There are a lot of people online talking about the stigma attached to a diagnosis of personality disorder, ‘PD’. Some warn that the effect of this diagnosis is that their trauma will go unrecognised. They warn that a person asking for help will be treated as if they are more or less to blame for their problems. They tend to make a distinction between this stigmatised ‘PD’ diagnosis and another diagnosis that seems to take into account trauma: PTSD.
(Perhaps if narcissistic perpetrators understood their behavior in this way, they might be more motivated and able to seek help and change their behavior.) As a person who was raised by a sadistic narcissist, I have to question the validity of this comment. Do you mean that if a Narcissist who gains approval or any financial gain or even just personally benefits at the expense of other people are going to suddenly want to change a behavior that benefits them?! I don't think so. Some narcissists may want to change with this knowledge but I know that my own mother would never face her own past because in order to do so she would have to take responsibility for the harm she has caused. No narcissists that I've ever met want to be humble and ordinary in any way. They like the idea of superiority (even if it isn't real), because gaining anything at the expense of another is a power play that will always work for them. Our society always look to these narcissists as ambitious and go- getter types without realizing that they are stepping on others to get there. As long as power is the main goal in this life for many people, I don't see any reason that the narcissist should want to change.
Thanks Donovan. I feel like this article is not complete without comments and come back like this. I agree with what youve said, although there is a range of severity in narcissism, and also for some the costs of their behaviour can start to outweigh the gains. It sounds like ghis never happened in your personal experience. But for example, I was encouraged by the response of Tupac’s mother to his death (see post). I acknowledge from sometimes painful experience, that to a large extent you are right. “Our society always look to these narcissists as ambitious and go- getter types without realizing that they are stepping on others to get there.” This is well put and one of the main things i am interested in. We have started equating success with narcissism and to some degree post traumatic symptoms.
Respectfully I think this is a bit misleading. Personality disorders result from disruptions in the formation of a person's core identity. Which is often related to early childhood trauma. But they are not PTSD though people who suffer with them may also suffer from PTSD. I fully agree that it should all be destigmatized and it would be great if more people with Personality Disorders sought treatment. But these are distinct disorders with overlapping symptoms. It sort of reads like the need to categorize PDs as "a form of PTSD" is just playing into the exact stigma around these disorders that you're getting at here. Many disorders have overlapping symptoms with each other, many can cause difficulty in interpersonal relationships. For instance someone with untreated Major Depressive Disorder is not very likely to be a good friend, partner, or parent when their symptoms are at their most debilitating. Yet this is also a separate disorder that may be related to a history of trauma. None of these labels are "good" or "bad" or say anything about the morals of the person suffering from them, they just differentiate the best treatment options for that person.
Thanks Nat L for your thoughtful comment. I agree that trying to avoid stigma is not a good reason to change a diagnostic label. And it doesnt tend to work. But I do think personally that describing bpd as a kind of complex ptsd is more accurate because we understand it better than when we called it ‘borderline’. I agree bpd is still somewhat distinguishable from cptsd, but then so is simple ptsd. I believe also that complex ptsd sometimes impacts on the person’s core identity. And so im not sure that this is a distinguishing symptom of bpd. I guess this article was an opinion about the direction these different diagnoses (and the evidence) are heading in and so time will tell us to what extent ive got this right.
I think we're going to have to agree to disagree here. I think this is also missing the biological aspects that set these disorders apart. First there's a genetic factor in both, someone who's predisposed to develop PTSD will likely do so if exposed to trauma that activates their sympathetic nervous system, but the disorder isn't going to emerge if this exposure never happens. Yet someone who's predisposed to a PD might develop one even without exposure to an event that activates their sympathetic nervous system. Ted Bundy is possibly an example of this, he insisted to his dying day that he was never abused as a child, though the veracity of this might be questionable there's no solid evidence to the contrary. The only thing we know for sure is at some point he discovered his "sister" was actually his mother and that he was illegitimate, and that he harbored an enormous amount of resentment over this. So we have this event that can shatter the identity of the person, but likely isn't going to result in the intense sympathetic response to danger, and the PD fully emerges. Growing up in a dysfunctional environment doesn't always mean the sympathetic activation that's a fundamental requirement for PTSD. While these days we might call repeatedly being made to feel shame as a child "trauma," when we're talking about the feelings/traumas that underpin PTSD we're really talking about extreme fear.
There's also evidence that people with BPD can sort of grow out of it eventually, as many experience a natural reduction in symptoms as they age even with no other interventions. Which again suggests some other biological/neurodevelopmental component that differs from CPTSD. CPTSD can reach subclinical levels with treatment, but it's not going to be reduced as a natural part of the aging process. An elderly patient with CPTSD they've never sought treatment for will likely be significantly impaired, while an elderly patient with untreated BPD might not have many symptoms at all.
Thanks again Nat L. We can agree to partially agree and partially disagree as im sure its a bit of both. Im going to respond to your thoughtful comments in turn:
“While these days we might call repeatedly being made to feel shame as a child "trauma," when we're talking about the feelings/traumas that underpin PTSD we're really talking about extreme fear.”
Yes agreed about ptsd. But i think this is where complex ptsd is different. It is not so fear-specific.
I agree (although i didnt cover it in the article) that there will be a genetic vulnerability to bpd and npd. But there will also be for ptsd/c-ptsd. So the fact that there is a genetic factor does not in itself mean bpd/npd are not post traumatic syndromes or are fundamentally unconnected with c-ptsd.
“An elderly patient with CPTSD they've never sought treatment for will likely be significantly impaired, while an elderly patient with untreated BPD might not have many symptoms at all.”
Yes this may turn out to seperate cptsd and pds. I havent thought about this angle before.
I agree that we can’t count all cases of PDs as forms of PTSD, because BPD and NPD can occur out of environments that, while maladaptive, are not always “traumatizing”.
Thanks Colette for your comment. Yes there are people with bpd and npd who have not received ill treatment or abuse or even overt neglect. But i think it depends on how we define trauma. What causes a trauma effect in the mind of a child - overwhelming an emotional system with, for example shame or despair repeatedly, could look from the outside unremarkable. In my thinking trauma can range from the illegal to a child’s emotional attachment needs being repeatedly unmet (i wrote a post about this ‘the map of narcissism part 1’). Many, if they were able to remember, and then if they were able to compare with others, would perhaps still not call such experiences trauma.
Yes, I absolutely agree it depends on what you count as “trauma”, which these days has a bit of concept creep. I’m thinking of Pete Walker’s book and when he talks about early histories of people with NPD who are “golden children” given tons of praise and awards for excelling at various things. While maybe not the best idea to obsessively praise a child, if the child feels it to be ego-syntonic then I would struggle to cause that “traumatic”. Dysfunctional from an attachment point of view for sure, but personally for me anyway I wouldn’t call that trauma. But we can of course agree to disagree 😇
Ah yes i agree. The recipe of childhood experiences for narcissism to develop includes egosyntonic experiences which are not traumatic. Im using Ryles theory (i think he agrees broadly with Kernberg on this point) which combines this idealisation of the child with condemnation and emotional neglect. Among the icons i have studied, john lennon and charles chaplin would be great examples of people who had both these experiences. See also my article on the map of narcissism which describes this theory. I think the idealisation on its own doesnt quite explain narcissism. I think learning to perform or looking beautiful etc represents the child finding emotional safety and escape from condemnation and invalidation. So the emotional trauma and the praise work together to shape escape strategies.
Yes when you put those two together it makes a lot of sense. This is not my area, but I’m curious your thoughts on the reported rising rates of narcissism in younger generations. I don’t work with kids but have been hearing a lot about techniques like “gentle parenting” which made me wonder about this unlimited praise/validation without the neglect and condemnation as you mention (and maybe lacking basic boundaries). I may be swerving completely out of my lane here as I don’t work with kids, but curious if you had thoughts on reported rising rates of narcissism and possible early antecedents of that.
Thanks Colette. I also dont work with kids, but i am interested in this question. I havent read much on it specifically though - in terms of research etc. i think the obvious places to look would be firstly, the idea that narcissism can (socially) breed narcissism. So if society’s parents become more materialistic, absent, externally focussed (achievements, posessions, appearance etc) then children on the receiving end will pick up these strategies whilst being emotionally lacking validation and attrntion. This isnt a popular idea, but look at the life of elizabeth taylor in my recent article as a prime example. She was practically molded to be narcissistic. So in theory each generation might become slightly more narcissistic than the last. Secondly, there is social media which seems to prize performance and appearance over authentic (vulnerable) connection snd intimacy. Overall perhaps vulnerability is less valued as contributing anything in the modern west. And this idea is part of the essence of narcissism.
Interesting article, agree with much of it although I have a few points I wanted to offer. I hope you don’t mind, this comes from my research and clinical expertise on CPTSD, a topic I am passionate about especially because there’s so much misunderstanding around it.
One important thing to consider is that people with PDs like BPD and NPD can actually cause complex PTSD in others (eg, parent with PD causes CPTSD in child, then adult). Or, at least some pretty serious attachment insecurity. I’m not sure if the reverse is true; it might be, but more of what I’ve seen clinically is where CPTSD is a result.
People with CPTSD might resort to borderline or narcissistic defenses under times of severe stress but these can be deactivated in safe places/with safe people and are not as pervasive as how they show up in true PD.
Interesting you mention Kernberg as he talked about a core narcissism within BPD. I had the absolute privilege of being part of his residency seminar during my training, it was a real treat to watch a master clinician and theorist at work.
A couple of resources if folks are reading this and affected by CPTSD are “Out of the Storm”, an online education and survivor forum, as well as Pete Walker’s book “Complex PTSD: From Surviving to Thriving”.
Thanks again Colette. Its great to have these expert and challenging comments. Great that youve been able to hear directly from Kernberg. I received some of his recent training on narcissism. Yes i can see how your points would distinguish between cptsd and bpd. Im not saying they are the same thing. But in some ways ‘mild bpd’ can be quite different to ‘severe bpd’ in similar ways - how compulsively defences are used, how transient symptoms are etc. Kernberg’s approach focusses on the tranference phenomena in bpd and npd. Transference is a relational version of feeling ‘as if’ something from the past is being repeated in the present. The terminology is from psychoanalysis, but the actual experience is surely related in some way to flashback phenomenon - inwhich the person ‘reexperiences the past ‘as if’ it is happening in the present? Just a thought.
Yeah what you’re saying definitely makes sense and maybe the flashbacks of CPTSD overlap more with what people are calling “quite borderline”, absolutely.
Very insightful. i was diagnosed with clinical depression and was on meds for 25 years. Then, through testing, PTSD was suspected. With discussion, C-PTSD became obvious. I have been in counseling for over a year now and things are getting much better. Thanks again for this post.
I’d like more examination of the body-mind relationship from the mental health professions: How does nutrition, illness, and other physiological issues affect a person’s response to adversity? For those who develop NPD or BPD with obvious adversity, could physiological issues play a role? There’s pattern recognition and taxonomy in mental health, but rarely attention to the whole system of the human body.
Thanks for this perspective. Yes the body is largely neglected in relation to personality didorder. I can think of some ways inwhich the body plays a part in triggering episodes of narcissistic strategies being used (most obviously illness sabotaging a powerful or admired role) And i can think of ways inwhich narcissistic strategies can impact on physical health. According to Alexander Lowen in narcissism in particular there is an insensitivty to the body - its alarm bells and its needs.
Fascinating piece teasing out the distinctions between the Cluster B conditions and PTSD. It's touchy territory that you've tackled with honesty and objectivity. No doubt people who have been on the receiving end of Cluster B parenting and behaviour will have other perspective to offer.
Thanks Natalie! Yes if we are on the receiving end of cluster b parenting or behaviour, our job will not be to theorise like this. If we do, it might be a sign that we are not taking our own needs and feelings seriously enough. If we are being victimised, i think our job is to label behaviour/language in the other and its impacts in ourselves (how it makes us feel). And try to stop there. I think youve written alot about this. If abusive or neglectful behaviour is a coping strategy developed after a traumatic childhood, that still means the person should be given responsibility for that behaviour.
Im more interested in understanding narcissism and fame from a distance. And from a distance we often blame cluster b behaviour in celebrities on the effects of fame (or success or power) itself. I think it matters if these are quite traumatised people whom we select, follow and admire in the first place.
Sure. I dont think there is 100% overlap. There are features that distinguish all of these, and i know from experience that treating npd is different to treating bpd. But i think there is a post traumatic aspect to all, whilst this aspect is heavily played down in npd in the media. I dont think im denying the potential for lived experience in the therapist or psychologist. My doctoral thesis touched on this comparing psychologists with their bpd clients on mentalizing :-)
Hi Simon - I think we have crossed wires here. Someone wrote a long comment directed to me and I replied to them but it looks like they deleted their comment so it looks like I’m responding to your earlier points again :)
Mental health professionals that are head centered, not heart centered, aren’t doing their clients or anyone a favors by cathecting on endless assessments, hairsplitting over disgnostic categories and judgment of those they deemed less enlightened and knowledgeable than themselves. This is particularly prevalent in the clinical psychology space. If you truly feel you were called to this work, consider that. If you were called to serve — do that.
Thanks Anna, I hope it came across that i think these diagnostic categories that are kept (historically) seperate are actually related. So less splitting and more joining perhaps? Yes if we leave out the heart in serving our clients we get lost. I do think of this space (this blog) as a place to think though.
‘Splitting’ is an interesting word choice. I respect the need for clinical psychologists to have their safe spaces to think although I don’t agree with your conclusions or approach to working with clientele. Intellectual freedom and discourse are important. Indeed, Substack is one place where you can choose to do that.
Thanks Anna. I want to be clear that i am not writing here about my approach to my clientele. I am writing theoretically to see what the freedom to think produces. As you say this is to some extent an intellectual exercise and not what I spend all my time doing when I am in my job. In my practice i use a specific model of treatment and i am not focussed on that model here on this blog. Yes do disagree with my conclusions and let me know what you think and why.
Apologies - i accidentally deleted your comment! 😳 I thought i was deleting my reply. So sorry - it was a very thoughtful comment. Anyway my reply to your comment which i deleted is as follows:
Alot to think about here. Yes the overlaps between concepts are very complicated. For example, the motivation for Bowlby proposing different attachment styles was not related to ill health but as a way of understanding the ‘normal’ population. Personality disorders on the other hand are diagnoses that can be applied to patients asking clinicians for treatment. But they overlap as you say. Yes i have wondered about a venn diagram for npd and cptsd. There is overlap.
In general im focusing on narcissistic strategies rather than the npd diagnosis. These strategies might be shaming, or performing. I think most people from time to time may use a narcissistic strategy. And some who use them alot (tgey might reach threshold for NPD) may use other kinds of strategy also. The helpfulness of diagnostic categories is limited - their main purpose is to decide on treatment.
In relationships, the basic way to respond is to name external behaviour (or words) in the other and the (internal) impact on ourselves (eg it hurts). The problem is that with a narcissistic person this approach can be very frustrating or it can be met with more problematic behaviour. But this problem doesnt in itself mean the strategy is wrong.
(Perhaps if narcissistic perpetrators understood their behavior in this way, they might be more motivated and able to seek help and change their behavior.) As a person who was raised by a sadistic narcissist, I have to question the validity of this comment. Do you mean that if a Narcissist who gains approval or any financial gain or even just personally benefits at the expense of other people are going to suddenly want to change a behavior that benefits them?! I don't think so. Some narcissists may want to change with this knowledge but I know that my own mother would never face her own past because in order to do so she would have to take responsibility for the harm she has caused. No narcissists that I've ever met want to be humble and ordinary in any way. They like the idea of superiority (even if it isn't real), because gaining anything at the expense of another is a power play that will always work for them. Our society always look to these narcissists as ambitious and go- getter types without realizing that they are stepping on others to get there. As long as power is the main goal in this life for many people, I don't see any reason that the narcissist should want to change.
Thanks Donovan. I feel like this article is not complete without comments and come back like this. I agree with what youve said, although there is a range of severity in narcissism, and also for some the costs of their behaviour can start to outweigh the gains. It sounds like ghis never happened in your personal experience. But for example, I was encouraged by the response of Tupac’s mother to his death (see post). I acknowledge from sometimes painful experience, that to a large extent you are right. “Our society always look to these narcissists as ambitious and go- getter types without realizing that they are stepping on others to get there.” This is well put and one of the main things i am interested in. We have started equating success with narcissism and to some degree post traumatic symptoms.
Respectfully I think this is a bit misleading. Personality disorders result from disruptions in the formation of a person's core identity. Which is often related to early childhood trauma. But they are not PTSD though people who suffer with them may also suffer from PTSD. I fully agree that it should all be destigmatized and it would be great if more people with Personality Disorders sought treatment. But these are distinct disorders with overlapping symptoms. It sort of reads like the need to categorize PDs as "a form of PTSD" is just playing into the exact stigma around these disorders that you're getting at here. Many disorders have overlapping symptoms with each other, many can cause difficulty in interpersonal relationships. For instance someone with untreated Major Depressive Disorder is not very likely to be a good friend, partner, or parent when their symptoms are at their most debilitating. Yet this is also a separate disorder that may be related to a history of trauma. None of these labels are "good" or "bad" or say anything about the morals of the person suffering from them, they just differentiate the best treatment options for that person.
Thanks Nat L for your thoughtful comment. I agree that trying to avoid stigma is not a good reason to change a diagnostic label. And it doesnt tend to work. But I do think personally that describing bpd as a kind of complex ptsd is more accurate because we understand it better than when we called it ‘borderline’. I agree bpd is still somewhat distinguishable from cptsd, but then so is simple ptsd. I believe also that complex ptsd sometimes impacts on the person’s core identity. And so im not sure that this is a distinguishing symptom of bpd. I guess this article was an opinion about the direction these different diagnoses (and the evidence) are heading in and so time will tell us to what extent ive got this right.
I think we're going to have to agree to disagree here. I think this is also missing the biological aspects that set these disorders apart. First there's a genetic factor in both, someone who's predisposed to develop PTSD will likely do so if exposed to trauma that activates their sympathetic nervous system, but the disorder isn't going to emerge if this exposure never happens. Yet someone who's predisposed to a PD might develop one even without exposure to an event that activates their sympathetic nervous system. Ted Bundy is possibly an example of this, he insisted to his dying day that he was never abused as a child, though the veracity of this might be questionable there's no solid evidence to the contrary. The only thing we know for sure is at some point he discovered his "sister" was actually his mother and that he was illegitimate, and that he harbored an enormous amount of resentment over this. So we have this event that can shatter the identity of the person, but likely isn't going to result in the intense sympathetic response to danger, and the PD fully emerges. Growing up in a dysfunctional environment doesn't always mean the sympathetic activation that's a fundamental requirement for PTSD. While these days we might call repeatedly being made to feel shame as a child "trauma," when we're talking about the feelings/traumas that underpin PTSD we're really talking about extreme fear.
There's also evidence that people with BPD can sort of grow out of it eventually, as many experience a natural reduction in symptoms as they age even with no other interventions. Which again suggests some other biological/neurodevelopmental component that differs from CPTSD. CPTSD can reach subclinical levels with treatment, but it's not going to be reduced as a natural part of the aging process. An elderly patient with CPTSD they've never sought treatment for will likely be significantly impaired, while an elderly patient with untreated BPD might not have many symptoms at all.
Thanks again Nat L. We can agree to partially agree and partially disagree as im sure its a bit of both. Im going to respond to your thoughtful comments in turn:
“While these days we might call repeatedly being made to feel shame as a child "trauma," when we're talking about the feelings/traumas that underpin PTSD we're really talking about extreme fear.”
Yes agreed about ptsd. But i think this is where complex ptsd is different. It is not so fear-specific.
I agree (although i didnt cover it in the article) that there will be a genetic vulnerability to bpd and npd. But there will also be for ptsd/c-ptsd. So the fact that there is a genetic factor does not in itself mean bpd/npd are not post traumatic syndromes or are fundamentally unconnected with c-ptsd.
“An elderly patient with CPTSD they've never sought treatment for will likely be significantly impaired, while an elderly patient with untreated BPD might not have many symptoms at all.”
Yes this may turn out to seperate cptsd and pds. I havent thought about this angle before.
I agree that we can’t count all cases of PDs as forms of PTSD, because BPD and NPD can occur out of environments that, while maladaptive, are not always “traumatizing”.
Thanks Colette for your comment. Yes there are people with bpd and npd who have not received ill treatment or abuse or even overt neglect. But i think it depends on how we define trauma. What causes a trauma effect in the mind of a child - overwhelming an emotional system with, for example shame or despair repeatedly, could look from the outside unremarkable. In my thinking trauma can range from the illegal to a child’s emotional attachment needs being repeatedly unmet (i wrote a post about this ‘the map of narcissism part 1’). Many, if they were able to remember, and then if they were able to compare with others, would perhaps still not call such experiences trauma.
Yes, I absolutely agree it depends on what you count as “trauma”, which these days has a bit of concept creep. I’m thinking of Pete Walker’s book and when he talks about early histories of people with NPD who are “golden children” given tons of praise and awards for excelling at various things. While maybe not the best idea to obsessively praise a child, if the child feels it to be ego-syntonic then I would struggle to cause that “traumatic”. Dysfunctional from an attachment point of view for sure, but personally for me anyway I wouldn’t call that trauma. But we can of course agree to disagree 😇
Ah yes i agree. The recipe of childhood experiences for narcissism to develop includes egosyntonic experiences which are not traumatic. Im using Ryles theory (i think he agrees broadly with Kernberg on this point) which combines this idealisation of the child with condemnation and emotional neglect. Among the icons i have studied, john lennon and charles chaplin would be great examples of people who had both these experiences. See also my article on the map of narcissism which describes this theory. I think the idealisation on its own doesnt quite explain narcissism. I think learning to perform or looking beautiful etc represents the child finding emotional safety and escape from condemnation and invalidation. So the emotional trauma and the praise work together to shape escape strategies.
Yes when you put those two together it makes a lot of sense. This is not my area, but I’m curious your thoughts on the reported rising rates of narcissism in younger generations. I don’t work with kids but have been hearing a lot about techniques like “gentle parenting” which made me wonder about this unlimited praise/validation without the neglect and condemnation as you mention (and maybe lacking basic boundaries). I may be swerving completely out of my lane here as I don’t work with kids, but curious if you had thoughts on reported rising rates of narcissism and possible early antecedents of that.
Thanks Colette. I also dont work with kids, but i am interested in this question. I havent read much on it specifically though - in terms of research etc. i think the obvious places to look would be firstly, the idea that narcissism can (socially) breed narcissism. So if society’s parents become more materialistic, absent, externally focussed (achievements, posessions, appearance etc) then children on the receiving end will pick up these strategies whilst being emotionally lacking validation and attrntion. This isnt a popular idea, but look at the life of elizabeth taylor in my recent article as a prime example. She was practically molded to be narcissistic. So in theory each generation might become slightly more narcissistic than the last. Secondly, there is social media which seems to prize performance and appearance over authentic (vulnerable) connection snd intimacy. Overall perhaps vulnerability is less valued as contributing anything in the modern west. And this idea is part of the essence of narcissism.
Interesting article, agree with much of it although I have a few points I wanted to offer. I hope you don’t mind, this comes from my research and clinical expertise on CPTSD, a topic I am passionate about especially because there’s so much misunderstanding around it.
One important thing to consider is that people with PDs like BPD and NPD can actually cause complex PTSD in others (eg, parent with PD causes CPTSD in child, then adult). Or, at least some pretty serious attachment insecurity. I’m not sure if the reverse is true; it might be, but more of what I’ve seen clinically is where CPTSD is a result.
People with CPTSD might resort to borderline or narcissistic defenses under times of severe stress but these can be deactivated in safe places/with safe people and are not as pervasive as how they show up in true PD.
Interesting you mention Kernberg as he talked about a core narcissism within BPD. I had the absolute privilege of being part of his residency seminar during my training, it was a real treat to watch a master clinician and theorist at work.
A couple of resources if folks are reading this and affected by CPTSD are “Out of the Storm”, an online education and survivor forum, as well as Pete Walker’s book “Complex PTSD: From Surviving to Thriving”.
Thanks for your article and this conversation 😊
Thanks again Colette. Its great to have these expert and challenging comments. Great that youve been able to hear directly from Kernberg. I received some of his recent training on narcissism. Yes i can see how your points would distinguish between cptsd and bpd. Im not saying they are the same thing. But in some ways ‘mild bpd’ can be quite different to ‘severe bpd’ in similar ways - how compulsively defences are used, how transient symptoms are etc. Kernberg’s approach focusses on the tranference phenomena in bpd and npd. Transference is a relational version of feeling ‘as if’ something from the past is being repeated in the present. The terminology is from psychoanalysis, but the actual experience is surely related in some way to flashback phenomenon - inwhich the person ‘reexperiences the past ‘as if’ it is happening in the present? Just a thought.
Yeah what you’re saying definitely makes sense and maybe the flashbacks of CPTSD overlap more with what people are calling “quite borderline”, absolutely.
Sorry, “quiet” not “quite”.
Very insightful. i was diagnosed with clinical depression and was on meds for 25 years. Then, through testing, PTSD was suspected. With discussion, C-PTSD became obvious. I have been in counseling for over a year now and things are getting much better. Thanks again for this post.
Thanks for the comment Rick. Glad it was helpful.
I’d like more examination of the body-mind relationship from the mental health professions: How does nutrition, illness, and other physiological issues affect a person’s response to adversity? For those who develop NPD or BPD with obvious adversity, could physiological issues play a role? There’s pattern recognition and taxonomy in mental health, but rarely attention to the whole system of the human body.
Thanks for this perspective. Yes the body is largely neglected in relation to personality didorder. I can think of some ways inwhich the body plays a part in triggering episodes of narcissistic strategies being used (most obviously illness sabotaging a powerful or admired role) And i can think of ways inwhich narcissistic strategies can impact on physical health. According to Alexander Lowen in narcissism in particular there is an insensitivty to the body - its alarm bells and its needs.
Fascinating piece teasing out the distinctions between the Cluster B conditions and PTSD. It's touchy territory that you've tackled with honesty and objectivity. No doubt people who have been on the receiving end of Cluster B parenting and behaviour will have other perspective to offer.
Thanks Natalie! Yes if we are on the receiving end of cluster b parenting or behaviour, our job will not be to theorise like this. If we do, it might be a sign that we are not taking our own needs and feelings seriously enough. If we are being victimised, i think our job is to label behaviour/language in the other and its impacts in ourselves (how it makes us feel). And try to stop there. I think youve written alot about this. If abusive or neglectful behaviour is a coping strategy developed after a traumatic childhood, that still means the person should be given responsibility for that behaviour.
Im more interested in understanding narcissism and fame from a distance. And from a distance we often blame cluster b behaviour in celebrities on the effects of fame (or success or power) itself. I think it matters if these are quite traumatised people whom we select, follow and admire in the first place.
Oh and as I said above, you can have BPD and NPD without a history of trauma.
Sure. I dont think there is 100% overlap. There are features that distinguish all of these, and i know from experience that treating npd is different to treating bpd. But i think there is a post traumatic aspect to all, whilst this aspect is heavily played down in npd in the media. I dont think im denying the potential for lived experience in the therapist or psychologist. My doctoral thesis touched on this comparing psychologists with their bpd clients on mentalizing :-)
Hi Simon - I think we have crossed wires here. Someone wrote a long comment directed to me and I replied to them but it looks like they deleted their comment so it looks like I’m responding to your earlier points again :)
Ah - I was wondering if i’d missed a comment! Thanks for explaining. Shame i missed the deleted comment.
Meet people where they are. 🫶🏻
Mental health professionals that are head centered, not heart centered, aren’t doing their clients or anyone a favors by cathecting on endless assessments, hairsplitting over disgnostic categories and judgment of those they deemed less enlightened and knowledgeable than themselves. This is particularly prevalent in the clinical psychology space. If you truly feel you were called to this work, consider that. If you were called to serve — do that.
Thanks Anna, I hope it came across that i think these diagnostic categories that are kept (historically) seperate are actually related. So less splitting and more joining perhaps? Yes if we leave out the heart in serving our clients we get lost. I do think of this space (this blog) as a place to think though.
‘Splitting’ is an interesting word choice. I respect the need for clinical psychologists to have their safe spaces to think although I don’t agree with your conclusions or approach to working with clientele. Intellectual freedom and discourse are important. Indeed, Substack is one place where you can choose to do that.
Thanks Anna. I want to be clear that i am not writing here about my approach to my clientele. I am writing theoretically to see what the freedom to think produces. As you say this is to some extent an intellectual exercise and not what I spend all my time doing when I am in my job. In my practice i use a specific model of treatment and i am not focussed on that model here on this blog. Yes do disagree with my conclusions and let me know what you think and why.
Thanks Lissa,
Apologies - i accidentally deleted your comment! 😳 I thought i was deleting my reply. So sorry - it was a very thoughtful comment. Anyway my reply to your comment which i deleted is as follows:
Alot to think about here. Yes the overlaps between concepts are very complicated. For example, the motivation for Bowlby proposing different attachment styles was not related to ill health but as a way of understanding the ‘normal’ population. Personality disorders on the other hand are diagnoses that can be applied to patients asking clinicians for treatment. But they overlap as you say. Yes i have wondered about a venn diagram for npd and cptsd. There is overlap.
In general im focusing on narcissistic strategies rather than the npd diagnosis. These strategies might be shaming, or performing. I think most people from time to time may use a narcissistic strategy. And some who use them alot (tgey might reach threshold for NPD) may use other kinds of strategy also. The helpfulness of diagnostic categories is limited - their main purpose is to decide on treatment.
In relationships, the basic way to respond is to name external behaviour (or words) in the other and the (internal) impact on ourselves (eg it hurts). The problem is that with a narcissistic person this approach can be very frustrating or it can be met with more problematic behaviour. But this problem doesnt in itself mean the strategy is wrong.
I appreciate your response. And no worries about the accidental deletion!