"We have known for a long time that feelings of superiority and inferiority exist together. If one is on top, the other is underneath." Lowen (pg. 20)
The origins of NPD are believed to develop from abuse/lack of empathic parental care in the earliest years of life. BPD may also have it's origins at this early stage but the traumatic abuse (physical, sexual etc.) that is usually experienced by Borderlines can also be the cause of their personality disturbance at a much later age.
People with BPD are Narcissist's because they focus solely on getting their own needs and wants fulfilled. They are placed in the middle of Lowen's "spectrum of narcissistic disorders" (pg. 14). The symptoms of NPD and BPD overlap and as such making a clear cut diagnosis is not always easy for a Therapist. However, it is accepted that Borderlines are more disturbed as they are more likely to suffer from splitting and disassociation. Borderlines can experience hallucinations, delusions and thought disorders. Those with NPD tend not to exhibit these afflictions. As a result a Borderlines grasp of reality is much less secure than that of a person with NPD hence the placement of the condition at the middle of Lowen's spectrum. Some would argue that there is the need for another scale within the scope of BPD to differentiate between those with milder Borderline tendencies and those who verge on the psychotic.
Narcissist's may also suffer from splitting and both the Narcissist and the Borderline have a tendency towards inflation and devaluation of others, transferring their secret feelings/views of themselves on to those they interact with. They tend not to be able to see another persons good and bad traits at the same time.
Both suffer from depression and cover up their insecurities via a false Self which helps them to project a grandiose image. They deny their feelings and manipulate others but the Borderlines false Self "readily crumbles under emotional stress, and the person reveals the helpless and frightened child within." thus indicating that those with NPD have a stronger sense of Self (Lowen, pg. 18).
While Borderlines tend to have grandiose perceptions of themselves e.g. being superior to others or being irresistible to the opposite sex they are afraid to follow through with their convictions. Lowen (pg. 19) states that "narcissistic characters do not hold back. They have the necessary aggression to achieve some degree of success, suggesting an ego strength that the borderline personality lacks." This doesn't sound as good for the Narcissist as is implied because their grandiosity is still often contradictory to reality.
Narcissist's may have a stronger sense of Self but this is a result of consistently being pumped up by others. Their ego "has never truly been smashed down" by their parents (Lowen, pg. 20). As a result of their stronger ego they are less likely to self-harm, less likely to commit suicide (because they see it as a sign of weakness) and they are less impulsive. That is not to say that traumatic life events in their future e.g. ill health, divorce, death of a significant NSS, financial loss etc. will not result in breaking their inflated ego as they fail to live up to their grandiose fantasies. If this happens and NS is not in abundant supply Narcissist's can also respond with despair and may even seek to end their own lives.
The acquisition of NS is of vital importance to both personality structures. A Narcissist will derive their NS from extracting admiration and acknowledgement from others but unlike a Borderline they are not reliant on the presence of another person in order for them to feel "whole".
Borderlines experience guilt for not being good enough, for being victims of abuse they feel they deserve. Narcissist's on the other hand do not experience guilt. They only experience shame and fear of humiliation if their false image is called in to question.
Unlike those who suffer from NPD, Boderline's are capable of great empathy. In the case of Borderlines who have experienced abuse they are able to recognise or associate the painful feelings that are/may be experienced by others.
Both the Borderline and the Narcissist rarely admit they have a psychological problem. Borderlines are more likely to come to the attention of the mental health profession at a younger age, their capacity to experience guilt makes it more likely they will go in to therapy in search of help and the existence of a medical cause for BPD makes it treatable in part through medicine. These factors mean that the treatment of BPD is more likely to be a success than the treatment for NPD. However, any treatment requires commitment from the patient for it's continued success.
The trauma sustained from sexual abuse is more likely to lead to a greater dissociation with reality as the child attempts to block out what has been done to them by someone they love and depend upon (if the abuser is a member of their family). As girls are more likely to be sexually abused than boys this may explain to some degree why women are more likely to suffer from BPD than men.
As discussed in "What kind of parenting leads to NPD?" children can have strong reactions to constant perceived criticism. Boys and girls usually have different ways of dealing with criticism. Girls tend to internalise the criticism they receive whereas boys tend to cast it out. This may be explained by the fact that the female brain functions in a different way to that of a male brain. It could also be due to the manner in which girls are primarily socialised as nurturers who shoulder the burden when things go wrong within the family. This role of the female nurturer is also encouraged through the mass media. This conditioning may lead to low-self esteem and feelings of guilt that are evidenced in patients with BPD. This guilt and low-self esteem is one of the reasons why women tend to seek help more often than men in order to allow a diagnosis to be made.
Women are also conditioned to be subordinates to partners and are therefore "more prone to anxiety, depression, and feelings of helplessness than men. Similarly, submissiveness and fear of abandonment are more consistent with women's social role than men's" (Bockian pg. 46)
In addition to their tendency to cast out criticism boys are encouraged (more so than girls) to act out any aggression they feel towards others through viable channels e.g. contact sports and competition in business. As a result they are less likely to suffer from guilt and low self-esteem.
Some Psychologist's believe the reason there are more women diagnosed with BPD than men is because the Psychologist making the diagnosis has their own bias and stereotypes of relating to the sexes eg. a man who acts out in anger and takes part in self-damaging behaviour such as alcohol abuse is seen as antisocial rather than emotionally disturbed.
Despite suffering from a greater narcissistic disturbance the prognosis for successful treatment of a Borderline patient is a little better than that of a patient with NPD. A Borderline is more likely to be referred for help based on their self-harming behaviour and thanks to their guilty feelings in periods of regret they are more inclined to look for a recovery than those with NPD. In addition BPD is in part attributed to chemical imbalances in the brain which can be treated medically.
However, like other Narcissist's those suffering from BPD can be the barrier to their own recovery. Not all will admit they have a problem - they may even claim that people they interact with are in need of help not them. Borderlines have a tendency to go in and out of therapy rather than working through the treatment long term and often expect special treatment from their Therapist wanting attention at a moments notice regardless of if it is convenient e.g. the Therapist is with another patient or on holiday. Some will verbally abuse their Therapist and may use emotional blackmail to get the attention they crave e.g. threatening to commit suicide - even making an attempt where the Therapist has not met their needs.
Whilst Borderlines can be intelligent and accomplished members of the community it is the degree of disturbance that determines the effectiveness of treatment and the Borderlines ability to stick with it.
The two most successful treatments used to help treat people with BPD are Dialectical Behaviour Therapy (DBT) and medication.
Dr Marsha Lineham has pioneered the DBT treatment for BPD. Indications show that it is successful in helping those with BPD to change their behaviour with many going through treatment not exhibiting any symptoms of BPD afterwards.
The treatment uses four techniques; individual therapy, group skills training, telephone contact and Therapist consultation. The process is not quick, it often takes years to benefit from treatment and it requires the Borderlines continued commitment to treatment.
Medication can be used to help stabalise the chemical imbalances in the brain. Prescriptions are usually for antidepressants like Prozac which helps to regulate serotonin levels thus improving the Borderlines mood and alleviating some of the symptoms of BPD. There are, however, a wide variety of pills that can be used to treat the condition and can include Antipsychotic Medications (for treatment of hallucinations and delusions), Atypical Antipsychotic Medications (to reduce psychosis and improve overall functioning), Mood Stablilsers and Antianxiety Medications (Bockian, pg. 121). These pills do of course have side effects which need to be considered before treatment begins.
Most likely a combination of therapy and medication is used to treat BPD.
While reportedly less effective, other therapies can also be used in treating BPD: