Narcissistic personality disorder (or NPD) is a personality disorder that frequently co-occurs with borderline personality disorder (BPD). The addition of NPD into the diagnostic picture may complicate the treatment and course of BPD.
What Is Narcissistic Personality Disorder?
NPD is one of 11 personality disorders recognized in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. NPD is one of the "Cluster B" or dramatic/erratic personality disorders.
Narcissistic personality disorder is characterized by the presence of five (or more) of the following symptoms:
- Inflated sense of self-importance
- Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love
- Beliefs that he or she is “special” and can only be understood by other special or high-status people
- Requires excessive admiration
- Sense of entitlement
- Takes advantage of others
- Lacks empathy
- Is often envious of others or believes others are envious of him or her
- Behaves in an arrogant, haughty way
In short, people with NPD might be described as being very self-absorbed or egotistical; this self-absorption rises to the level of a clinical disorder because it significantly interferes with relationships, occupation, or other important domains in life. Many experts believe that this egotistical style is actually the NPD individual's attempt to deal with an underlying poor sense of self worth.
How Often Do NPD and BPD Co-Occur?
While the overlap between NPD and BPD are discussed quite often in the popular psychology literature and online, very few careful studies of the co-occurrence of NPD and BPD have been conducted. One such study found that only about 16 percent of patients with BPD also meet the diagnostic criteria for NPD. However, another study that drew from a community (rather than a treatment-seeking) sample found that almost 39% of people with BPD also have NPD.
How Does Narcissistic Personality Disorder Affect the Course of BPD?
There are a number of theoretical reasons to believe that someone with both NPD and BPD would be less likely to get better over time. People with NPD have been described as very resistant to treatment; people with NPD often have poor insight about the ways that there behaviors are detrimental to themselves or others. Also, people with NPD may in fact cause more emotional pain to others than they cause themselves. So, their motivation to change their behavior may be very low.
Research does suggest that people with both NPD and BPD are less likely to have their BPD symptoms get better over time. For example, one study that followed BPD patients over 6 years found that rates of co-occurring NPD were fairly low (about 6%) in patients whose BPD eventually went away (remitted). However, rates of co-occurring NPD were higher (around 19%) in patients whose BPD did not remit after 6 years. So, there is a subset of individuals with non-remitting BPD and higher rates of NPD.
Relationships in People with NPD and BPD
The relationships of individuals with BPD are often quite dysfunctional. However, adding NPD into the mix can create even more disordered conditions. In addition to the chaotic emotional life and fears of abandonment associated with BPD, a person with co-occurring NPD may also take advantage or manipulate other people, and have little empathy for others' concerns. This combination can be incredibly destructive in relationships.
Treatment for Narcissistic Personality Disorder and BPD
There are currently no empirically supported treatments for NPD, and no published clinical trials of treatments for NPD alone or co-occurring and BPD. The only published research on the treatment of NPD is limited to some case studies or anecdotal accounts, but these types of studies tend to be unreliable and subject to bias. The case study literature on the treatment of NPD has primarily centered around the use of modified psychoanalytic techniques and has recognized the challenges of successfully treating this disorder.
The clinical literature in general tends to regard NPD as a largely untreatable condition, particularly in its most severe forms. Some people believe that because there is some overlap between NPD and BPD symptoms (i.e., impulsivity and destructive behaviors) treatments designed for BPD (such as Dialectical Behavior Therapy) may also work with NPD. However, this remains to be seen; more research on the topic is sorely needed.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. American Psychiatric Association: 2000.
Dhawan N, Kunik ME, Oldham J, Coverdale J. Prevalence and treatment of narcissistic personality disorder in the community: a systematic review. Comprehensive Psychiatry, 51(4):333-339, 2010.
Grant BF, Chou SP, Goldstein RB, et al. "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions," Journal of Clinical Psychiatry, 69(4): 533-545, 2008.
Kernberg OF. Narcissistic personality disorders: Part 1. Psychiatric Annals, 39(3):105-107, 110, 164-166, 2009.
Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, Reynolds V. Axis II comorbidity of borderline personality disorder. Comprehensive Psychiatry, 39(5):296-302, 1998.
Zanarini MC, Frankenburg FR, Vujanovic AA, Hennen J, Reich DB, Silk KR. Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission. Acta Psychiatrica Scandinavica, 110(6):416-420, 2004.