Borderline Personality Disorder and Narcissism

Narcissism

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Borderline personality disorder and narcissism (more accurately, narcissistic personality disorder, or NPD) are both personality disorders. When the two occur together, symptoms of each may worsen. It may be more challenging to diagnose and treat the conditions. But it's possible that treating BPD (borderline personality disorder) may help alleviate some of the symptoms of NPD.

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How to Identify a Malignant Narcissist

Narcissistic Personality Disorder (NPD)

Narcissistic personality disorder (NPD) is one of 10 personality disorders recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). NPD is one of the "Cluster B", or dramatic/erratic, personality disorders.

Narcissistic personality disorder is characterized by the presence of five or more of the following symptoms:

  • A sense of entitlement
  • An inflated sense of self-importance
  • Arrogant, egotistical, or haughty behavior
  • Envious of others or believes others are envious of them
  • Lack of empathy
  • Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love
  • Requiring excessive admiration
  • Taking advantage of others
  • Believing that they are "special" and can only be understood by other special or high-status people

In short, people with NPD might be described as being very self-absorbed or egotistical. This self-absorption rises to the level of a clinical disorder when it significantly interferes with the person's relationships, job, or other important domains in life. Many experts believe that this egotistical style is actually an attempt to deal with an underlying poor sense of self-worth.

Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is also a Cluster B personality disorder. It is characterized by consistent changes in behavior, mood, and self-image. Episodes of anger, depression, and anxiety lasting up to a few days are common for people with BPD.

People with BPD frequently change their opinion of themselves and others and their interests. Drastic changes in opinion often lead to tumultuous or unstable relationships with others. Other symptoms of BPD include:

Especially during times of stress, people with BPD can experience dissociation. Someone experiencing dissociation can feel like they don't have a sense of self or identity. They can feel detached from their emotions, memories, and thoughts. They can also experience significant memory loss of times in their life, people, and events.

If you or someone you care about is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

How Often NPD and BPD Co-Occur

While the overlap between NPD and BPD is discussed often in the popular psychology literature and online, very few careful studies of the co-occurrence of NPD and BPD have been conducted. One older study reported that almost 39% of people with BPD also have NPD.

A 2018 study that drew from a treatment-seeking sample rather than a community sample found that about 13% of patients with BPD also meet the diagnostic criteria for NPD.

Another 2018 study showed a strong correlation between BPD and a certain type of narcissism: vulnerable narcissism, which is characterized by hypersensitivity, defensiveness, and low self-esteem. The same study also found that male patients had higher narcissistic scores than female patients. But its sample size was small (65 people).

How NPD Affects BPD

There are a number of theoretical reasons to believe that someone with both NPD and BPD would be less likely to get better over time. People with NPD can be resistant to treatment, and often have poor insight into the ways that their behaviors are detrimental to themselves or others.

Also, people with NPD may cause more emotional pain to others than they cause themselves. This can mean that their motivation to change their behavior is very low.

Research supports the theory that when people have both borderline personality disorder and narcissism, their BPD symptoms are less likely to improve over time.

One study that followed BPD patients over six years found that rates of co-occurring NPD were fairly low, about 6%, in patients whose BPD eventually went away (remitted).

However, rates of co-occurring NPD were higher (around 19%) in patients whose BPD did not remit after six years. So there is a subset of people with non-remitting BPD and higher rates of NPD.

NPD and BPD in Relationships

The relationships of people with BPD are often quite dysfunctional. Adding NPD into the mix can create even more disordered conditions. One study notes, for example, that as the severity of NPD increases, so does aggression (directed at oneself or others) and difficulty with interpersonal behavior and moral functioning.

In addition to the chaotic emotional life and fears of abandonment associated with BPD, a person with co-occurring NPD may also take advantage of or manipulate others while having little empathy for others' concerns. This combination can be incredibly destructive in relationships.

If you are in a relationship with someone who has BPD, NPD, or both, encourage them to seek treatment. Individual therapy for each partner, along with couples' therapy, may help you both cope with the symptoms of personality disorders that make relationships difficult.

Treatment for NPD and BPD

There are currently no empirically supported treatments for NPD and no published clinical trials of treatments for NPD alone or co-occurring with BPD.

Published research on the treatment of NPD is limited to some case studies or anecdotal accounts, but these types of studies tend to be unreliable and subject to bias. The case study literature on the treatment of NPD has primarily centered around the use of modified psychoanalytic techniques and has recognized the challenges of successfully treating the disorder.

The clinical literature, in general, tends to regard NPD as very difficult to treat, particularly in its most severe forms.

Some researchers suggest that because there is some overlap between NPD and BPD symptoms (such as impulsivity and destructive behaviors), treatments designed for BPD, including dialectical behavior therapy (DBT), mentalization-based therapy, schema-focused therapy, and transference-based psychotherapy, may also work with NPD. However, more research on the topic is needed.

A Word From Verywell

Personality disorders, including borderline personality disorder and narcissistic personality disorder, can be difficult to cope with. Co-existing personality disorders or other psychological conditions make diagnosis and treatment more complicated. However, there are some therapies that can be effective. If you are living with NPD or BPD, or have a loved one who is, seek support to help manage the condition and its effects on both of you.

Frequently Asked Questions

  • What is the difference between borderline personality disorder and narcissism?

    Both borderline personality disorder (BPD) and narcissistic personality disorder (NPD) are cluster B personality disorders, meaning they share some characteristics. Both involve dramatic, overly emotional, or unpredictable thinking or behaviors.

    People with both types of disorders may have very low self-worth. But in NPD, that leads to egotistical behavior and a lack of empathy. In BPD, anger may be turned inward, resulting in frequent changes in behavior and mood.

  • What is a borderline narcissist?

    "Borderline narcissist" is not a diagnosis. It may be used informally to refer to someone with borderline personality disorder (BPD) who also has narcissistic personality disorder (NPD). Or, it may refer to someone who has some symptoms of NPD, but not enough for a diagnosis.

  • Is narcissism a symptom of BPD?

    Narcissism is not a symptom of BPD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, as many as 40% of people with BPD may also have narcissistic personality disorder, so people with BPD may also show signs of narcissism.

11 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association.

  2. National Institute of Mental Health. Borderline personality disorder.

  3. National Alliance on Mental Illness. Dissociative disorders.

  4. Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533-545. doi:10.4088/jcp.v69n0404

  5. Hörz-Sagstetter S, Diamond D, Clarkin JF, et al. Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder. J Pers Disord. 2018;32(4):562-575. doi:10.1521/pedi_2017_31_306

  6. Euler S, Stöbi D, Sowislo J, et al. Grandiose and vulnerable narcissism in borderline personality disorder. Psychopathology. 2018;51(2):110-121. doi:10.1159/000486601

  7. Zanarini MC, Frankenburg FR, Vujanovic AA, Hennen J, Reich DB, Silk KR. Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission. Acta Psychiatr Scand. 2004;110(6):416-420. doi:10.1111/j.1600-0447.2004.00362.x

  8. Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: Diagnostic and clinical challenges. AJP. 2015;172(5):415-422. doi:10.1176/appi.ajp.2014.14060723

  9. Dimaggio G. Treatment principles for pathological narcissism and narcissistic personality disorder. J Psychother Integr. 2021. doi:10.1037/int0000263

  10. Dieckmann E, Behary W. Schema therapy: An approach for treating narcissistic personality disorder. Fortschr Neurol Psychiatr. 2015;83(08):463-478. doi:10.1055/s-0035-1553484

  11. Volkert J, Gablonski TC, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: Systematic review and meta-analysisBr J Psychiatry. 2018;213(6):709-715. doi:10.1192/bjp.2018.202