The symptoms and clinical presentation of narcissistic and borderline personality traits

Narcissistic and borderline personality traits are rooted in a particularly unstable or ‘fragile’ sense of self, as the title of Phil Mollon’s classic 1993 work on these specific types of personality suggests (The Fragile Self: The Structure of Narcissistic Disturbance‘), one that is often organised around early forms of disorganised attachment. This sense of internal and relational instability can manifest as rapidly alternating emotional moods and behaviours, with the individual characteristically switching between states of idealisation and denigration of others, and feelings of both grandiosity and emptiness. Often these disruptive moods and behaviours centre on, or are triggered by, underlying issues of abandonment and rejection.

Though the two personality disorders share some common relational traits, they are considered by the DSM to be distinct disorders with their own set of diagnostic criteria.

Borderline personality traits

Over the years, various traits have been associated with borderline personality disorder, including:

  1. Frantic efforts to avoid abandonment
  2. Intense/unstable relationships with extremes of idealisation & denigration
  3. Identity disturbance with a profoundly unstable sense of self (Kernberg’s Identity Diffusion)
  4. Impulsive self-damaging behaviours
  5. Recurrent suicidal behaviour or threats or self-injuring behaviour
  6. Emotional instability marked by intense periods of irritability or anxiety
  7. Chronic feelings of emptiness (related to sense of Rejection, Abandonment & Betrayal)
  8. Frequent displays of inappropriate anger or rage
  9. Transient, stress-related paranoid experience, delusions or severe dissociative symptoms

(Source: Jack Nathan, Confer Talk)

The most recent edition of the DSM (DSM 5, 2011) categorises individuals as suffering from borderline disorder only if they display these behaviours over time and if they cause a significant impairment in social functioning (e.g., work and relationships).

As the above list suggests, the borderline personality is characterised by noticeably unstable behaviours.

Relationships with others tend to be intense and marked by conflict, arguments and frequent breakups, with the individual often caught in a dynamic of pulling others in and pushing them away. As Mizen notes, “Borderlines are driven by that dynamic” (Link to Talk), a dynamic that has been popularly summed up as ‘I hate you, don’t leave me’ (the title of a best-selling book in the 1980s that first brought the concept of ‘borderline’ into the mainstream). This formulation captures the elements of rage, abandonment, dependency, and vulnerability, that characterise this personality structure. As Steiner notes, the term ‘borderline’ “does not only refer to a category of patients but also to a particular aspect of the mental structure of these patients and the location of the self in that structure” (Steiner, 1993).

The characteristic manifestations of rage, impulsivity, and destructive self-harming are typically related to and rooted in a desperate attempt to temporarily free the personality from an unbearable sense of inner shame, emptiness, or early sense of abandonment. These feelings of emptiness and shame are often masked and defended against in both borderline and narcissistic personalities, but can emerge suddenly and unpredictably when the underlying ‘wound’ to the self is exposed.

Narcissistic personality traits

Whereas individuals with borderline traits are diagnostically characterised by impulsive and compulsive behaviours (such as excessive spending, binge eating, self-harm, and risky sexual behaviours), those with narcissistic personality traits have been recognised as exhibiting an inflated sense of self-importance or grandiosity, and often take advantage of others to get their needs met. Over the years, various traits have been associated with borderline personality disorder, including:

  1. Grandiose sense of self-importance
  2. Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people
  4. Requires excessive admiration
  5. Has a sense of entitlement, and unreasonable expectations of especially favourable treatment
  6. Is interpersonally exploitative
  7. Lacks empathy
  8. Is often envious of others or believes that others are envious of him/her
  9. Displays arrogant, haughty behaviours or attitudes

(Souce, Phil Mollon Talk on Narcissistic Vulnerability and Shame)

The most recent edition of the DSM (DSM 5, 2011) categorises individuals as suffering from narcissistic disorder only if they display these behaviours over time and if they cause a significant impairment in social functioning (e.g., work and relationships). Narcissists are also likely to have problems with self-direction and closeness. Many narcissists are also substance misusers.

Individuals with this personality type may believe that they are special and therefore entitled to special treatment, require constant admiration and attention from others, and often exaggerate their achievements and fantasise about being powerful, attractive, or successful. Significantly lacking in empathy or awareness of the concerns or desires of those around them, they may take advantage of other people and show little interest in other people’s feelings or needs. Being preoccupied with self-image, the narcissistic personality is also often unempathic and envious towards others. It is this dynamic – an excessive need to inflate their sense of self, coupled with a concomitant need to deflate, denigrate, or dismiss others – that make this such an isolating and disruptive personality type.

Shame and grandiosity

Shame is commonly seen as “the core dread in narcissistic disturbance” (Mollon), a deep and pervasive feeling of being inadequate or unworthy. This may be due to early relational disruption, with the parent not attending to the infant in a responsive, nurturing way (see the ‘Blank Face’ experiments that Mollon describes, which suggest the bewildering distress that can be generated by the mother blanking her expression towards the three-month old infant; Mollon, Talk (video). This objectifying (‘I-It’) and dismissive form of attention may generate an enduring sense of not being worthy in the individual – not being worthy enough even to be looked at, perhaps thereby generating mechanisms of ‘self-mirroring’ in which the individual subsequently gets trapped inside (Mollon).

Because of its centrality in the aetiology of narcissistic disturbance, shame has therefore been called ‘the narcissistic affect’ (see Link to Talk), a catastrophic recognition of one’s essential inadequacy. The intense difficulty of revealing or ‘showing’ this wound to others can make therapeutic treatment very difficult: exposure of our narcissism also evokes shame. What is being ‘exposed to view’ here is a ‘shameful’ reminder of our deep dependency on others, hence our vulnerability – evoking this relational dependency can be a powerful reminder of how this can be misused or abused by others around us.

The characteristic formation of a ‘grandiose’ sense of self may thus be a ‘protective’ defence mechanism against an underlying and unbearable sense of humiliation and worthlessness – the ‘narcissistic wound’ that is such a feature of this type of personality, and a key focus of the analytic literature on it. Unmodified narcissism may manifest in clients variously as issues of shame (“shame-based clients”), anxiety, or an embarrassed, uncertain sense of self, or ‘false self’.

Thick-skinned and thin-skinned narcissism

The vulnerability and injury that lies at the heart of all forms of narcissism typically manifests as an acute sensitivity to insults, slights, or rejection. This sense of inner vulnerability may result in either a shy or withdrawn sense of self (so-called ‘thin-skinned’ form of narcissism) or a more grandiose or false sense of self (‘thick-skinned’ narcissism). Both forms serve to protect the vulnerable core. The key differences between these two types of narcissism has been summed up by Holmes:

THICK (or ‘overt’ narcissism): is unaware of impact on others; oblivious, tends to be male, thinks only of himself
THIN (or ‘covert’ narcissism): more commonly female, fragile, but parasitic

Holmes compellingly relates these two related forms to the figures of Narcissus and Echo in the original Greek myth, with Narcissus as the more obvious, well-known aspect (interestingly, it is this form of narcissism that seems to get the headlines and grab our attention), and the poor ‘thin-skinned’ nymph Echo, whose well-being and existence is utterly dependent on being admired by the other, on whom she is totally focussed. If the other disappears, she collapses: Echo has no voice of her own. Rosenfeld also distinguishes between thin-skinned narcissism (he notes its extreme sensitivity, and how it often manifests as issues of rejection or abandonment), and the thick-skinned form (characterised by entitlement, grandiosity, and arrogance). It is important to note that both forms present grandiosity and vulnerability; and both are self-absorbed (Pincus et al, 2009; see also Ronningstam & Guderson, 1991). As Mucci observes, the thin-skinned or ‘soft-skinned’ type is also similar in some ways to the ‘hyper-vigilant’ type as defined by Gabbard (low self-esteem, rejection sensitivity, diminished energy and vitality): an inhibited, shy, self-effacing self who avoids being the centre of attention (but whose self-devaluation exists side by side with a subtle form of superiority and entitlement: see Broucek, 1991).

Levels of severity: from ‘healthy’ to ‘malign’ narcissism

There has been extensive discussion concerning the different forms and levels of severity of narcissism, with some postulating a ‘healthy narcissism’ as essential to normal development, as distinct from the ‘malign’ or ‘pathological’ forms of narcissism (see Controversies). It is a fascinating but problematic area, tending to divide analysts into those who see narcissistic traits as essentially a compensation and defence for early relational rejection or disruption (Symington, Abse & Riddell, Lasch, Jung etc), and others who see it as something we are born with (Freud, Kohut, etc).

In its ‘malign’ or pathological form, individuals with narcissistic traits tend to have a problematic and frustrating relationship with social reality, which constantly threatens to undermine or expose the ‘grandiosity’ that the narcissistic self requires to maintain its identity. In this sense, as Mollon succinctly notes, “narcissism hates reality”: “Reality impinges on the illusory nirvana of experiencing no need, feeling only pleasure, and being the omnipotent centre of one’s world.” But, as with the issue of ‘healthy’ narcissism, the question of ‘reality’ is rather more problematic and complex than at first sight may appear, since reality is always a culturally and historically mediated construct, and all personality ‘disorders’ are defined against what is considered a social or cultural ‘norm’. In some cultures narcissistic traits may be more tolerated and even cultivated than in others, as Christopher Lasch’s best-selling book On Narcissism(1973), drew popular attention to (see also ‘Controversies‘).

Relational aspects

As Abse and Riddell suggest, narcissistic traits do not exist in isolation and can perhaps best be understood in terms of their relational aspects and dynamics. Pathological narcissism can be very damaging to other people, especially those who find themselves in an adult relationship with individuals with strong narcissistic traits, and we can be deeply wounded by the self-enclosed narcissism of other people. Similarly, individuals with narcissism might themselves have been deeply wounded in their early maturational development, through abusive, overstimulating, or erratic parenting (see ‘Aetiology‘).

Mollon notes that in our narcissistic state “we hate others”, as they impinge on our narcissism, our ‘centre-of-the-world’-ness. Relationships with other human beings also acutely but unconsciously remind the narcissistic self of its early (catastrophic) dependency and reliance on another, so that this aspect of the self may become cut off and disavowed: “The despised, needy, imperfect, defeated self is also hated”. This hatred of the whole concept of “dependency”, and the shame it evokes, can have profound political as well as personal implications.

As Nathan observes, narcissism generates an “intolerance of the receptive dependency on good objects”, leading to what Freud termed “the repudiation of femininity” (Freud, 1937c). Steiner also suggests how the deep embarrassment of (having feelings of) dependency can be quickly followed by “envious attack”: an envy-embarrassment axis, in which any issues to do with being small, dependent, and grateful – or indeed of being genuinely ‘good’, or improving/ progressing – can be ruthlessly torn down and attacked – as being despicable (Steiner, 1993). This again may make therapeutic treatment extremely difficult, since the very idea of ‘therapy’ suggests ideas of improvement and indeed dependency.