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Narcissism with Other Mental Health Disorders (Co-Morbidity and Dual Diagnosis)
Written by Sam Vaknin   
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Dec 02, 2008 A +  A -  RESET  

Each personality disorder has its own form of Narcissistic Supply:

  • HPD (Histrionic PD) Derive their supply from their heightened sexuality, seductiveness, flirtatiousness, from serial romantic and sexual encounters, from physical exercises, and from the shape and state of their body;
  • NPD (Narcissistic PD) Derive their supply from garnering attention, both positive (adulation, admiration) and negative (being feared, notoriety);
  • BPD (Borderline PD) Derive their supply from the presence of others (they suffer from separation anxiety and are terrified of being abandoned);
  • AsPD (Antisocial PD) Derive their supply from accumulating money, power, control, and having (sometimes sadistic) "fun".

Borderlines, for instance, can be described as narcissists with an overwhelming fear of abandonment. They are careful not to abuse people. They do care deeply about not hurting others but for a selfish motivation (they want to avoid rejection).

Borderlines depend on other people for emotional sustenance. A drug addict is unlikely to pick up a fight with his pusher. But Borderlines also have deficient impulse control, as do Antisocials. Hence their emotional lability, erratic behavior, and the abuse they do heap on their nearest and dearest.

Abandonment, NPDs and Other PDs

  • Both narcissists and Borderlines are afraid of abandonment. Only their coping strategies differ. Narcissists do everything they can to bring about their own rejection (and thus "control" it and "get it over with"). Borderlines do everything they can either to avoid relationships in the first place or to prevent abandonment once in a relationship by clinging to the partner or by emotionally extorting his continued presence and commitment.
  • Seductive behavior alone is not necessarily indicative of Histrionic PD. Somatic narcissists behave this way as well.
  • The differential diagnoses between the various personality disorders are blurred. It is true that some traits are much more pronounced (or even qualitatively different) in specific disorders. For example: delusional, expansive, and all-pervasive grandiose fantasies are typical of the narcissist. But, in a milder form, they also appear in many other personality disorders, such as the Paranoid, the Schizotypal, and the Borderline.
  • It would seem that personality disorders occupy a continuum.

NPD and BPD - Suicide and Psychosis

A sense of entitlement is common to all Cluster B disorders.

Narcissists almost never act on their suicidal ideation Borderlines do so incessantly (by cutting, self injury, or mutilation). But both tend to become suicidal under severe and prolonged stress.

NPDs can suffer from brief reactive psychoses in the same way that Borderlines suffer from psychotic microepisodes.

There are some differences between NPD and BPD, though:

  1. The narcissist is way less impulsive;
  2. The narcissist is less self-destructive, rarely self-mutilates, and practically never attempts suicide;
  3. The narcissist is more stable (displays reduced emotional lability, maintains stability in interpersonal relationships and so on).

NPD and Antisocial PD

Psychopaths or Sociopaths are the old names for Antisocial Personality Disorder (AsPD). The line between NPD and AsPD is very thin. AsPD may simply be a less inhibited and less grandiose form of NPD.

The important differences between narcissism and the antisocial personality disorder are:

  • Inability or unwillingness to control impulses (AsPD);
  • Enhanced lack of empathy on the part of the psychopath;
  • The psychopath's inability to form relationships, not even narcissistically twisted relationships, with other humans;
  • The psychopath's total disregard for society, its conventions, social cues and social treaties.

As opposed to what Scott Peck says, narcissists are not evil they lack the intention to cause harm (mens rea). As Millon notes, certain narcissists "incorporate moral values into their exaggerated sense of superiority. Here, moral laxity is seen (by the narcissist) as evidence of inferiority, and it is those who are unable to remain morally pure who are looked upon with contempt." (Millon, Th., Davis, R. - Personality Disorders in Modern Life - John Wiley and Sons, 2000)

Narcissists are simply indifferent, callous and careless in their conduct and in their treatment of others. Their abusive conduct is off-handed and absent-minded, not calculated and premeditated like the psychopath's.



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Last Updated( May 28, 2009 )
reviewed by: Harry Croft, MD
Psychiatrist, HealthyPlace.com Medical Director
 

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