Understanding Differences Narcissistic Personality Disorder vs. Borderline Personality Disorder

When you hear the word “narcissist,” what images come to mind? In my world, “narcissist” is a term that’s both overused and misunderstood. In common vernacular, it can be inflammatory and insulting, but in medical circles, Narcissistic Personality Disorder (NPD) is a real diagnosis with real impacts on the sufferers, their families, and their friends. The good news is that it’s treatable.

NPD is a complex mental health condition characterized by an inflated sense of self-importance, a need for excessive attention and admiration, and a lack of empathy. People with this diagnosis also display unhealthy emotional patterns that may include a sense of grandiosity, entitlement, and preoccupation with fantasies of unlimited success, power, brilliance, and ideal love.

The Diagnostic and Statistical Manual of the American Psychiatric Association, 5^th Edition (DSM-5) places NPD in the Cluster B Personality Disorders category. Left untreated, NPD can lead to significant challenges in relationships and work.

Understanding NPD requires moving beyond common misconceptions and stereotypes. Myths about narcissism result from a lack of knowledge – leading to stigma, misunderstanding, inadequate support, unfair treatment, and prolonging the time they and those close to them have to live with the adverse consequences of an untreated medical condition.

Narcissistic Personality Disorder – a Deeper Dive

NPD is a condition that goes beyond slightly exaggerated self-confidence or occasional self-centeredness. The DSM-5 defines NPD as a person having a grandiose sense of self-importance, exaggerating achievements and talents, and expecting to be recognized as superior even without commensurate achievements. Individuals with this diagnosis can also exhibit a preoccupation with fantasies of success, power, beauty, and idealization.

Mental health professionals look for a combination of behaviors and attitudes before assigning an NPD diagnosis, such as:

• an exaggerated sense of one’s own importance;
• indulging in fantasies of great success, power, brilliance, or beauty;
• establishing relationships with high-status or prominent people;
• arrogance and haughtiness towards others, or
• grandiose expectations of recognition and praise far beyond what they deserve.

These traits are deeply ingrained in NPD sufferers, consistently influencing their behavior and interactions with others. They help to mask their fragile self-esteem, which is highly dependent on external validation.

A lack of empathy opens another window to understanding the narcissist. They find it difficult, if not impossible, to understand or relate to the emotions and experiences of others. This lack of empathy often comes with a lack of accountability and a transactional approach to relationships.

Despite their outward display of confidence, individuals with NPD are highly sensitive to criticism and perceived slights. They may react angrily or go to great lengths to avoid or discredit any perceived sources of criticism. They may appear charming and charismatic, but these social skills are deployed to gain approval and admiration, rendering personal relationships to a superficial and transactional status. They may become envious of others’ successes, where competitive and resentful behavior places a strain on relationships.

Like many psychological disorders, narcissism is a spectrum disorder. It can range from healthy self-belief to pathological narcissism. At the mild end of this spectrum lies what can be termed ‘healthy self-belief.’ This involves a balanced sense of self-worth and confidence. People who possess this are capable of empathy, can form meaningful relationships, and can handle criticism constructively.

Narcissism can be considered a spectrum disorder, ranging from healthy self-confidence to pathological narcissism. On the lower end, people can have a balanced sense of self-worth, develop meaningful relationships, and accept constructive criticism. Moving further along the spectrum, symptoms may be noticeable but not debilitating. Individuals with subclinical narcissism may exhibit self-centered behaviors and a desire for admiration.

NPD sits at the pathological end of the spectrum, and behaviors associated with it reflect a profound dysfunction that affects one’s ability to maintain healthy relationships and to function effectively in society.

Finally, at the extreme end of the spectrum lies malignant narcissism. This is a severe form of narcissism that combines the traits of NPD with antisocial behaviors, paranoia, and aggression. Malignant narcissism is characterized by a profound lack of empathy, a propensity for cruelty, and a willingness to harm others without remorse.

Understanding Differences Between Narcissistic Personality Disorder and Borderline Personality Disorder

There is also an important distinction to be drawn between NPD and Borderline Personality Disorder (BPD). Both are Cluster B personality disorders; however, they have distinct characteristics and should not be confused with one another.

As we have discussed, NPD is primarily characterized by grandiosity, a lack of empathy, and a need for admiration. Individuals with NPD view themselves as superior to others and may exploit relationships to achieve their own ends. Conversely, BPD is marked by emotional instability in relationships and within their own self-image. Individuals with BPD experience intense emotional fluctuations, fear of abandonment, and difficulty maintaining stable relationships.

There is a contrast when assessing emotional responses as well. Those suffering from NPD may display superficial charm and self-assurance but are prone to feelings of anger or rage when their sense of superiority is threatened. In contrast, individuals with BPD often exhibit intense emotional reactions and mood swings, including periods of depression and anxiety. These may be heightened when there is perceived rejection or abandonment.

A final key difference can be viewed through the prism of relationships. NPD-influenced relationships tend to be one-sided, with individuals seeking admiration and control. BPD-influenced relationships are often tumultuous, with a pattern of intense and unstable interactions.

Dispelling Myths About Narcissistic Personality Disorder

By debunking common myths about NPD, we can remove bias and unfair generalizations from the conversation about this disorder. Some of the most common are listed below.

• Myth: Narcissists are Just Self-Centered or Egotistical – a common misconception about NPD is that it is simply an exaggerated form of self-centeredness or egotism. This characterization oversimplifies the complexities of the disorder. NPD involves pervasive patterns of behavior that deeply affect an individual’s interactions, self-perception, and emotional regulation.
• Myth: Narcissists are Always Successful and Charismatic – while some people with NPD can be outwardly charming and may achieve success in certain areas, this is not universally true. NPD can manifest in a variety of ways, and not all individuals with the disorder exhibit the charm and success often associated with narcissism. Many struggle with interpersonal relationships, work instability, and emotional turmoil.
• Myth: Narcissism is Incurable and Untreatable – this misconception stems from the belief that individuals with NPD are incapable of change due to their lack of empathy and resistance to acknowledging their flaws. However, while NPD presents significant treatment challenges, it is not beyond the reach of effective therapy.

Psychotherapeutic approaches, particularly those focusing on long-term behavioral changes and emotional regulation, have been shown to help individuals with NPD. These options are discussed in more depth below.

Causes and Risk Factors Associated with Narcissistic Personality Disorder

NPD can affect anyone, but certain segments of the population are more likely to be affected based on their physical attributes (genetics) or life experiences.

Certain genetic predispositions could make an individual more vulnerable to developing personality disorders, including NPD. While not determinative on its own, this link suggests that genetic factors play a role in who gets diagnosed with NPD.

Childhood is an essential time for laying out healthy emotional patterns and behaviors. Trauma, neglect, and inconsistent or excessively critical parenting can significantly impact a child’s emotional development. A child’s experiences of excessive praise or criticism, or parents who exhibit narcissistic traits and behaviors, can lead to an unhealthy sense of self-importance or a profound lack of self-esteem. These may be precursors and lead to the development of narcissistic traits as a form of psychological defense.

While we can’t say with certainty what causes NPD, we can say with confidence that the condition is treatable.

Treatment Options and Approaches for Narcissistic Personality Disorder

Psychotherapy remains the gold standard for treating NPD. Cognitive-behavioral therapy (CBT) is often employed to help individuals with NPD recognize and alter maladaptive thought patterns and behaviors. This approach focuses on challenging grandiose thinking and improving empathy. Dialectical behavior therapy (DBT) is also effective, particularly in teaching skills for emotional regulation, distress tolerance, and interpersonal effectiveness.

Prescription medication administered in partnership with a healthcare professional who can monitor, gauge, and adjust it as needed can be beneficial for managing conditions such as depression, anxiety, or mood disorders that appear alongside NPD. These medications can also clear a path for a more effective therapeutic intervention.

Finally, the importance of support networks and access to resources play a critical role in the treatment and recovery of individuals with NPD. Supportive relationships with family, friends, and peers can provide stability and encouragement, fostering an environment conducive to positive change. Where these relationships are lacking or are a contributing factor to ongoing NPD, self-help groups can offer essential support.

Key Takeaways

Narcissistic personality disorder (NPD) is a medical condition, and it is treatable. The hope is that after reading this blog, you will have a better understanding of NPD, how it is defined, how it manifests, and how it can be treated.

Perhaps the most crucial point is the understanding that individuals with NPD need those around them to approach them with empathy and a willingness to understand their struggles. There is no doubt that the behaviors that come with NPD can be challenging. But hopefully, you can now appreciate how individuals with NPD often grapple with deep-seated insecurities and a fragile sense of self.

A powerful stigma, unhelpful labeling, misunderstanding, and prejudice by those who don’t understand NPD keep people from seeking help and receiving appropriate support. By educating ourselves and others about the nuances of personality disorders, we can foster a culture of acceptance and openness, encouraging those affected to seek the help they need.

Promoting mental health awareness not only benefits individuals with personality disorders but also enhances our collective ability to support one another in navigating the complexities of mental health challenges. In doing so, we pave the way for a more compassionate and informed society where everyone has the opportunity to thrive.

We believe in the resilience of the human spirit, and that survivors deserve to come out of the fog into the light. The goals of Scars to STARs (Survivors of Toxic Abusive Relationships) and TAR Network™ include helping survivors to find awareness, transformation, and self-love; both aim to educate, empower, and energize people as they reclaim their sense of self-worth, rebuild their lives, and emerge stronger than ever. Our international programs are here to support you every step of the way, while breaking the chains of transgenerational trauma.

TAR Anon™ is a global fellowship dedicated to supporting STARs (Survivors of Toxic Abusive Relationships). As a program of the TAR Network, a 501(c)(3) global charity, TAR Anon provides a safe and supportive community for people affected by narcissistic abuse, trauma, and Complex Post-Traumatic Stress Disorder (CPTSD), and caregivers in high-conflict situations.