/. (I wrote that post under the pen name Alaina Adams. I have since changed my pen name to Linda Lee, because it’s more like the real me.)

I had originally met the newly hired doctor when I was first put in the asylum and he was there, finishing his psychiatric residency. He had told me then that there was nothing mentally wrong with me, in his opinion, and he was confident that the psychiatrist in charge of my ward would soon have me released.

When Dr. Fenster took over my case more than a year later, he was shocked and dismayed to see that I was still there. Within the first five minutes of his first day on the job, the good doctor made me a promise: “I am going to get you out of here as soon as possible. You never should have been put here in the first place!”

But his promise turned out to be much easier said than done. Eight months later, Dr. Fenster called me into his office one last time before sending me out into the world. “I am very sorry that it has taken me so long to get you out of here,” he said. “The amount of legal red tape involved to release a patient from a state hospital is unbelievable, especially when it comes to a minor child. Because you are only sixteen, you are legally a ward of the state and you cannot be released on your own recognizance until you are twenty-one, five years from now! Until then, you can only be released into the care of a responsible adult. I have spoken with every adult in your family several times, at length – with your grandparents on both sides, and your mother and father. I hate to tell you this, but every last one of them is far sicker than you ever were! Frankly, it’s no surprise to me that you had emotional problems. Coming from a hateful, self-centered crew like that, I don’t understand how you can be as sane as you are! Even your maternal grandparents are unbelievably hard-hearted and selfish! At first, I thought they would be the best hope for you to have a decent chance at life. With your grandfather’s current position as the associate warden of Leavenworth Federal Prison, they could so easily provide you with a stable home and every advantage.”

He shook his head sadly. “I hate to tell you this, Linda, but no one in your family wants you. Every single one of them came right out and told me they don’t want a ‘mental patient’ living in their home. It didn’t make any difference when I told them that you are not mentally ill and you never should have been put here in the first place. In fact, when I mentioned that, your mother said that just by virtue of the fact that you have been kept here in this place for so long, you have probably been changed by the experience and now you may be dangerous! So… when I kept hitting a brick wall with everyone in your family, I gave up and tried to find a foster home willing to take you in. But they have to be informed about your time in this institution, and I could not find any foster parents willing to take the chance. I even tried to talk my wife into the two of us fostering you, but… it was a no-go.”

Dr. Fenster stared down at his hands, which were lying palms-up on his desk in an attitude of defeat. “Your mother is coming to take you out of here today,” he said. “although she is the last person I want to send you home with. Why she chose to have so many kids when she doesn’t have a maternal bone in her body is beyond my understanding. But she is coming to get you because – frankly – I found out something about her and I have used it to blackmail her. But even then, she would not agree to take you unless I wrote your discharge paper in such a way that it says you are being sent home on an ‘indefinite leave.’ I’m sorry this isn’t a full discharge. What it means is that your mother can bring you back here at any time, for any reason, or for no reason at all. So my advice to you is to get as far away from everyone in your family as soon as you can – and don’t ever go back!”

A nurse handed me a paper bag full of my threadbare clothes, then escorted me from the doctor’s office down to the lobby. My mother and her mother were waiting there, both with very grim faces. After a tense, silent two-hour car ride to my mother’s house, I discovered that I no longer had a bedroom or a bed – I was told to sleep on the living room sofa. In fact, everything that I had ever owned, my beloved books, the papers I had written, my clothes, my costume jewelry, and the childhood toys I had cherished and saved, were all gone. Taken to the dump, I was told, right after I was put in the mental institution.

My “WELCOME HOME” was nonexistent. Not one person said “I’m glad you’re back, I’ve missed you.” My much younger sisters and brothers had always looked up to me, loved me, and depended on me, especially during our mother’s deep depression after the violent end of our parents’ marriage. Along with my new stepfather, my four little siblings had begged our mother not to send me to the institution two years earlier. Even my grandparents may have questioned why she would send her adolescent daughter to the most notorious insane asylum in the region, when my behavior, to all outward appearances, was completely normal. So then my mother had told horrible projecting lies about me, to justify what she had done. Lies which the majority of my family apparently believe to this day.

Three days after my return “home,” while I was being ultra careful not to be a bother to anyone in any way, my mother waited until my stepfather was at work and my school age siblings were all in school, and then she told me that I needed to leave – to run away – because she could not afford to feed a big grown girl like me.

“I can barely afford to feed the five little ones,” she said. “Your father doesn’t pay nearly enough child support, and it wouldn’t be fair to expect your stepfather to feed you. And after where you have been, I am afraid you might be a bad influence on the younger children. I had you when I was only eighteen, too young to know what I was doing. So I made all my mistakes on you. Unfortunately, it’s too late for you. But I think that throwing one child away, in order to save the other five, is the right thing to do, don’t you? And don’t worry, I promise I won’t call the police and report you as a runaway!” She said this, about not calling the police, with a big smile on her face, as though she had just handed me the keys to a brand new car.

“You know, I married your father when I was sixteen. Sixteen is old enough to be on your own. And, like I’ve been telling you ever since you reached puberty – no house is big enough for two women!”

This happened in the middle of a cold December and there were several inches of snow on the ground. The tiny town where my mother and stepfather had moved to while I was in the institution was miles away from a city, where there might be some kind of shelter or help. Without a penny to my name, with my few clothes bunched up in a pillowcase, because the paper bag I had brought my clothes home from the hospital in, had torn – and I remember feeling guilty for taking one of my mother’s pillow cases, that’s what a “terrible” daughter I was! – I walked out the door into the frozen December morning. I had not eaten any breakfast that day, because no one had offered me anything and I was trying so hard not to be a bother….

Whew. Right now, as I am writing about that terrible time in my life, I feel so ANGRY!

My husband today, a combat veteran from the war in Vietnam, has talked about the pain of coming back from the hell of war and getting rejection, instead of a Welcome Home. I’ve told him I understand how that feels. A few years ago, there was a big push to finally welcome our Vietnam War Veterans home. I’m so glad they got that. They deserve it. But… deep down inside, I feel like I am still waiting for my Welcome Home.

I did not follow Dr. Fenster’s advice to have nothing to do with anyone in my family of origin, until I was in my fifties. Why? Because I loved my family. I wanted to have a family! Although I stopped living in the same state forty years ago, I kept reaching out to them, time and time again, over the years – by driving very long distances to visit them, by phone calls, by letters, and finally, when social media became available, I reached out to them through Facebook.

With the exception of my aunt (my mother’s younger sister) and my oldest niece, every time that I have ever reached out in any way to anyone in my family of origin, I have been hurt and abused all over again. The bullying I took on Facebook was so bad, I ended my account. Even today, every time I see that ubiquitous blue logo, I shudder inside.

WHY does my family of origin despise me so much? Because they apparently believe my mother’s lies about why she “had no choice” but to commit me to an insane asylum almost half a century ago. And anything that I have to say on the subject is suspect because, you know, I must have been really crazy in order to be locked up.

They BREAK you, and then they HATE you for being broken.

Every trauma story is unique. Some people have told me that my trauma story is so extreme, it makes them feel ashamed of having any kind of emotional problems when their trauma is “less” by comparison. But I absolutely do not want anyone who reads this to feel that way! Please!! Pain is pain, trauma is trauma, and – in my experience – THE WORST PAIN OF ALL IS THE PAIN OF BEING REJECTED BY THE PEOPLE WHO ARE SUPPOSED TO LOVE YOU. Not the terrifying episodes of violence, not the rapes, not even being labeled “crazy” and locked up for almost two years in a lunatic asylum, hurts as bad as this!!

If you, like me, have ever been scapegoated, lied about, shunned, and rejected for being so “bad” as to have any kind of emotional or mental problems, then I believe your wounds go just as deep as mine.

Thank you for reading this. Please feel free to share your own story in the comments. And thank you, Lucky Otter, for giving people like me the opportunity to share our mental health struggles with your readers. God bless.

In truth and love, Linda Lee

PS: Today is Easter, the day we Christians celebrate our risen Lord. I believe HE is the reason why I finally got free of the insane asylum, during an era when 97% of the people committed there were never released. (This is what one of the psychiatrists told me right after I got there, when I asked him how soon I could go home.) I was one of the lucky few who got a second chance at life. I think the reason may be because I had given my heart to Christ when I was a little girl. “Weeping may endure for a night, but joy comes in the morning.” Amen!

Is BPD a real disorder or should it be eliminated as a diagnosis?

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The myriad ways experts “see” borderline personality disorder. (click to enlarge)

There’s a great deal of confusion and disagreement in the professional literature about the nature of Borderline Personality Disorder. The blogger BPDTransformation (whose blog is excellent if sometimes a little on the scholarly side), who was cured of BPD, thinks the label should simply be done away with and that BPD doesn’t really exist at all–the label being merely a placeholder for a group of symptoms that are widely variable, and that experts can’t even agree on. He believes BPD is categorized as a Cluster B (dramatic/emotional) disorder only because mental health experts can’t decide where else to put it.

The stigma of BPD as a Cluster B disorder.

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The problem with labeling BPD in the Cluster B category of personality disorders is the stigma that classification carries–that people with BPD (like those with NPD or ASPD) are evil, untrustworthy, selfishly manipulative, grandiose, dishonest, lack empathy, and really no better than people with malignant narcissism or even ASPD. (It sure doesn’t help any that an obviously sociopathic criminal like Jodi Arias has a diagnosis of BPD, when she more likely fits the criteria for high spectrum [malignant] narcissism, at the very least.) Insurance companies assume anyone with a Cluster B disorder is incurable, and therefore will not pay claims where a person is diagnosed with a Cluster B disorder. This is very damaging to those of us with BPD who have either successfully learned to modify and control our symptoms–or have even been cured, as BPDTransformation has been. People continue to believe we are lying about the success of the treatments or therapy we have received. Borderlines who have never been treated may find it difficult to find a therapist willing to work with them.

BPD is far more amenable to deep insight therapy than NPD (which is extremely difficult to cure but not impossible for non-malignants) and light years away from a disorder like ASPD (antisocial personality disorder), which can probably not be cured. Because the symptoms of BPD are so disagreeable to the sufferer (and not just to others), it is common for borderlines to present themselves for therapy, unlike people with NPD or ASPD. The vast majority or borderlines are unhappy with themselves and the way their lives have turned out. But many therapists won’t work with borderlines (other than with behavior modification treatments like DBT) because they know insurance companies will not pay such a claim.

What are borderlines on the border of, anyway?

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The name “borderline” itself is confusing. What are borderlines on the border of anyway? Neurosis and psychosis? A normal sense of self and Narcissism? Mexico and the United States?

The experts are all over the map on this, with some recent theories stating that BPD is actually a less adaptive, more ego-dystonic form of narcissism. But the original term “borderline” actually referred to the belief that the disorder was on the “border” between psychosis and neurosis:

[…]It is called borderline because it was originally thought that people were on the ‘border’ of psychosis and neurosis. BPD is also sometimes called Emotionally Unstable Personality Disorder (Borderline type). Approximately 75% of people given this diagnosis are women and 50% have experienced physical and/or sexual abuse.

Because BPD is more commonly diagnosed in women than in men, it’s also been referred to as the female form of narcissistic personality disorder (which is more commonly diagnosed in men than in women).

Psychotic, neurotic, both, or none of the above?

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Credit: Judgybitch/Dzhokhar Tsarnaev

The reason why BPD is sometimes regarded as the midpoint between neuroses (mild and easily treated anxiety or depressive disorders) and psychoses (disorders where the victim is out of touch with reality, such as schizophrenia and the manic-depressive form of bipolar disorder) is because people with BPD can, when emotionally upset, display psychotic or delusional symptoms such as splitting (black and white thinking), dissociation (feelings of unreality either about the self or the environment), magical thinking, severe paranoia, delusions of grandeur or persecution, and sometimes even hallucinations and disorganized speech or thought. However, for a borderline, these psychotic symptoms don’t last and as soon as the emotional crisis has passed, the borderline’s “sanity” normally returns. Antipsychotic medication can be helpful, but isn’t always necessary, as it usually is for a truly psychotic individual.

Others have speculated that BPD is really a severe form of PTSD or C-PTSD caused by trauma, and should be treated the same way as PTSD. Personally, I think it’s more long-standing than a reactive disorder like PTSD and is a true personality disorder, but it does make sense that BPD may have originally begun as a form of PTSD at an early age, often due to sexual abuse.

There is so much confusion and contradiction in the literature about BPD that I’m slowly coming around to BPDTransformation’s way of thinking that it should possibly be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) until mental health professionals can get a better handle on what BPD actually is, and whether it’s even a valid diagnosis (or simply a group of symptoms that could indicate several other disorders). There should at least be more agreement among the professionals at any rate.

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

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.

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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.

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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.”