What is borderline personality disorder? What is a Narcissistic Personality Disorder? Perhaps you have a boss, friend, relative, or partner that suffers from one of these disorders. Learn how to best support borderline personality disorder relationships in a loving and caring.

Borderline personality disorder and Narcisst Personality Disorder

What is borderline personality disorder and Narcissist Personality Disorder?

Family Psychotherapist Dr. Margalis Fjelstad describes Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD) as having a “highly sensitive” emotional system that fosters rapid, intense reactions to experiences. Because of this reactivity, change is often hard for people who have BPD and NPD. Most individuals with a healthy self-esteem learn how to develop autonomy and deal with social interactions. BPD and NPD, however, are incapable of processing information about the world in such an orderly fashion.

Margalis has found that “highly sensitive” children who experience  traumatic events (e.g.-sexual, verbal, or physical abuse) or abandonment due to non-responsive or invalidating parents will most likely fail to develop a fully matured, adult personality. Instead, they seem to get “stuck” or impaired at fairly early levels of emotional development, usually around 18 to 24 months of age. Although they may acquire the mental content, vocabulary, and experiences of an adult, their ability to process complex and personal relationships won’t develop beyond early childhood levels.

VIDEO:

0:35 Margalis Fjelstad talks about how her work as a family psychotherapist started her research into Borderline Personality Disorder and Narcissism.

1:12 What is Borderline Personality Disorder?

Diagnosing BorDERline personality disorder and Narcisst Personality Disorder

What is the difference between Borderline Personality Disorder and Narcissist Personality Disorder?

Dr. Fjelstad observes that these two disorders share many similarities and some obvious differences. They are both serious mental illnesses and have a profound impact on the family members as well. Here are differences described in Dr. Margalis Fjelstad’s book: “Stop Caretaking the Borderline or Narcissist: How to End the Drama and Get On with Life:

“The NP and the BP present themselves to the world in opposite ways, as the light and the dark, the charming and the hostile, the positive and the negative of each other. They appear rather like a pair of opposites on the outside. The Borderline acts emotionally more negative, less social, less predictable and more dependent. The Narcissist acts more friendly, outgoing, outrageously optimistic, fantastically competent and in control. However, these two external personality patterns really have a similar internal sense of: Low self-esteem, fear, anxiety, paranoia, and deep emotional pain from a sense of “not feeling good enough”. Both will also go to extremes to protect their emotional vulnerability. Most importantly, both use many of the same defense mechanisms: Blaming, Projection, Devaluing, Idealization, Splitting, Denial, Distortion, Rationalization, and Passive-Aggressiveness. Narcissists also use Omnipotence, whereas Borderlines will use Acting Out. Sometimes these defense mechanisms can reach delusional or psychotic levels.

Because of these internal emotional similarities and their similar use of defense mechanisms in interpersonal and intimate relationships, close family members who deal with the Borderline or Narcissist (BP/NP) will see many similar behaviors. The fears and needs of both are very much alike. They both need a Caretaker to provide extensive validation, to let them have control over the relationship, to give then an unending amount of attention, and to reassure them that they and the Caretaker have the same thoughts, feelings and beliefs.”

Source: Fjelstad, M. (2013). Stop caretaking the borderline or narcissist: How to end the drama and get on with life. Lanham: Rowman & Littlefield.

VIDEO

18:14 How is Narcissism related to Borderline Personality Disorder? Narcissists have a false facade that they build over Borderline Personality disorders.

Borderline personality disorder symptoms, tests, criteria, traits, signs, SYMPTOMS

According to the National Alliance on Mental Illness, there is no single medical test to diagnose BPD. In fact, mental health professionals generally diagnose based on a person exhibiting at least 5 to 9 of the symptoms listed below. As with all personality disorders, the person must be at least 18 years old before they are properly diagnosed..

The below section on symptoms is taken from “Stop Caretaking the Borderline or Narcissist: How to End the Drama and Get On with Life:

“The term Borderline Personality Disorder came into use to describe ongoing, long-lasting dysfunctional behaviors in people who did not have a full-blown psychosis, such as schizophrenia, but who also were significantly more dysfunctional than people with problems of anxiety and depression. The Borderline Personality Disorder is described by the DSMIV as a “Pervasive pattern of instability of interpersonal relationships, self-image and affects or moods, and marked impulsivity, beginning by early adulthood and present in a variety of contexts…” including at least 5 of the following: [i]

1. Frantic efforts to avoid real or imagined abandonment. Persons with Borderline disorder (BP) may not be willing or able to do much of anything alone. The BP can become frantic over events such as having lunch alone or having to be at home alone at night. The BP may drink, call loved ones dozens of times an hour, go out and pick up a stranger for sex, have crying fits, cut themselves, etc. to avoid being alone. The more dramatic, intense and self-destructive the BP’s behaviors usually the more dysfunctional the person is.
2. A pattern of unstable and intense interpersonal relationships. This refers to the pattern of the BP going from intense love and adoration to intense hate, rage and anger over and over in love relationships. They are known for being happy one minute and threatening divorce a few minutes later. They break up with loved ones only to get back together and break up over and over.
3. Unstable self-image or sense of self. The BP may not believe s/he exists in the mind of others unless the other person is in direct contact and giving direct feedback to the BP. The BP can receive a loving comment and in the same conversation state she believes she is not loved or even thought well of by the other person. The BP alternately sees himself as all good or all bad, superior or inferior, caring and hateful. They find it hard to hold in mind different feelings and different qualities of personality together at the same time.
4. Impulsivity. Because the Borderline person (BP) has strong, wildly fluctuating emotions, which are extremely intense, they often act impulsively and may respond suddenly with extremely negative or extremely positive emotions. He may throw things, walk out of an anniversary dinner, shout profanities in public, or send dozens of red roses and propose to a new love he’s just met a few hours earlier. Often the BP responds quite differently to the same situation at different times. This makes it very hard to predict how a BP may act in any given moment.
5. Recurrent suicidal behavior, gestures or threats of self-mutilation. The BP’s emotional reactions to disappointment, loss, fear, anxiety or abandonment can be extreme. She can believe that the current feeling will, literally, never go away, so suicide can seem to be the only answer. Cutting or burning herself with cigarettes may be used by the BP to decrease her awareness of her emotional pain by focusing on a concrete physical pain.
6. Mood instability, reactivity, depression, anxiety, rage and despair. This is a hallmark of BPD. The BP is extremely vulnerable to falling into negative moods in an instant and is usually very fast to change moods, sometimes within seconds or minutes, and these emotions can fluctuate quickly back and forth. These emotions are often extremely strong, and the BP is at a loss as to how to handle them alone.
7. Chronic feelings of emptiness. The BP may feel invisible and often does not believe anyone remembers her when she is not in that person’s presence. She may expect others to not think about her when she is gone, but at the same time, may be enraged by not have her needs anticipated. She may have no sense of who she is, what she wants in life, or what her skills, values or beliefs are, but she may also expect a loved one to know these things for her.
8. Inappropriate intense anger or difficulty controlling anger. The intensity of the BP’s anger can be shocking to others around him. The BP may act physically abusive, striking out by hitting, throwing things, screaming, threatening harm, or in extreme cases, killing the loved one. He can also act in emotionally abusive ways through blaming, put downs, impossible demands, and ultimatums. The BP cannot seem to let go of such intense anger even with the attention of a loved one. If the BP feels an emotion, whatever it is, that feeling is absolutely true to the BP and cannot be changed by logic. Because the BP cannot figure out how the emotion came about, s/he usually blames someone else for causing the feeling.
9. Transient, stress-related paranoid ideas or severe dissociative symptoms. This is the most confusing symptom demonstrated by the BP. The BP can instantaneously change from seeing a loved one as precious and supportive person to seeing the same loved one as a threatening enemy. As a result, the BP can say things and act toward her spouse and child in ways that she would only do to her worst, most hated enemy. In addition, the BP typically forgets what he said and did a few hours or a day later, and he almost never understands the emotional impact of his outburst on his loved ones. While the hurtful words and actions still sting in the other person, the BP sees no reason to apologize or even discuss what happened, because as far as the BP is concerned it never even happened or it is all in the past.

BPD is difficult to identify, because many of the above behaviors are ones that anyone could have on occasion, especially under stress. For the Borderline person (BP), however, it is more a difference of intensity, frequency and choice. In the BP these behaviors can occur several times a week, several times a day or even several times an hour. They can be shockingly sudden and intense, and they don’t seem to be entirely under the control of the BP. Situations which are not particularly stressful for an emotionally healthy person can be overwhelming to the BP. The BP’s upset often seems to come “out of the blue. It is also important to remember that no two BP’s act completely alike.”

Source: Fjelstad, M. (2013). Stop caretaking the borderline or narcissist: How to end the drama and get on with life. Lanham: Rowman & Littlefield.

VIDEO:

3:44 What are the Borderline Symptoms? Margalis discuss how a psychotherapist diagnoses borderline personality disorder.

7:31  How often does a person with Borderline Personality Disorder experience these symptoms?

Who gets borderline personality disorder? How does it change with age?

National Alliance on Mental Illness estimates that 1.6% of the adult U.S. population has BPD but it may be as high as 5.9%. Nearly 75% of people diagnosed with BPD are women. However, recent research suggests that men may be almost as frequently affected by BPD. In the past, men with BPD were often misdiagnosed with PTSD or depression.  – See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder#sthash.BqZuMR0d.dpuf:

“Like most personality disorders, BPD will typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.” source: http://psychcentral.com/disorders/borderline-personality-disorder-symptoms/

VIDEO:

13:29 Who gets Borderline Personality Disorder? How does it change with age?

20:39 How does Borderline Personality Disorder show up from childhood, teenage, and adulthood years?

23:53 What is the intention behind cutting?

Borderline personality disorder causes

The causes of borderline personality disorder are not fully understood, but scientists agree that it is the result of a combination of factors (source: NAMI.com):

• Genetics. While no specific gene has been shown to directly cause BPD, studies in twins suggest this illness has strong hereditary links. BPD is about five times more common among people who have a first-degree relative with the disorder.
• Environmental factors. People who experience traumatic life events, such as physical or sexual abuse during childhood or neglect and separation from parents, are at an increased risk of developing BPD.
• Brain function. The way the brain works is often different in people with BPD, suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions of the brain that control emotions and decision-making/judgment may not communicate well with one another.

– See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder#sthash.BqZuMR0d.dpuf

What is the course of Borderline Personality Disorder?

There is considerable variability in the course of Borderline Personality Disorder. The most common pattern is one of chronic instability in early adulthood, with episodes of serious loss of emotion and impulsive control, as well as high levels of use of health and mental health resources. The impairment from the disorder and the risk of suicide are greatest in the young-adult years and gradually wane with advancing age. During their 30s and 40s, the majority of individuals with this disorder attain greater stability in their relationships and job functioning.

Is Borderline Personality Disorder inherited?

Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders (e.g., drug abuse), Antisocial Personality Disorder, and Mood Disorders, like depression or bipolar disorder.

Related Conditions

BPD can be difficult to diagnose and treat—and successful treatment includes addressing any other disorders somebody might have. A person with BPD may have additional conditions like:

Anxiety disorders, such as PTSD.

Bipolar disorder.

Depression.

Eating disorders, notably bulimia nervosa.

Other personality disorders.

Substance use disorders.

– See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder#sthash.BqZuMR0d.dpuf

VIDEO:

14:31 How is Borderline related to other disorders?

25:55 How does Borderline Personality Disorder differ from Bipolar Disorder?

Borderline personality disorder treatment?

Nonetheless, we have needed more ideas for treating BPD. Dialectical Behavior Therapy, as effective as it is, sometimes fails to improve life satisfaction and quality of life as much as one would hope. And in the past few years, new treatment ideas have begun to emerge. These include:

• Mentalization-Based Therapy (MBT)
• Transference-Focused Psychotherapy (TFP)
• Schema Therapy (ST)
• Cognitive Behavioral Therapy (CBT) tailored specifically to BPD

Treatment

A typical, well-rounded treatment plan includes psychotherapy, medications and group, peer and family support. The overarching goal is for someone with BPD to increasingly self-direct her treatment plan as a person learns what works as well as what doesn’t.

• Psychotherapy, such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT) and psychodynamic psychotherapy, is the first line of choice for BPD.
• Medications are often instrumental to a treatment plan, but there is no one medication specifically made to treat the core symptoms of emptiness, abandonment and identity disturbance. Rather, several medications can be used off-label to treat the remaining symptoms. For example, mood stabilizers and antidepressants help with mood swings and dysphoria. Antipsychotic medication may help control symptoms of rage and disorganized thinking.
• Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety.

• – See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder#sthash.BqZuMR0d.dpuf

VIDEO:

16:01 Borderline Personality Disorder Treatment?  Are there medications that work well? How does psychotherapy work?

Recovery:

http://www.borderlinepersonalitydisorder.com/presidents-blog/800-attend-israel-conference/

Narcisstic Personality Disorder: Symptoms, tests, criteria, traits, signs, SYMPTOMS

The below section on symptoms is taken from “Stop Caretaking the Borderline or Narcissist: How to End the Drama and Get On with Life:

“You may be more familiar with the personality pattern of Narcissism. Narcissism has come into the popular vocabulary, but only part of the personality behavior pattern is usually observed. The flamboyant, selfish behaviors are the ones most people see and identify as narcissistic. The DSM IV describes the person with NPD as having: An increased sense of importance, Preoccupations with fantasies of success, wealth, beauty, talent,            A strong sense of being unique and special, A sense of entitlement to being treated better than others, Exploitation of others, Unwilling or unable to notice or understand other’s feelings, Envy and arrogance.

These behaviors are pretty well known. The part of the pattern that is usually not known by most people is the hidden, self loathing, fear of rejection, and inner anxiety of the Narcissist. Narcissists are people with two different self esteems. There is a False Sense of Self, i.e. a pretend self that is extremely positive and desirable, and the hidden Real Self underneath the façade that is fearful and anxious.[ii] “

Source: Fjelstad, M. (2013). Stop caretaking the borderline or narcissist: How to end the drama and get on with life. Lanham: Rowman & Littlefield.

VIDEO:

19:14 When do traits of a Narcissistic Personality Disorder begin to show?

Borderline personality disorder relationships/ Narcissist PErsonality RElationships

Role Playing: Setting Boundaries

Margalis shares the strategy and language you should use to set Boundaries and Limits – Take Action and Discussion; Be firm and Reassure; Ignore Provocative Behavior. Talking about the situation doesn’t make it better. Use Repetition.

Borderline or Narcissist Personality Disorder at Work

VIDEO: 24:44 How do you know if your boss has Borderline Personality Disorder or Narcissist?

Relating to a Parent, Child, or Loved One who has Borderline Personality Disorder

VIDEO:

28:02 How do you work with a parent or family member that is Borderline?

30:13  What are some strategies and wording to try when working with a loved one that has Borderline Personality Disorder?

31:08 Techniques to try when someone who is emotionally sensitive (Role Play).

[i] Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed., [Washington, D.C.: American Psychiatric Association, 1994] , 633, 650-654.

[ii] Johnson, S., Character Styles, [New York: W.W. Norton, 1994], 171.

About Margalis Fjelstad -Licensed Marriage and Family Therapist

People with Borderline or Narcissistic Personality Disorders are master manipulators; Caretakers fall for them every time.  This book helps Caretakers break the cycle and puts you on a new path of personal freedom, discovery, and self-awareness, through the use of real stories and practical suggestions.

As a seasoned therapist, Margalis Fjelstad brings insight, compassion and good advice to people who have become Caretakers to a Borderline or Narcissist.  She shares techniques to neutralize crazy-making rules, set limits and boundaries, and stop the pattern of victim, persecutor and rescuer.