This article will explore both conditions, examine the potential environmental causes, discuss why they can be drawn together, and what can happen when they do. It’s important to remember each person, their condition, and their relationship is unique – this article is a broad overview.

Understanding Borderline Personality Disorder

The DSM -1V defines Borderline Personality Disorder (BPD) as a ‘pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity’. Some of the more common symptoms include:

• Dysfunctional interpersonal relationships
• Instability in mood
• Dysphoria
• Self-injurious behaviour
• Fear of abandonment
• Maladaptive coping behaviours^[1]
• Impaired occupational functioning^[2]

One of the easiest ways of understanding BPD is to consider people with the condition as having difficulty returning to their emotional baseline.

While people without BPD might see something that annoys them, get slightly angry about it, and move past it, this could provoke a huge, long-lasting emotional reaction in those with BPD. In the same way, if something good happens, people with BPD might feel ecstatically happy for much longer than someone else might. To friends, families, and loved ones, these huge emotional peaks and troughs can be difficult to deal with and cause relationship problems.

The precise cause of BPD is still a grey area – like many mental health conditions, it’s thought that it can arise from a combination of historical, genetic, and environmental factors, including:

• Childhood abuse (in particular, severe and sustained abuse)^[3]
• Neglect
• Genetics
• Separation from loved ones

Understanding Narcissistic Personality Disorder

According to research, narcissism usually starts to develop at around the ages of seven or eight – at the time when we start to assess ourselves based on our perception of others. The core belief of all narcissism is the belief that the person with the condition is somehow superior to others.

Narcissism is thought to be caused by a combination of genetic and environmental factors. If we’re brought up with parents that over-exaggerate our good qualities and achievements while only superficially engaging with us, it puts us at risk of developing Narcissistic Personality Disorder (NPD). On one level, we’re being told that we’re better than other people, while on another, we’re getting the conflicted message that we’re not worth having a meaningful relationship with.

It’s thought that narcissism occurs on a spectrum – people can have narcissistic traits or be clinically diagnosed with Narcissistic Personality Disorder. Common symptoms of the latter are:

• Being self-centred
• Feelings of grandiosity
• Being willing to exploit others to get what they want
• An overwhelming need to be admired
• A severe lack of empathy
• A desire for control^[4]

What Happens in a Relationship Between Someone With BPD and Someone With NPD?

Relationships between people with BPD and NPD can help each party fulfil their needs – albeit in an unhealthy manner. For the BPD sufferer, they see everything they can’t do in the narcissist – it’s someone who appears confident and self-assured. They can feel like the perfect counterbalance to their own insecurities, and this is amplified by the emotional dysregulation of BPD.

When the person with NPD meets someone with BPD, they can tend to use them to fulfil their need for validation, often at the expense of the BPD sufferer’s boundaries and feelings. This insatiable need for attention coupled with the heightened emotions of BPD to make a volatile mix. If the person with NPD’s needs aren’t met, they can often turn cold and distant, shunning the person with BPD and triggering their fear of abandonment.

However, the party with BPD isn’t always the victim. In certain instances, their extreme behaviour can push the person with NPD so far that they decide to move on and get their needs met by someone else. If the person with BPD pursues them after this, it can play into the person with NPD’s desire for attention and control.

Point To Remember

It’s important to remember that although the behaviours of both parties in this relationship have the capacity to cause pain and discomfort, it’s not done with malice. As distasteful as they may seem, they’re simply pursuing a maladaptive approach (often learned in childhood)^[5] to get their needs met.

However, in the context of a BPD/NPD relationship, these issues are not resolved by following the same patterns – they need to be addressed in trauma-informed therapy. By breaking the cycle with therapeutic intervention, it can prevent children from growing up in chaotic environments and potentially learning those maladaptive coping strategies.

If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

[1] Antai-Otong, Deborah. “Treatment considerations for the patient with borderline personality disorder.” The Nursing clinics of North America vol. 38,1 (2003): 101-9. doi:10.1016/s0029-6465(02)00063-4

[2] Zanarini, M C et al. “Axis I comorbidity of borderline personality disorder.” The American journal of psychiatry vol. 155,12 (1998): 1733-9. doi:10.1176/ajp.155.12.1733

[3] Lieb, Klaus et al. “Borderline personality disorder.” Lancet (London, England) vol. 364,9432 (2004): 453-61. doi:10.1016/S0140-6736(04)16770-6

[4] Cooper, Luke D et al. “Self- and informant-reported perspectives on symptoms of narcissistic personality disorder.” Personality disorders vol. 3,2 (2012): 140-54. doi:10.1037/a0026576

[5] Lachkar, Joan. The Narcissistic/Borderline Couple. 2nd ed., Brunner-Routledge, 2004.

The post Understanding the Dynamic in BPD/NPD Relationships appeared first on Khiron Clinics.

In recent years, we have come a long way in the destigmatisation of many mental illnesses, and we no longer view them as weakness, but rather treat them as the debilitating conditions that they so often are. However, our attitudes toward BDP are lagging behind and this is in part due to the way the condition is framed and indeed, because of the name itself.

Perhaps if instead of looking at BDP as a personality disorder, we saw it as a complex response to trauma, much of the stigma that currently exists would be reduced. Most individuals suffering from BDP have some sort of history of trauma, often originating in childhood. This may include abandonment and neglect, physical and sexual abuse and separation or loss of parents and loved ones. ‘Multiple studies have reported that a history of physical and sexual abuse in childhood has a high prevalence among patients with borderline personality disorder, with some studies finding that abuse is a nearly ubiquitous experience in the early lives of these patients.^[2]’

Despite the ever substantiated link between trauma and BDP, the DSM-V does not class trauma as a diagnostic factor for the disorder. This only serves to perpetuate the stigma of the disorder. Due to its similarities to complex PTSD, it isn’t unreasonable to suggest that it be regarded in the same light – as a trauma spectrum disorder as opposed to a personality disorder. Individuals suffering with both PTSD and BDP struggle to regulate their emotions, both experience sensations of shame, guilt and feeling of emptiness and they both have an elevated risk of suicide. ‘At least three-quarters of… patients [with BDP] attempt suicide and approximately 10% eventually complete suicide.^[3]’

Link Between the Name and the Stigma

In the 1930s borderline was used by psychoanalysts for patients who were bordering psychosis and neurosis. However there is an interpretation by some today that the “border” within the name signifies the bordering on being a real illness or not. Essentially there is an invalidation of the true suffering in the name of the illness. As one of the symptoms of BDP is not feeling validated as a person, the name may serve to enhance the feelings of invalidation the suffer already struggles with. Added to this is the concept many have that a personality disorder is not dissimilar to a personality flaw. There is not enough education around the term and this may lead sufferers of BDP to view themselves more negatively, and even more harmful – it may lead those close to them to do the same. All perpetrating the cycle and exacerbating their sense of worthlessness. Unfortunately it is not only the uneducated who discriminate against those suffering with BDP, clinicians and professionals, even within the mental health fields have been known to act frustrated with patients suffering with BDP as they can often struggle to engage.

Changing the Name

Diagnostic labels are meant to describe symptoms and answer the question of what is wrong with a patient. However this is often not the case which reduces the usefulness of diagnostic labels as a whole, but also may be harmful when the label actually denigrates and potentially invalidates a person’s suffering.

Changing the name to something that shines a light on the root cause of the condition, such as complex trauma disorder, could change the stigma surrounding borderline personality disorders from people who are “misbehaving” or not having a “real” condition, to viewing them as survivors of trauma. This could lead to better treatment engagement and better outcomes, even if it was just a change that was made informally.

If you have a client, or know of someone who is struggling to find the right help for borderline personality disorder, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

1. Coid, Jeremy & Yang, Min & Tyrer, Peter & Roberts, Amanda & Ullrich, Simone. (2006). Prevalence and correlates of personality disorder in Great Britain. The British journal of psychiatry : the journal of mental science. 188. 423-31. 10.1192/bjp.188.5.423.

2. Golier JA, Yehuda R, Bierer LM, et al.: The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. Am J Psychiatry 2003; 160:2018–2024

3. Black, Donald & Blum, Nancee & Pfohl, Bruce & Hale, Nancy. (2004). Suicidal Behavior in Borderline Personality Disorder: Prevalence, Risk Factors, Prediction, and Prevention. Journal of personality disorders. 18. 226-39. 10.1521/pedi.18.3.226.35445.

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Our bodies record everything that we experience throughout the whole of our lives translating each event to store in our mind and memory through the medium of our senses. As individuals who carry trauma, we each have our own experiences that remind us of the event.

The DSM -1V classification defines Borderline Personality Disorder (BPD) as a ‘pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity’. Presentation of the disorder typically involves a history of chaotic interpersonal relationships, unstable mood and self-image disturbances, self-injurious behaviours and other maladaptive coping behaviours (Antai-Otong 2003). It has been said that the extent of disability associated with the disorder ‘involves a terrible way to experience life’ (Gunderson 2001:13). Symptoms of BPD include significant emotional distress and impaired interpersonal and occupational functioning (Zanarini et al. 1998).  Also, to be diagnosed, a person must have at least five of the identified symptoms which are grouped into three clusters according to the DSM –IV (APA 2013) Classification.

There is some divergence between ICD-10 World Health Organisation WHO (1992) and DSM-IV (APA 2013) as to whether BPD can be diagnosed in adolescence younger than eighteen years of age.  The ICD-10 (WHO1992) sets out a criteria and classifies overall groups of disorders of adult personality and behaviour, whereas the DSM-IV (APA 2013) specifies that adolescents with BPD can be diagnosed if the features of the disorder have been present for at least one year (NICE 2008).  BPD is difficult to define and although a high percentage of people in a mental health setting may have been diagnosed with such a disorder, professionals are still undecided in their approach. It is very important to understand the above symptoms and borderline personality itself, as it can easily be misdiagnosed as another mental illness – particularly mood disorder (Arntz 1999). BPD is more likely to develop in women than men. It should also be noted that drug and alcohol use often occurs with personality disorders and also appears more apparent in those suffering with borderline personality disorder.

The cause of borderline personality disorder is still suggested as a grey area and complex. A strong thought is that the cause of BPD could arise from childhood abuse, neglect, separation from loved ones or caregivers. These are seen to be major contributing factors particularly if the abuse is severe and sustained (Leib et al, 2004). However, another school of thought is that BPD could run in families or that it may be related to a chemical imbalance in the brain (Alper 2001). Leib et al, (2004) agrees that  genetic components and adverse childhood experiences may cause childhood dysregulation leading to dysfunctional behaviours and conflicts later on in life. It is important to note that the United Kingdom is the only country in the world to have a health service in which personality disorders are considered to be of great importance. As a result, during 2003, it was decided to include the treatment of personality disorders as part of the service. The development of these services remains inconsistent and in some cases undeveloped (NICE 2008).

The implementation of relevant legislation and guidelines has been set out in England and Wales to support all who meet the criteria of BPD. The National Institute for Health and Clinical Excellence (NICE 2008) draft consultation document has commissioned a clinical guideline for anyone that has developed this disorder. Aims set out by this document include the evaluation of specific psychosocial and pharmacological interventions regarding treatment, whilst providing choice, best practice and advice for care and treatment of the individual. Raising the Standard: The Revised Adult Mental Health National Service Framework and an Action Plan for Wales (WAG 2005) sets out guidelines relating to the diagnosis of BDP using the DSM- 1V (APA 2013) and criteria to combat over- diagnosis. These guidelines lay down paramount importance on the delivery of client centred care. If the usual treatment is not sufficient, the drug treatment must be tailor made to meet the individual’s needs with BDP and then combined with psychotherapy or behavioural strategies to be effective. All team members involved must be educated fully in the presentation of BDP and it is vital that the team approach is integrated to provide consistency.

Still to this day psychotherapeutic treatment of this patient group remains one of the most challenging for our mental health professionals. The underlying dynamics of this complex disorder and common lack of understanding leave patients diagnosed with BPD extremely difficult to engage and work with. Clients with BPD continue to significantly utilise medical and psychiatric care. Their symptoms of self-destruction, anger, mood instability and impaired interpersonal relationships can hinder their development of a therapeutic alliance and successful treatment outcome. When dealing with this group of individuals staff may have feelings of stress, anxiety, confusion, loss of achievement and  may find it difficult to move away from what is familiar to them or to the unknown (Marquis and Huston 2006). 

However, In more recent years the development of therapeutic models by practitioners such as Meares (Meares et al. 1999) and Linehan (1993a; 1993b) has provided a basis for focused therapy for which there is increasing evidence of successful outcomes. Effective treatment strategies for BPD with a central focus on the implementation of interventions using the concepts of Dialectical behavioural therapy (DBT) has been proven to build effective coping strategies and skilful behavioural responses for improved quality of life. According to the American Psychiatric Association (2013) practice guidelines, DBT is a psychotherapeutic approach that has been shown to be effective in randomised trials.

The Welsh Assembly Government (WAG) (2005) state that support should be in place for all staff at all levels to help cope with this challenging group of clients. As research continues and more sufferer’s of BPD continue to experience a better quality of life armed with more robust coping skills, the future for this client group and the expansion of DBT services appears brighter.

If you have a client, or know of someone who is struggling to find the right help for borderline personality disorder, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

References

Alper, G Peterson S J (2001) Dialectical Behavior Therapy for Patients with Borderline Personality Disorder. Journal of Psychosocial Nursing and Mental Health Services. 39 10.

American Psychiatric Association (2000) Diagnostic and Stastisical Manual of Mental Disorders. (4^th edn.) DSM-IV. Washington DC: APA.

Arntz A (1999) Do personality disorders exist? On the validity of the concept and its cognitive-behavioural formulation and treatment. Behaviour Research and Therapy.37 97- 134.

Crane J.T (2017) The Trauma Heart. Florida: Health Communications, Inc.

Gunderson, J G & Kolb J E (2008) Discriminating features of borderline patients. American  Journal of Psychiatry. 135 792-796 Lieb, K Zanarini, M C Schmahl, C

Linehan, M Bohus M (2004)  Borderline Personality Disorder. The Lancet: 364, 9432, RCN Edition: Pro-Quest Nursing and Allied Health Source. 453

Marquis, B L & Huston (2006) Leadership Roles in Management Functions in Nursing. (6^thedn.). Philadelphia: Lippincott: Williams & Wilkins.

National Institute of Clinical Excellence (2008) Borderline Personality Disorder: Treatment and Management. A draft Consultation.

http//www.nice.org.uk/guidance/index.jsp?action=folder&o=4039 Accessed 16/06/08.

Otong.A (2003) Evidence-Based Care of the Patient with Borderline Personality Disorder. 2016 Jun; Vol. 51 (2), pp. 299-308.

Welsh Assembly Government (2005) Raising the Standard: The Revised Adult mental Health National Service Framework and Action Plan for Wales: Welsh Assembly Government. Linehan M (1993) Cognitive Behavioral Therapy of Borderline Personality Disorder. New York: Guildford Press

World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.

Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL. (1989). The Revised Diagnostic Interview for Borderlines: discriminating BPD from other axis II disorders. J Personal Disord.: 3:10–18.

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