The main features of borderline personality disorder (BPD) are a dramatically shifting degree of stability in emotional expressions, relationships, and self-esteem. This combines with a tendency to act impulsively. Those with a narcissistic personality disorder (NPD) are more noted for grandiose or highly self-important behavior and thoughts, a constant need to be admired by others, and a failure to empathize with others. Borderline and narcissistic personality disorder have other differences but also share many traits in common.
NPD and BPD may arise from exceptional damage to self-esteem development in childhood. People with NPD often have a pattern of neglectful parents who could also, in turn, lavish attention. Many of those with BPD are victims of physical or sexual abuse. This impairment in childhood results in very different behaviors in adults with either of these personality disorders.
One of the ways that borderline and narcissistic personality disorder differs is in how they initially present in a clinical setting. The person with BPD is likely to be friendly, cooperative, and willing to share. A client with NPD is likely to spend a great deal of time trying to convince a therapist of his importance, which is usually accomplished with boasting and tall tales. The NPD client also wants to charm the therapist, but tends to spend more time in exaggerated description of his own merits.
When the NPD client can’t elicit the admiration of the therapist, he or she may give up and move on to someone else. This profoundly differs from scenarios that may occur the day the BPD client is disappointed by a therapist. The response could be disproportionate fury, which might include acting out, quitting therapy immediately, or refusing to cooperate. This response is characteristic of borderline personality disorder in most relationships.
A commonality in borderline and narcissistic personality disorder is a history of failed relationships, which differ in quality. Those with BPD usually have intense relationships that finally end because of the other party’s failure. They may attribute this to a pattern, such as: “I always choose the wrong men.” An NPD client is likely to describe many sketchy associations without much depth. These often end when the other party fails to appropriately appreciate the person’s unique qualities.
Individuals with these conditions may also differ in reactions to disappointment. In BPD, actions in response to perceived injury include real suicide attempts, self-injury, and substance abuse. People with NPD may register shock and alarm, but their pattern is to move onto someone else who better appreciates them.
Both borderline and narcissistic personality disorder are marked by intensely poor self-esteem. People with these disorders don’t have a reliable means to feel good about themselves. They look to others to fill their sense of extreme emptiness or inner loathing, and they don’t realize their own behaviors result in being rejected. NPD and BPD sufferers lack the capacity to self-scrutinize, and when problems happen, it is always the fault of other people.
Blaming others for self-generated problems makes these conditions difficult to treat. Adequate treatment may take years, and requires clinicians with strong experience in treating the personality disorders. There are some therapy models that may be most successful with BPD and NPD. These include Object Relations and dialectical behavioral therapy.