Narcissists have unrealistic images of themselves as being flawless people who are superior to others. The image of perfection that narcissists project is there to cover up the fact that on the inside they are remarkably insecure and have very low self-esteem. Yeomans suggested that there are two types of narcissists – thick-skinned and thin-skinned – and that thin-skinned narcissists may be more likely to seek NPD treatment.

Thick-Skinned Narcissists

As Yeomans explained it, a thick-skinned narcissist has a very effective defensive armor that they use to fend off any observations or criticisms that might reveal their negative traits. They don’t acknowledge or absorb criticism at all, so they remain in a bubble where nothing they do is wrong and everyone else is inferior to them and to blame.

Thick-skinned narcissists have an extra layer of unreality protecting them from meaningful self-realizations that might threaten their sense of themselves as superior human beings.

Thin-Skinned Narcissists

On the other hand, Yeomans described thin-skinned narcissists as being much more fragile when it comes to perceived criticism. A thin-skinned narcissist’s sense of grandiosity may crumble simply as a result of looking at them the wrong way.

Thin-skinned narcissists may be more likely to seek professional NPD treatment for their problems, as it is not uncommon for them to develop depression or powerful feelings of hopelessness. Once NPD treatment has begun, it may take awhile before a therapist determines that the underlying issue of narcissism is what is really behind the patient’s depression.

Challenges of NPD Treatment

Due to the fact that narcissists cannot emotionally tolerate perceived flaws or imperfections in themselves, Narcissistic Personality Disorder treatment presents some real challenges. Therapists must seek to guide their narcissistic clients toward important self-realizations without alienating them from the therapeutic process altogether.

The goal of treating Narcissistic Personality Disorder is to help the client develop a healthy, balanced sense of themselves with both strengths and weaknesses. However, therapists with narcissistic clients often must tread very carefully in order to avoid challenging their clients’ defensive systems and causing them to flee NPD treatment altogether.

Yeomans described some of the challenges to effective treatment of Narcissistic Personality Disorder. He explained that clients can be so remarkably over-sensitive to criticism that they devalue the therapist completely by taking a position of arrogant superiority over them. If the patient has no respect for the therapist, it can make progress difficult.

In one instance when his client continually pointed out how inferior she believed her therapist to be, Yeomans replied with compassion that “it must be difficult to have a therapist with so many limitations.” In saying this, he accepted the flaw she was projecting on to him and demonstrated that accepting a flaw about himself did not make him less whole or less capable of doing his job effectively.

Over time, by taking their patient’s criticisms in stride, the therapist becomes an example of a person who has both positive and negative characteristics and a realistic self-image. When a patient sees this quality in their therapist, they may be able to see it in themselves as well and eventually work toward a more balanced and healthy self-image.

Narcissistic Personality Disorder vs. Borderline Personality Disorder

Narcissistic Personality Disorder and Borderline Personality Disorder (BPD) are related in the sense that they are both what Yeomans called “identity disturbances,” in which an individual’s sense of self is skewed and unrealistic.

In people with BPD, this identity disturbance presents as a fragmented sense of self that changes rapidly, while in a person with NPD their sense of self is stuck in one place. A person with BPD often believes that they are worthless or undeserving of love, while a person with NPD believes they are without flaws.

Narcissistic Personality Disorder Characteristics

Narcissistic Personality Disorder is characterized by a sense of grandiosity. An individual with NPD wants power and the admiration of others, they frequently display a sense of entitlement, and they can come across as haughty or arrogant. Those are the outward manifestations of what is really going on, which is that people with NPD have a very fragile self-esteem that they protect by creating the illusion of perfection for both themselves and others. Inside, a person with NPD is constantly comparing themselves to an image of perfection and striving to attain it.

People with a healthy self-esteem understand that they are not all good or all bad. They are able to recognize their flaws and accept themselves as individuals who have both strengths and weaknesses. They accept that they may be extremely skilled in some areas and perhaps lacking in others, but this does not debilitate their ability to develop a healthy self-esteem. When we see ourselves realistically, we hold reasonable expectations of ourselves and set goals accordingly.

People with Narcissistic Personality Disorder often devalue others because they project their negative self-image outward. Intolerance for any flaw they perceive in themselves causes them to direct their disappointment at other people. It is, simply put, building their selves up by tearing others down. They are unable to develop a balanced and realistic idea about who they are because they focus exclusively on maintaining a sense of themselves as superior and omnipotent. When people cannot hold a realistic view of themselves, it prevents them from developing as a whole person and engaging in healthy relationships.

Many people with Narcissistic Personality Disorder can become more and more isolated as they age. To seek loving relationships means exposing their flaws at some point, and this becomes too much of a threat to their fragile sense of grandiosity. The illusion of perfection is one they cannot tear away for fear of facing their own flaws in the light of day. Not engaging with others in a genuine way prevents this inevitable exposure and protects them from feeling pain or humiliation. Rather than seeking love, people with NPD seek admiration.

In a re-cap of the second portion of Dr. Yeomans’ discussion, we’ll look at the two different kinds of narcissist – thick-skinned and thin-skinned – and explore the challenges inherent in therapeutically treating people with Narcissistic Personality Disorder.

For some people with Borderline Personality Disorder, it can be exceptionally difficult to focus on therapy and recovery while simultaneously coping with day-to-day life and troubled interpersonal relationships. On occasion, we all struggle to handle everything that life throws our way. For a person with BPD, the ups and downs of a busy lifestyle can be overwhelming and cause such great emotional dysregulation that it impairs their ability to integrate the concepts of BPD therapy into their relationships.

Focus on BPD Recovery

Residential BPD treatment offers a way for people with Borderline Personality Disorder to completely immerse themselves in the healing process and focus exclusively on recovery. By removing the stressors and triggers of everyday life, residential BPD treatment creates the space patients need to gain greater perspective and understanding about the ways in which BPD is negatively impacting their lives. The structure provided in a residential BPD treatment center can be a welcome respite from the chaos many people with BPD experience in their outside lives.

A complete and accurate diagnosis, coupled with the right medications and therapy, is the foundation of any effective course of Borderline Personality Disorder treatment. While in residential BPD treatment, people with Borderline Personality Disorder will receive individual attention from a therapist several times a week. Therapists may treat BPD using such therapies as Dialectical Behavior Therapy (DBT) and Mentalization-Based Therapy (MBT).

In addition to attending individual therapy sessions several times a week, residents will participate in group therapy sessions. Group therapy in residential BPD treatment can include mindfulness groups, yoga therapy, DBT skills groups, and art therapy.

Any co-existing psychiatric disorders, such as eating disorders, substance abuse, or anxiety disorders, will be identified and addressed accordingly. Thorough assessments will be made regarding what medications a patient is taking or may need to take.

The comprehensive approach to Borderline Personality Disorder treatment offered in residential treatment programs may integrate nutrition, exercise, and physical therapies such as massage and acupuncture with psychiatric therapies to give patients the most well-rounded and holistic treatment possible.

Why Residential BPD Treatment?

The primary goal of residential Borderline Personality Disorder treatment is to help patients acquire the life skills necessary to transition back into their regular lives and function independently. While in a supportive and nurturing residential environment, they will learn how to identify their problem behaviors, manage their BPD symptoms, and improve their interpersonal relationships.

Borderline Personality Disorder patients who enter residential BPD treatment and complete a course of care in this environment often transition into day treatment or outpatient treatment as they achieve a greater level of independence and learn to effectively apply the skills acquired in residential BPD treatment.

Even if your mother hasn’t received an official BPD diagnosis, there are some signs to keep an eye out for. Let us take a look at some of the many ways BPD often manifests itself in parenting.

• Neglect:  People with Borderline Personality Disorder can be so absorbed in their own pain that they are incapable of putting even their own children’s needs before their own.
• Over-control: It is quite common for parents with Borderline Personality Disorder to attempt to control their children’s behaviors, feelings, and actions to a degree that inhibits their child’s ability to develop independently.
• Rage: Parents with BPD can have reactions that are wholly disproportionate to the perceived infraction. Occurrences of prolonged rages and angry outbursts are common.
• Criticism: Mothers with Borderline Personality Disorder often hurl put-downs and insults at their children. As children are often seen by their BPD mothers as merely extensions of themselves, this may reflect feelings the parent has about themselves and represent a form of projection.
• Blame: A child of a BPD mother may be made to feel that they are to blame for their mother’s sadness or anger. People with BPD have trouble taking responsibility for their own feelings.
• Enmeshment: People struggling with Borderline Personality Disorder have a deep fear of abandonment. Sometimes a BPD mother may develop a relationship with her child that is stifling to the child’s attempts to become an individual. She may look to this child for comfort and validation rather than the other way around.
• Parental alienation: A mother with BPD may not be able to tolerate a loving relationship between her kids and their father. She may feel that this love threatens her own relationship with their children. Sadly, it is not uncommon for these mothers to speak poorly about the other parent in an attempt to turn their children against them.

Learning to Cope with a BPD Mother

Children who are raised by mothers with Borderline Personality Disorder can develop any number of emotional problems themselves. They face great hurdles in overcoming their dysfunctional upbringings and may need to seek professional help to work through their feelings.

If you are one of these children, you may be struggling with low self-esteem, anger, or depression. Recognizing that you are not to blame for your mother’s behavior will be a necessary first step toward healing some of your wounds.

Talking to others will help. Find friends, relatives, support groups, or a therapist who can lend an understanding ear and lend moral support. There are websites with forums for people who have a loved one with BPD. Venting in a “safe” place and learning from others’ stories will let you release some of the pain and validate your feelings. Books such as “Understanding the Borderline Mother,” by Christine Ann Lawson, Ph.D., can also be helpful. 

Educate yourself about ways to change the dynamic in your relationship with your mother. Learn to set boundaries and overcome feelings of guilt and obligation. It is possible to move past a painful home life and form a healthier relationship with your mother.

If you have a relationship with someone you suspect has Borderline Personality Disorder, you probably want nothing more than to see them get help and live a more peaceful life. It may be tempting to approach them about BPD in the hopes that they will seek help, but you must consider many things before doing so because this type of intervention can result in further conflict.

People with Borderline Personality Disorder frequently project their behaviors and feelings on to others since they cannot bear to hear anything negative about themselves. There’s a fairly good chance that telling them you believe it’s possible they have BPD will result in them accusing you of having it. When they perceive that you are criticizing or slighting them, a person with BPD will be likely to lash out, denying their problems and enumerating yours instead. This will not generally result in them seeking professional BPD treatment. In fact, it may make them more adamant to not get help.

Like most people, those with Borderline Personality Disorder don’t like being told what to do or how to fix their problems. Unsolicited advice is rarely met with instant acceptance. For this reason, you will want to gauge whether the person with BPD may be seeking BPD treatment on their own before you jump in and tell them they need to get help.  

How to Approach Someone About BPD

If you tread carefully, there may be ways to engage with a person who has BPD in constructive and non-confrontational ways that could steer their thinking toward the possibility of change. This is not a simple one day task. You will need to take it slowly and see how things progress. Here are some ways to do that:

1. Adopt an empathetic tone when in dialogue with the person who has Borderline Personality Disorder. Let them know that you know how they feel. This is not the same thing as accepting or condoning poor behavior, but it does indicate that you hear them and understand their feelings.
2. Try getting the person with Borderline Personality Disorder to see discrepancies in their statements and actions without being confrontational about it. “I’m confused. A minute ago you said X and now you are saying Y. Can you help me understand?” or “You said you wanted to X and then you did Y. I don’t understand.” This may help them to see the contradictions between their thoughts and actions.
3. Accept resistance. No one can change until they are ready to, and no amount of cajoling or coaxing will help. If you feel resistance, you must accept that the time for change is not now and let it go. Pushing won’t help, and can very likely make things worse.
4. Encourage the person by letting them know that you believe in their ability to change and improve their lives. Be available for support. 

While you may find that some of the above steps improve communication, it is still an uphill battle to persuade a person with Borderline Personality Disorder to seek BPD treatment by telling them that you believe they suffer from the psychiatric disorder. Your loved one may believe a diagnosis of Borderline Personality Disorder will result in them being stigmatized or unsupported. 

But the biggest pro to telling someone that they have Borderline Personality Disorder is that they can finally get the BPD treatment they need to live a better life, have better relationships, and make a recovery from their BPD symptoms.

Acting impulsively with no regard for potential consequences is something people with Borderline Personality Disorder do in response to negative emotions. It’s another way to avoid feeling unwanted distress.

Gone untreated, impulsivity problems can cause great damage in multiple areas of the person’s life. Financial instability, unhealthy relationships, and problems maintaining steady employment are a few ways that impulsive behavior can have a negative effect on someone with BPD.

Impulsive behaviors experienced by someone with Borderline Personality Disorder include the following:

• Gambling
• Promiscuity
• Substance abuse
• Self-harm
• Rage
• Shoplifting
• Driving recklessly

Regardless of what the specific impulsive act is, it is generally indicative of an inability to self-soothe and an attempt to create distraction from underlying emotional issues. Don’t like the way you’re feeling? The fastest way to change that is to do something else as quickly as possible (or so goes the unconscious decision-making process, anyway).

Treatment for Impulsivity

Treating impulsivity effectively means teaching the person with Borderline Personality Disorder how to sit with unwanted feelings and allow those feelings to dissipate naturally without acting out in potentially destructive ways.

Dialectical Behavior Therapy (DBT) is now considered to be one of the most successful therapeutic approaches to Borderline Personality Disorder. It involves one-on-one therapy sessions, group therapy, and the teaching of four DBT skills: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

All four of these skills can help to successfully treat impulsivity. For example, mindfulness techniques teach patients how to tolerate unpleasant emotions until they pass. We can only act impulsively when we’re not thinking clearly and we can only begin to think clearly when our judgment is not clouded by emotion. Mindfulness techniques, along with distress tolerance and emotion regulation, teach people with Borderline Personality Disorder how to manage emotional distress instead of acting on it in potentially destructive ways.

Treatment for impulsivity also means targeting specific impulsive behaviors. Behaviors such as substance abuse and gambling addiction will need to be addressed on their own to be effectively treated. In some instances, medications may also be necessary to treat symptoms of impulsivity.

It should be noted that impulsivity is not exclusively associated with Borderline Personality Disorder, but is listed as a potential symptom of many other conditions and personality disorders. And not all impulsive behaviors are indicative of a larger mental health issue – we all have moments of impulsivity from time to time. It becomes a problem when the behavior has a lasting negative effect on a person’s interpersonal relationships and quality of life. Getting BPD treatment will help curb dangerous impulsive behaviors and result in greater emotional stability.

This evidence-based course, developed by the National Education Alliance for Borderline Personality Disorder (NEA-BPD), provides the most current information and research on BPD treatment, teaches coping skills based on Dialectical Behavior Therapy (DBT), and helps families to develop a support network. 

“We are very excited to again offer this evidence-based curriculum to the community at no cost,” saidMichael Roy, MSW, founder and executive director of Clearview Women’s Center for Borderline Personality and Emotional Disorders. “We put a priority on helping families understand how BPD impacts their loved ones and their family, and NEA-BPD’s course has been shown to help families learn useful skills and become better educated about the disorder.” 

Data from the National Institute of Mental Health documents that family members who participate in Family Connections experience a decrease in depression, burden, and grief, and an increase in empowerment through learning specific DBT therapy skills. 

More Information on Family Connections at Clearview 

The 10-week Family Connections course starts on Thursday, February 9, and runs on consecutive Thursdays, from 7:00 p.m. to 9:00 p.m. at theClearviewCenter inVenice Beach, Calif. The course is offered periodically at Clearview Women’s Center for Borderline Personality Disorder.

The Family Connections course is run by two Clearview staff members:Nicole Riddle, Psy.D., a DBT therapist, and Cris Shenk, MBA, national outreach director. Both were trained to lead the program through NEA-BPD. 

The Family Connections course is also offered at locations throughout the country, as well as via telephone. For more information and to register, visit NEA-BPD’s website. 

About Clearview Women’s Center  

Clearview Women’s Center for Borderline Personality and Emotional Disorders is the premier West Coast BPD treatment center. Located in Venice Beach, Calif., Clearview Women’s Center provides a full continuum of BPD programs and DBT therapy, including residential, outpatient, day treatment, and transitional living.

The kind of chaos that can result from having a child who may be angry, depressed, exhibiting compulsive behavior, or who has a substance abuse problem can wear you and other family members down and leave you feeling that you have little control over the situation.

In conjunction with appropriate Borderline Personality Disorder treatment for your child, there are communication techniques that you can employ with your child with BPD that can make a difference and help restore order in your home. One such technique that will complement the therapeutic process is learning to validate your child.

Validation Techniques

Adolescents and young adults with Borderline Personality Disorder are prone to emotional dysregulation. They often feel that no one understands or even likes them, and as these feelings become unbearable they act out accordingly. Assuaging these feelings can make a huge difference in reducing the distress they feel, and in helping them to better manage their BPD symptoms.

Alec Miller, Psy.D., offered the following validation techniques for parents with an adolescent suffering from BPD during a phone lecture offered by the National Education Alliance for Borderline Personality Disorder (NEABPD). Miller emphasized that validation is a crucial tool for both parents and therapists to understand.

• Validating your child can and should take many forms but, first and foremost, listen to them with your full attention. Make eye contact and really listen to their grievances. Repeat back to them how they feel and refrain from dismissive remarks such as “You shouldn’t feel that way, you know you’re smart, so just move on and get over it.” You want your child to know that their feelings are valid regardless of whether they “should” or “shouldn’t” feel as they do about what you may view as a relatively minor incident.
• Engage with warmth. It’s likely that your relationship with your BPD child may have become quite strained as a result of ongoing unresolved conflict. Repairing wounds begins with adopting a warm and interested tone with them, including your body language.
• Communicate your own feelings and vulnerabilities and be human! You don’t always have to conform to rigid roles of parent and child power dynamics. You can just be you around your child sometimes, thus fostering a relationship that connects you on a different level.
• Encouragement or cheerleading can be a way of demonstrating that you believe in your child’s ability to overcome obstacles and achieve goals. Praise them for what they do well and encourage positive behaviors through reinforcement. 
• Articulate their feelings for them when they may have difficulty expressing themselves. “You feel angry because I let your sister go to the party and you feel you are old enough to go, too. I understand that would make you upset. Do you feel hurt by that?”  If your child feels understood, they feel validated and may be able to move on from temporary emotional distress knowing that their feelings are noted and accepted.

It’s easy to see that what kids with BPD need in terms of validation are things we all need from time to time. In time, you will see that giving your child support through validation can reduce some of the pain they associate with feeling misunderstood or worthless.

It can be frustrating, painful, and exhausting to traverse the unpredictable terrain of a relationship with a person who has BPD. In this article, we will attempt to shed some light on what makes people with BPD think and act as they do.

Fear of Abandonment

Let us first note that almost all behaviors associated with Borderline Personality Disorder can be attributed to a deep and unceasing fear of abandonment. People living with BPD have often experienced childhoods fraught with trauma of one kind or another: abuse either physical or psychological, loss of one or both parents, or perhaps they were adopted and struggle with feelings of abandonment by their biological parents.

No matter the origin of the fear, it persists long past childhood and becomes the driving force behind all kinds of damaging behavior. We may feel that our reassurance and commitment to our loved one with Borderline Personality Disorder speak for themselves and should be enough to assuage their fears, but applying these kinds of logical assumptions simply doesn’t address the fact that it is not possible for the person suffering with BPD to feel or act any differently than they do, no matter what amount of effort you put into trying to make it so.

Rage

People with Borderline Personality Disorder are so convinced that they will inevitably be abandoned by loved ones that their behavior can swing in disparate directions in desperate attempts to avoid the pain of loss. Frequently, loved ones are subjected to intense rage and blame attacks. This is not how we might expect a person to behave if they fear being left alone. After all, wouldn’t excessive rage and anger drive people away faster?

For a person with BPD, unconscious choices are made in attempts to avoid unpleasant feelings. Rage can be a way to preemptively strike out against a person who they believe will leave them anyway. It can provide a temporary restoration of their sense of control over their emotions. When rage is directed outward, it can mask the inner pain that is driving it.

Depression, Self-Harm, and Suicidal Gestures

Loved ones with Borderline Personality Disorder may have debilitating depression, engage in self- harmful behaviors such as cutting or eating disorders, or they may even make attempts to kill themselves. All of these are distress signals that can be seen as attempts to gain the attention and love that they feel is missing in their lives.

By behaving in ways that often alarm and frighten loved ones, the person with BPD unconsciously seeks to pull people closer to them by demonstrating helplessness and fragility that must be attended to by family members. If they cannot be left alone for fear that they will hurt themselves, they have successfully avoided abandonment.

A Final Thought

The truth is that for those of us who do not suffer from Borderline Personality Disorder, absorbing all the information in the world about the disorder may never fill the gap that we experience in trying to understand their mindset. If you have never felt an utterly debilitating fear of abandonment or the loss of all control emotionally, you simply cannot imagine what it is like.

Until a person with Borderline Personality Disorder becomes an active participant in their own recovery, developing skills to help them self-soothe and communicate effectively, they will continue to exhibit BPD symptoms.

Due to this disparity, most BPD literature focuses primarily on how the disorder manifests in women. With men, there are some important differences in how the symptoms of Borderline Personality Disorder are both acted out and interpreted by others, and you may not even realize that your boyfriend is displaying symptoms of BPD.

While an official diagnosis of Borderline Personality Disorder is always recommended, here are some signs that your boyfriend might have BPD.

Fear of Abandonment

The underlying issue in people with Borderline Personality Disorder is the same for men and women: a fear of abandonment, often caused by abuse or neglect experienced in childhood. In the beginning of your love relationship, your boyfriend may have made you feel that you had finally found a man who didn’t fear commitment and appreciated you for the wonderful woman that you are. He might have presented himself as sensitive, loving, and extremely attentive.

However, when he felt confident that he “had” you, his behavior may have changed drastically and suddenly the honeymoon and romance were replaced by constant conflict. Fear of abandonment is the root cause of him pushing you away: because he is sure you will leave him, he may feel the need to criticize and reject you. While he likely has strong feelings for you, his innate fear of abandonment may keep your relationship from progressing unless he gets BPD treatment.

Anger Issues

People with Borderline Personality Disorder may have outbursts of intense anger. Displays of aggression are interpreted in men differently from how they are perceived in women. When men rage, it is generally seen to be more acceptable than expressing the fear, depression, or insecurity they may actually be feeling.

Men are also more likely to express rage physically than women are. Even if your boyfriend doesn’t lay a hand on you (and let’s be clear that men with BPD do sometimes abuse their partners physically), if he acts out physically in other ways such as punching walls or kicking things when he is angry, this is a sign that his “anger issues” may be indicative of something far more complex.

Compulsive Behaviors

Addictions and substance abuse have been shown to be more prevalent in men with Borderline Personality Disorder than in women. Compulsive behaviors such as sex addiction and gambling may also be present along with other signs of Borderline Personality Disorder.

While compulsive behaviors are often problems on their own, they may be a sign of a more complex psychiatric disorder such as Borderline Personality Disorder.

There is something to be said for intuition as well. If you feel in your gut that something is very “off’ with your relationship and the ways your boyfriend reacts to seemingly benign incidents, trust those feelings and explore the symptoms of Borderline Personality Disorder further.Readingthrough a full description of BPD symptoms will surely ring bells if your boyfriend is suffering from it.