Narcissistic Personality Disorder and Borderline Personality

Narcissism

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Narcissistic personality disorder (NPD) is a personality disorder that frequently co-occurs with borderline personality disorder (BPD). The addition of NPD into the diagnostic picture may complicate the treatment and course of BPD.

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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 because it significantly interferes with relationships, occupation, or other important domains in life. Many experts believe that this egotistical style is actually the NPD individual's attempt to deal with an underlying poor sense of self-worth.

Borderline Personality Disorder

Borderline personality disorder (BPD) 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, others, and their interests. Their 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 often experience dissociation. Someone experiencing dissociation can feel like 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 1-800-273-8255 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 are discussed quite often in the popular psychology literature and online, very few careful studies of the co-occurrence of NPD and BPD have been conducted.

One such study found that only about 16% of patients with BPD also meet the diagnostic criteria for NPD.

However, another study that drew from a community (rather than a treatment-seeking) sample found that almost 39% of people with BPD also have NPD.

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 have been described as very 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, in fact, cause more emotional pain to others than they cause themselves. So, their motivation to change their behavior may be very low.

Research does suggest that people with both NPD and BPD are less likely to have their BPD symptoms get better 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 individuals with non-remitting BPD and higher rates of NPD.

Relationships and NPD and BPD

The relationships of individuals with BPD are often quite dysfunctional. However, adding NPD into the mix can create even more disordered conditions.

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.

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 this disorder.

The clinical literature, in general, tends to regard NPD as a largely untreatable condition, particularly in its most severe forms.

Some people believe that because there is some overlap between NPD and BPD symptoms (such as impulsivity and destructive behaviors), treatments designed for BPD like dialectical behavior therapy (DBT) may also work with NPD. However, this remains to be seen, and more research on the topic is sorely needed.

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5 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 ed. Washington, DC: American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596

  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. 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

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