Many people wonder how Borderline Personality Disorder differs from Narcissistic Personality Disorder, or how Borderline Personality Disorder differs from the usual symptoms of trauma. While there are a few overlapping symptoms between these conditions, there are many marked differences between Borderline Personality Disorder and Narcissistic Personality Disorder that are worth highlighting. There are also some important distinctions between Borderline Personality Disorder and more temporary symptoms of trauma.

Borderline personality disorder (BPD) is a mental health condition with a long-term, sustained pattern of behavior characterized by emotional intensity and affective dysregulation, a pattern of unstable relationships, impulsivity, frantic attempts to avoid abandonment and reoccurring self-harm. Symptoms of BPD usually begin in adolescence, but BPD can only be diagnosed in adults.

What Can Be Misdiagnosed as BPD?

Some of the symptoms of Borderline Personality Disorder can co-occur or overlap with those of Post-Traumatic Stress Disorder (PTSD) or complex trauma – for example, irritability, reckless behaviors, dysregulated emotions, rage, dissociation or identity disturbance and self-harm in the case of complex PTSD. As a result, there are times that people can be misdiagnosed with BPD when they are actually suffering from the effects of complex trauma or PTSD.

Some therapists have noted that individuals can also be misdiagnosed with BPD when they are actually experiencing more temporary traumatic symptoms resulting from abusive relationships. Many of the same symptoms – such as emotional ups and downs due to the “mean and sweet” cycle of abuse and frantic attempts to avoid abandonment can occur in these tumultuous relationships. As a researcher who specializes in narcissism and psychopathy, I have also observed individuals who have been in romantic relationships with narcissistic or psychopathic partners reporting that they experience PTSD symptoms that “mimic” patterns of BPD even though they do not have BPD. This is due to the natural trauma reactions that arise in response to the abusive cycles and trauma bonding in these relationships. In those cases, such symptoms tend to improve and heal after exiting the abusive relationship and with appropriate trauma treatments. There are also cases of individuals with BPD having a pattern of being in relationships with narcissistic or psychopathic individuals or being targeted by narcissistic or psychopathic individuals due to their emotional vulnerabilities. Such relationships can exacerbate any pre-existing symptoms of BPD and may cause additional complex trauma.

What Causes BPD?

Research indicates that BPD may arise from a combination of environmental factors interacting with a biological predisposition for heightened sensitivity in the brain. For example, neuroscience studies note that in individuals with BPD, there is an increased activation in the amygdala (the part of the brain that processes fear and emotions) and reduced prefrontal cortex regulation (which helps manage emotions, impulses and decision-making) during emotion-inducing situations. Other research shows that BPD may also be hereditary, as the diagnosis of BPD was found to be four times higher in the biological relatives of people with BPD, and twin and familial studies show an estimated heritability of approximately 40%. Pre-existing sensitivities can interact with early upbringing, as studies support the associations between an emotionally invalidating family environment and BPD, as well as childhood maltreatment and the development of BPD. Interestingly, some individuals with Borderline Personality Disorder may report having been emotionally invalidated or mistreated by narcissistic parents.

What is Narcissistic Personality Disorder? What are the Differences?

Narcissistic personality disorder (NPD) is a personality disorder characterized by a chronic lack of empathy, exploitation of others, an excessive sense of entitlement, pathological envy, a haughty or condescending attitude, vanity or self-absorption and a need for admiration. While the exact origins of NPD are unknown and likely also involves an interaction between biological and environmental factors, some research, including longitudinal studies, suggest that parental overvaluation in childhood may cause narcissistic traits.

One of the biggest differences between Narcissistic Personality Disorder and Borderline Personality Disorder is in the capacity for emotional empathy. Some research shows that individuals with BPD can have enhanced emotional empathy for others and even have an ability to recognize the subtle emotional states of other people. This enhanced emotional empathy contrasts Narcissistic Personality Disorder, where a lack of emotional and affective empathy is a hallmark of the disorder, although narcissists are still capable of cognitive empathy, often using it to better manipulate others. However, individuals with BPD can struggle with conveying their empathy appropriately when they are distressed, emotionally overwhelmed and self-focused. As research indicates, individuals with BPD can also have a negative bias in emotion recognition and misattribute neutral emotions in others as negative ones, which may cause them to react to the “assumed” emotions of others more intensely.

People with Borderline Personality Disorder can experience intense and overwhelming emotions, which can lead to interpersonal difficulties if they do not receive treatment. Dr. Marsha Linehan, an expert on Borderline Personality Disorder and creator of Dialectical Behavior Therapy, an effective and evidence-based treatment for BPD, notes that this emotional reactivity stems from what feels like emotional “third-degree burns” within the individual with BPD, symbolizing the wounds which cause the individual to feel “agony at the slightest touch or movement.”

Unlike people with BPD, narcissistic individuals may display more “flat” impoverished emotions in response to the distress of others, more negative or antagonistic emotions and inappropriate emotions to certain stimuli (such as positive emotion in response to sad faces or heightened anger). Generally, their emotions are not as intense as the emotions of individuals with BPD, aside from malicious envy and narcissistic rage in response to perceived slights, criticism or threats to their excessive sense of entitlement. Due to their lack of empathy, the emotions of narcissistic individuals are linked moreso with their own needs rather than the needs or emotions of others. Individuals with BPD also experience rage on a heightened level, though their rage tends to be in response to perceived neglect, abandonment, or arising from their struggles with tolerating emotional distress.

People with BPD can engage in maladaptive behaviors to prevent being neglected in their relationships. They are more likely to harm themselves, while narcissistic individuals tend to exploit and manipulate others deliberately for personal gain, profit or pleasure. While individuals with BPD have an intense fear of abandonment, a marked characteristic of their disorder, narcissists are often the ones doing the abandoning as they tend to deliberately devalue and discard their intimate partners after a period of idealization for the purposes of power and control. Narcissists may also have high self-esteem either due to a grandiose self-image or low-self-esteem depending on whether they have more vulnerable or grandiose narcissistic traits. They engage in impression management and can have a charming false mask, whereas individuals with BPD tend to experience instability in self-esteem and a disrupted self-image.

People with BPD often struggle with the following symptoms:

• Intense relationships. People with BPD tend to have a series of intense relationships that can end as quickly as they began. They can experience abrupt shifts in their emotions toward people in relationships, “splitting” between idealizing their partner one day and intensely disliking or devaluing them the next. They may see their loved ones in “black and white” terms or “good” or “bad.”  Unlike narcissistic individuals who may use the idealize-devalue cycle deliberately to control others, this is not deliberate but rather a naturally occurring aspect of their emotional dysregulation. Note: This symptom should also not be confused with an abuse victim who experiences these shifts naturally due to the ongoing hot-and-cold cycle, Jekyll-and-Hyde behavior of their abusers and the chaos of an abusive relationship.
• Frantic attempts to avoid abandonment. Individuals with BPD may make frantic attempts to avoid abandonment (whether real or imagined) in their relationships and can be hypersensitive to perceived rejection from friends, family members, and relationship partners. This can occur in various ways: they can constantly ask for reassurance, or they may contact someone excessively. They might create crises with a sense of urgency to compel the person to rescue them, flatter, “fawn” or cater to that person to avoid being abandoned. They may even push the other person away first or vacillate between closeness and avoidance so they aren’t the ones being immediately abandoned.
• Moods that can change abruptly. People with BPD have intense, fluctuating moods (usually lasting a few hours at a time) that can shift rapidly. They may experience heightened irritability and anxiety, which may cause them to lash out at others, especially under times of distress. If left untreated, this emotional dysregulation can disrupt their daily functioning and can make it challenging for them to maintain relationships.
• Intense rage. People with BPD can experience rage disproportionately, especially in response to more seemingly “minor” inconveniences, perceived neglect or abandonment from others.
• Chronic feelings of emptiness and loneliness. An individual with BPD can experience chronic feelings of emptiness and loneliness which can cause them to crave and chase after relationships and external validation to fill the void. However, due to their emotional dysregulation and interpersonal difficulties, being in relationships can exacerbate their symptoms, especially if they do not undergo treatment.
• Dissociation and paranoid ideation. People with BPD might experience episodes of dissociation – a feeling of being separate from their own bodies and the world. They can also experience paranoid ideation during times of acute stress.
• Identity disturbance and an unstable sense of self. Individuals with BPD can experience a fluctuating and unstable self-image where they may not feel a solid sense of “self.” This may lead to contradictory or abrupt changes in beliefs, opinions, ideas, lifestyle or their personal style.
• Dangerous, impulsive and reckless behaviors. People with BPD may engage in reckless behaviors that harm themselves or others due to their impulsivity, such as substance use, risky sexual behavior, self-harm, excessive gambling, or reckless driving.
• Reoccurring suicidal and parasuicidal behaviors. Due to their overwhelming, intense emotions and challenges in tolerating distress, people with BPD may cry out for help with reoccurring self-harming and self-mutilating behavior or even suicide attempts. Non-suicidal self-injury (NSSI) is prevalent in this group.

If you or someone you know is struggling with symptoms of BPD, help is out there. While NPD has a more challenging prognosis as many narcissistic individuals are unwilling to seek help and lack empathy for the way their behaviors harm others, people with BPD often end up in treatment due to self-harm or interpersonal difficulties, and usually have a desire and willingness to improve the quality of their mental health and relationships. Studies show that with time and with the help of appropriate treatments such as Dialectical Behavior Therapy, people with BPD can experience a sustained remission of their symptoms.