BPD & Other Personality Disorders

When we think of personality, the first thing we think about are character traits. Is someone organized and conscientious? Are they extraverted? A lot more goes into personality than that. 

Personality also includes: 

• our sense of self or identity

• knowing our values, our interests, our goals

• what motivates us

• what we like and don’t like

• knowing our story, how we came to be who we are

• self-esteem 

• our coping and defense strategies 

• self-image 

• attachment style

• how we perceive others

Sometimes parts of the personality function in ways that cause problems. For example:

• Our sense of self could be unstable. It could shift day-to-day, hour-to-hour. 

• Our sense of self could be poorly integrated, leading to chronic feelings of emptiness and a sense of not knowing who you are.

• Our self-esteem could be too rigid. We might feel we are always falling short of our expectations. We might feel ashamed, intolerant of our limitations. 

In general, problems arise when parts of the personality are too rigid and inflexible, or too unstable and unintegrated. Personality problems range from mild, not very noticeable, to severe.

What causes BPD?

We don’t completely know. There is a strong genetic component. Heritability estimates are 50 percent or more. The environment also plays a role. Sometimes the fit between children and their parents is not the best. People with BPD often remember being treated insensitively growing up. In addition, many people with BPD have histories of trauma.

Treatments for BPD

Transference-focused psychotherapy (TFP), general psychiatric management (GPM), mentalization-based treatment (MBT), dialectical behavior therapy (DBT), and schema therapy are evidence-based treatments for BPD. Research indicates they are all about equally effective. 

When looking for BPD treatment, I recommend you read up on different approaches and seek out the one that resonates most. Medications can lessen symptoms of BPD. However, the primary treatment for BPD is psychotherapy. 

Many people with BPD have long-standing depression and have been in therapy many times before. Some have not benefitted in previous therapist. This is often because past treatments they received were for depression and anxiety rather than BPD. If you suspect you have BPD, I advise seeking out a bonafide treatment for BPD. 

Narcissistic vulnerability, or pathological narcissism, refers to rigidity or instability in self-esteem. 

• People with narcissistic vulnerability have a dysregulated self-esteem.

• They rely on validation, admiration, and achievement to maintain self-esteem.

• They are sensitive to signs of falling short, being criticized, judged, looked down upon, disrespected, or slighted. They feel shamed, humiliated, or enraged as a result.

• They feel safest when they are in control and self-sufficient. They struggle to be vulnerable and depend on others. 

• Their standards are unrealistically high. They can be overly harsh with themselves. Sometimes, out of fear of falling short, they avoid engaging with the world. 

• Issues related to self-esteem can lead them to be critical and envious of others.

• They can have a black-and-white, all-or-nothing view of self-worth. They are either strong or weak, superior or inferior, accomplished or incompetent.

Narcissistic vulnerability is common and ranges from mild to severe. It does not mean you're a bad person, unpleasant to be around, or disliked. Many kind, generous, successful people have narcissistic vulnerability. 

Treatment for Narcissistic Vulnerability

Unfortunately, there is not a lot of empirical research on treating this disorder. Transference-focused psychotherapy (TFP), mentalization-based therapy (MBT), and general psychiatric management (GPM) were recently adapted for narcissistic vulnerability. These treatments are still being researched, but seem to be helpful. In addition, psychodynamic therapy and psychoanalysis have been the treatments of choice for people with this condition for decades.