Is she a borderline or is she a narcissist? Is he a narcissist or is he a psychopath? Does she have borderline or is she simply traumatized?
CPTSD, complex trauma, is he a covert narcissist or is he a covert borderline? Is he a covert borderline or is he a covert borderline?
Whew! This is a serious problem in modern diagnostic psychology, clinical and abnormal psychology. We call it the polythetic problem.
We have comorbidities. Comorbidities means that two or more mental health issues are diagnosed in the same individual.
And sometimes these mental health issues are mutually exclusive. They contradict each other.
For example, when we diagnose psychopathy and borderline personality disorder in the same person, psychopathy, no empathy, no emotions, borderline personality disorder, only emotions, dysregulated emotions.
So it's a joke. The whole thing is a joke.
Differential diagnosis. Differential diagnosis are feeble attempts in the diagnostic and statistical manual to help us to tell these disorders apart.
Diagnostic and statistical manual had doubled these pages in the past 20 years, actually went up 10 times in terms of pages since 1952. We had 10 times mentally ill, 10 times more mentally ill, it seems, according to the committee of the DSM.
Well, until such time as the distinguished and venerable members of the Diagnostic and Statistical Manual Committee gather the courage to oppose the insurance and pharmaceutical industries and to do what the ICD, International Classification of Diseases Edition 11 had done, until such time as we recognize that there's only one personality disorder and that this one personality disorder is actually a form of complex trauma, CPTSD, post-traumatic condition.
Until such time, we are forced to cope with the whole zoo of literally indistinguishable allegedly different conditions, hence differential diagnosis. It's a mess. It's a joke. It's a caricature of science. It's pseudoscience, but it allows therapists, psychologists and psychiatrists to get reimbursed by insurance companies because they can point to a specific page or article in the DSM and it allows the pharmaceutical industry to inundate you with antidepressants, anxiolytics and other mind effing drugs.
So, all is well in the land of capitalism. I have prepared for you a playlist. A playlist is a series of thematically connected videos.
So, you go to the playlist and you watch a series of videos about the same topic.
Now, if you look at the description under the video, you will find that there is a link. If you click on the link, you will see a variety of videos. Each one of them will help you to distinguish autism from narcissism, narcissism from borderline, borderline from complex trauma, complex trauma from narcissism, narcissism from psychopathy, etc.
It's over and I encourage you to watch it.
Today, we are going to discuss autism, narcissism and borderline.
I'm going to add to the mountain of videos I've already made by calling your attention to a few additional similarities and differences between these disorders.
We start with autism and borderline.
There is an affinity between low-functioning autism and borderline personality disorder.
Low-functioning autism is the stereotypical autism. That's the kid who bangs his head on the wall, can hardly dress himself, is silent most of the time and suddenly erupts in rage, etc.
The classical picture, stereotypical picture of autism.
Now, most people with autism spectrum disorder are actually high-functioning. They have families, they have jobs, they go out into the world and they're almost indistinguishable from other people.
But there's a minority of people with autism spectrum disorder. There's a minority who are low-functioning autism people with low-functioning autism. They have a lot in common with borderline personality disorder, which of course raises the tantalizing possibility that both conditions are actually brain abnormalities.
In both cases, the sufferer is overwhelmed by stimuli. The person with autism spectrum disorder is overwhelmed by external stimuli. He drowns in the environment, is flooded by cues, messages, signals and information from his environment. He doesn't know how to react to this avalanche. He doesn't filter it as normal people do. He cannot relegate 95% of it to the unconscious as all of us do.
So instead of being exposed to 5% conscious content, he is exposed to 40% or 50% and of course such a person falls apart. It's terrifying. It's a feeling of being hemmed in, strangled, suffocating, smothered by the environment, the environment closing in on you like walls and it's very claustrophobic.
But the same way the autistic person is overwhelmed by the external environment, the borderline person is overwhelmed by her internal environment.
As the autistic person is exposed to external stimuli and then dysregulates, his behavior becomes out of control. The borderline is exposed to an avalanche, a tsunami of internal signals, internal stimuli, especially affects emotions and similarly she dysregulates. She falls apart. She's incapable of coping with the onslaught of emotions and so she emotionally dysregulates.
Indeed, autism and borderline personality disorder appear to be flip sides of the same coin. It is a form of dysregulation in reaction to stimuli, stimulus induced, stimuli induced dysregulation.
In both cases, self-harm serves to fulfill three self-soothing functions.
The autistic person self-harms, bodily, bangs his head on the wall, scratches himself, what have you. The borderline person does the same. He cuts himself or burns himself with a cigarette.
So both people with low functioning autism spectrum disorder and people with borderline personality disorder engage in self-harming, self-mutilating behaviors and these behaviors have the same three functions in both cases.
Number one, to reassert control over the dynamic of irritation and aggravation by the stimuli. Imagine the stimuli is an invading army. An invading army and the autistic person and the borderline person have no defenses. The borderline person is besieged internally by a fifth column, a Trojan horse, traitors from within and she can't cope with it. She's aggravated, she's irritated, she's terrified, she's anxious.
The same applies to the autistic person. He reacts this way to external stimuli. Both of them are trying to reassert control over this dynamic.
The elective act of self-mutilation and self-harm. This act is a form of I'm in control. I am cutting myself, I am burning myself, I am banging my head against the wall, but I'm in control of this.
A similar dynamic plays out of course in eating disorders. It's all about self-control. There is a niche, there is an act, there's a choice, there's a decision which I control fully. I can't control my external environment, I can't control my internal environment, but I can control how much I eat or how I harm myself or how I mutilate my body.
The second function of self-harm is to drown out sources of frustration and pain with even greater agony.
So the self-inflicted pain of the autistic person and the borderline person, they counterbalance and cancel out the pain, the hurt and the anxiety that they feel in reaction to over-stimulation.
So if the borderline cuts herself, for a minute there she's focused on the pain of the cut. She no longer is preoccupied with her emotions and what her emotions are threatening to do to her, which is to kill her.
Indeed 11% of people diagnosed with borderline personality disorder end up committing suicide. Actually cutting self-harm, self-mutilation, these are desperate attempts, desperate attempts to create an external pain, an external torture that counterways the internal battle, the internal battle that often is lost.
And the third function is to reawaken, feel alive as a self-inflicted hurt negates the numbing, the erstwhile numbing, both autistic people and borderline people react to their inner turmoil with numbing.
What we call reduced affect display. They acquire habits which deny to observers the ability to discern what's happening inside them.
So their emotions are shallow affect or flat affect. Their emotions are shallow and numb until the point where they decompensate and become rageful.
But most of the time they have numb emotions and in the case of the autistic person they have numb affect, in other words they don't show any emotions and any affects.
The only exception is of course the rage attacks, the aggression, the externalized aggression which are common to both the borderline and the autistic person.
Cutting, self-harming, self-mutilation, they revive the borderline, they revive the autistic person.
They imbue the borderline and the autistic person with a renewed sense of being embedded in reality. They bring them back to reality in a sense.
Now these are autists and borderlines.
What about narcissists and borderlines?
Again go to the description, there's a link there, it's a playlist. Click on the link, you will find a wealth, a plethora of videos about the differences between borderlines and narcissists, borderlines and complex trauma victims, borderlines and covert narcissists, etc. Watch these videos.
I'm not going to repeat myself. I'm going to add to what I've said in the past.
The narcissist experiences periods of collapse.
If you look at the recent videos I've made over the past week or two you will find a video dedicated to the collapse phase in narcissism and psychopathy.
So the narcissist experiences goes through horrible harrowing periods of collapse usually coupled with something known as narcissistic mortification but not always and not necessarily.
The collapse simply means a sustained failure to obtain narcissistic supply despite all efforts, attempts, and strategies.
The narcissist tries everything, attempts everything, changes himself, escalates his behavior, nothing works. He's unable to obtain supply so he collapses.
The collapse can be subclinical collapse. That's a protracted, drawn out, incremental type of collapse because there is some incoming narcissistic supply. It's barely sufficient and it's a maintenance dose of supply but there is still some supply coming in, drips and drops of supply coming in and so the narcissist is able to somehow maintain the precarious balance of his disorganized chaotic personality.
Apropos meaning and so this is called subclinical collapse. A slow inexorable, injurious traumatizing process of gradually and incrementally losing your supply day in and day out less and less supply by the day.
That is in contradistinction in contrast to traumatic collapse. Traumatic collapse is abrupt. It's when the narcissist loses all his sources of supply simultaneously. For example, when he goes to prison. It's an example or when he becomes very ill and is hospitalized or when he joins the army.
So this is an abrupt collapse or when everyone abandons him because he has been cancelled or he has been outed or he has been shamed and humiliated in public which also leads to mortification.
Okay, so that's the background of collapse. As long as the supply keeps coming, the narcissist is egodystonic, is happy-go-lucky. He is comfortable in his own skin. As long as the supply keeps coming, the narcissist is a-okay.
The collapse results in severe ego-dystony, the opposite of ego-syntony. Being dejected, unhappy, uncomfortable with yourself is called ego-dystony.
When you are very self-critical, self-punitive, self-loathing, self-defeating, self-destructive, it's a manifestation of ego-dystony.
So the collapse leads the narcissist to severe very harsh ego-dystony and dysphoria, often to the point of depression.
So in this sense, the collapse in narcissism resembles decompensation in border lines. Decompensation is a clinical term. It simply means the inactivation, the disabling of all psychological defense mechanisms, so that you are left naked, immediately exposed to the environment or as a scholar once said, without skin.
The borderline goes through decompensation when she is abandoned, rejected, humiliated, or when she anticipates such things. And so she decompensates.
And then later on, she acts out, she switches to secondary psychopathic self-state and acts out.
But decompensation resembles very much collapse in narcissism, very, very much actually, with one exception. Collapse does not include emotional dysregulation because the narcissist doesn't have access to his positive emotions.
His negative emotions, however, do get dysregulated.
His envy, his rage, his anger, all these, they do get dysregulated in the collapse phase.
Only positive emotions don't.
In the borderline, decompensation leads to an emotional dysregulation that is all- encompassing. Both her positive emotions and her negative emotions become dysregulated, go out of control, threaten to overwhelm her and destroy her, which is why she switches to a secondary psychopathic self-state.
So the first distinction between narcissism and borderline is that both of them go through collapse.
In the borderline case, it's called decompensation. Both of them lose everything, all their defenses, because narcissistic supply and the false self, it's a defense. It's a compensatory defense.
So both of them lose the defenses, but with a narcissist, only his negative emotions get dysregulated, and with a borderline, all her emotions get dysregulated, which further supports Grotstein's idea that borderlines are actually failed narcissists. They didn't make it. They got stuck in the middle, and so they still have access to their emotions, and they still have empathy.
So once the narcissist experiences collapse, he transitions from one type of narcissist to another type of narcissist. He transitions, for example, from cerebral to somatic, or he transitions from being overt to being covert. And this is exactly what happens with the borderline.
The borderline switches between self states.
Again, when she's abandoned, rejected, humiliated, or stressed, she then switches from borderline to secondary psychopath.
In this sense, the narcissist's type in constancy, his tendency to change his type like a chameleon, subject to environmental cues and stressors, is this very similar to the switching process in borderline.
But in borderline, the switch is very short, no longer usually than a few days, typically a few minutes or a few hours, but no longer than three or four days.
In the narcissist, the switch could last years, even decades. Narcissists could switch, could transition from being cerebral to being somatic, and it could last years.
I, for example, have switched from cerebral to somatic a few years ago, and it's still ongoing. Similarly, I've switched from somatic to cerebral, and I've stayed in a cerebral mode for 15 years. This is how long.
So the only difference, the only clinical, psychodynamic difference between narcissists and borderlines, is that when the narcissist switches between self states, when he alternates and cycles between self states, it's for long, it's for keeps, it could take years until the next switch is upon him.
When the borderline switches, it's a remedial measure, it's a solve, it's an adhesive. She's just trying to lick her wounds, to cater to her injury.
And then when this is done in a few hours, in a few days, she's back to her original state.
Now in this cerebral type, in narcissism, sexual abstinence is a form of self-supply. In other words, sexual celibacy, abstinence, makes the cerebral narcissist feel superior. He creates a whole ideology around it, that he doesn't have sex, just goes to prove that he isn't the next stage in evolution, that he is far above the bestial instincts of the hoi polloi, and the great unwashed.
In other words, the cerebral narcissist's asexuality, in effect asexuality, almost there, is at the service of his grandiosity. It's an integral part of his identity, and of the ways that he buttresses and sustains and supports his grandiose view of himself.
In other words, regards sexlessness as meritorious and virtuous, the same way the church regarded it during the middle ages.
It is the collapse induced depression that drives the narcissist to become sexually voracious in the somatic phase.
Now this is mind-warping, it's a mind-boggling insight.
In all people, and I mean all people, even mentally ill people, even schizophrenics, even people with borderline personality disorder, even bipolar, depression means a decrease in sexual libido, a decrease in the sex right. When you're depressed, you don't want to have sex. End of story. Very often, one of the ways we diagnose depression in clinical settings is we inquire about the sex life of the patient.
If we see a precipitous and sudden drop in sexual activity, we tend to immediately suspect depression.
But contrary to the rest of humanity, as usual, in narcissists, depression leads to enhanced libido, a higher sex drive, a stronger sex drive. When they're depressed, they want to have more sex.
Why?
Because sexual conquest and sexual performance are antidotes to the depression, because it's not really depression. It's a depression that is reactive to the loss of supply.
So the narcissist tries to garner new supply through sexual activity.
So depression, the chain of events is this. The narcissist loses his narcissistic supply. He becomes depressed. He needs to find new supply urgently or he will fall apart.
So he begins to have sex, because sex is immediate narcissistic supply.
And so with a narcissist, when he's depressed, he's likely to become a hyper sexual, sexually hyperactive, as opposed to all other humanity, the rest of humanity.
Now, in narcissism, and when it comes to borderline, the situation is different. A borderline who is depressed will become highly abstinent and highly celibate.
Actually, in borderline, we have periods of extreme promiscuity, unbridled, unboundaried, self trashing sexual misconduct, followed by periods of withdrawal, avoidance, and utter total sexual abstinence. It's similar with the narcissist. He goes through periods of sexual abstinence and period of sexual promiscuity, exactly like the borderline.
But as you see, the etiology, the reason this is happening is not like the borderline.
In the borderline, these alternations in sexual behavior are an outcome of her internal dynamics. For example, her perception of having been abandoned and humiliated and rejected by many people, by many intimate partners. In the narcissist, these alternations between sexual hyperactivity and sexual hyperactivity, low activity, they're driven by the fluctuations in supply.
Supply runs dry, the narcissist runs dry, the narcissist gets depressed, becomes sexually active. Supply runs high, the narcissist becomes grandiose, and idealizes sexlessness. Completely different etiologies, same behaviors.
Now, back to the types in narcissism.
We know somatics, the river, the word covert. The types are actually highly dissociative self-states.
In narcissism, these self-states are almost full-fledged personalities, which is why I think narcissism is a very close cousin, a first cousin of dissociative identity disorder, essentially a post-traumatic condition.
Because in narcissism, the self-states are very demarcated and they don't share a lot of information with each other. They have impermeable dissociative partitions. They don't have full access to the same database, for example, of memories. Each self-state has its own set of memories, which it doesn't share with the other self-states.
So, this is the narcissistic condition. And because they are not one and the same in narcissism, we in narcissism sometimes encounter binary systems.
We find narcissists which are both covert and overt at the same time, both cerebral and somatic and somatic at the same time. And the two self-states are in conflict, are in dissonance. These are passing phases, usually, except in extremely pathological conditions, but they're there.
And so, we could have a situation where the narcissist transitions from a cerebral phase to a somatic phase. And then the somatic phase, the somatic reification of the somatic embodiment of the narcissist, mourns the years of cerebral sexlessness.
So, you would talk to this newly minted somatic narcissist who used to be cerebral. And this somatic narcissist is in mourning and very angry at the cerebral for having denied the common body.
They both share sex. So, for example, I transitioned from cerebral to somatic a few years ago, and I'm furious at myself for having denied myself sex for 15 years. My somatic reincarnation is furious at my erstwhile cerebral manifestation for having denied our common body sex.
But similarly, the cerebral grieves over the time wasted by the somatic in the relentless pursuit of sexual conquests.
Both of these types fail to recall the bliss that they had experienced during the time spent as the other type, regardless of the so-called sacrifices made.
Because these types don't share information fully and don't have access to the same memories, they're very monopolistic and exclusive when it comes to memory, because they don't share a common template even though they share a body.
They're very angry at each other and they don't remember. The somatic doesn't recall, doesn't remember how good it had been, how good it had been to be a cerebral. And the cerebral doesn't recall.
What a wonderful time the somatic has had. They simply don't remember. And all they do remember are the sacrifices.
The somatic remembers that the cerebral had sacrificed their sexuality. And the cerebral remembers that the somatic had sacrificed their common time. These are the sacrifices.
But they don't recall at all that when they had been in the phase, when they had been a different type, they were happy. They were egosyntonic. They don't remember that.
So if you were to tell the somatic, but wait a minute, why are you angry at the cerebral? This 15 years that you didn't have sex, the cerebral was perfectly happy. It was a blissful period. And the somatic would deny this. He would say, not true. The cerebral had been depressed, but there's a misattribution here. There's a misunderstanding. The cerebral had been, the somatic remembers that the cerebral had been depressed because this depression had led to the emergence of the somatic. It's a bit complex.
Let me try to explain again. I know it's a bit complex.
Min break. The narcissist is sometimes cerebral, sometimes somatic. He transitions from cerebral to somatic because of collapse. He cannot obtain supply. So he becomes somatic to obtain supply via sex.
Get supply sex quick.
Okay. That much is clear. When he transitions from cerebral to somatic, the somatic is angry at the cerebral for not having had sex during the cerebral phase. And the somatic says the cerebral was depressed.
Cerebral experienced depression and he experienced depression because he didn't have sex or he didn't have sex because he experienced depression.
Somatic links the memory of the depression of the cerebral to the absence of sex.
But the somatic is getting it wrong. The reason the cerebral was depressed had nothing to do with the sex. The reason the cerebral had been depressed is because he couldn't get supply. The only reason for depression in the narcissist is collapse, inability to obtain supply. Depression in the narcissist is 100% reactive.
And so the somatic is getting it wrong. He's saying, look at this idiot, the cerebral, he didn't have sex. And consequently, he has had depression.
But the truth is the cerebral didn't have sex and was very happy with not having had sex. Very happy. It supported his grandiosity. He felt blissful and blessed and superior for not having had sex. That's not the reason he got depressed.
The cerebral got depressed because he couldn't obtain supply anymore. It has nothing to do with the sex. And so they keep blaming each other. They misattribute the depression brought on by imminent or actual collapse to the compulsive behavioral constriction of the other type.
And so this is very common in borderline as well.
This misattribution error or attribution error. The borderline attributes to her previous state, errors, mistakes, and misbehavior, guilt and shame.
So for example, when the borderline transitions to the secondary psychopathic phase, defending against abandonment, anxiety, humiliation, and stress, the secondary psychopathic borderline would criticize her behavior as a pure borderline before she had switched.
Each of the self-states of the borderline is critical of the other. The psychopath would say, look at this stupid borderline, how gallibal she was, how dependent she was, how weak she was. How weak she was.
So the psychopath criticizes the borderline. The borderline criticizes the psychopath. When she switches back from secondary psychopath to borderline, she would say, look at this psychopath, how reckless she had been, how stupid her decisions were.
So this conflict between the self-states, this dissonance, is common to borderlines and to narcissists. And attribution errors are common as well.
And the memory, the recall of the mood disorder that preceded like a warning sign, preceded the immediate switch.
So sequences, a collapse or an injury or humiliation or rejection in the case of borderline, and then a mood reaction, a reactive mood, and then the switch to another self-state.
Finally, both borderlines and narcissists experience separation insecurity colloquially known as abandonment, anxiety. Both of them are terrified of being abandoned because both of them have something called object inconstancy. I've made a gazillion videos about this topic, so please search the channel, use the magnifying glass, use the downward arrow on a smartphone.
Object inconstancy simply means that the borderline narcissist cannot maintain a stable representation of another person if he's not with them physically.
In their minds, there is no avatar or representation of the real person. The real person has to be with them, present physically.
The narcissist has a snapshot, but the snapshot has nothing to do with the real person. It's an idealized version of the real person.
So both of them suffer from abandonment, anxiety. Both of them also merge and fuse with an intimate partner in a symbiotic phase.
The shared fantasy. This is common to borderlines and to narcissists, but the borderline distances herself from her intimate partner, owing to an overwhelming and government anxiety. When she gets too close to her intimate partner, she feels suffocated. She feels subsumed, submerged, assimilated. She feels that she's about to disappear.
This creates in the borderline approachavoidance, repetition, compulsion, a cycle of approaching the intimate partner because she needs him to regulate her internal environment, emotions, but then she's terrified of too much intimacy because she feels that she's drowning. She's overwhelmed. She develops a motion of this regulation and runs away, decompensates and acts out in a secondary psychopathic phase. This is why the borderline is distancing herself, but the narcissist does not have an engagement anxiety. He devalues and discards his partner exactly as the borderline does, owing to his need to separate from a maternal figure.
Again, I recommend that you watch the several videos I've made, including conversations with Richard Grannon on the topic of separation individuation.
The borderline and the narcissist create a shared fantasy with the intimate partner. The borderline wants out because she feels that she's vanishing. She's disappearing within the shared fantasy. The narcissist wants out because he needs to separate from his intimate partner who had become his surrogate new mother, a maternal figure. He needs to complete the unfinished business, a cycle, complete the cycle, the early conflict and the unfinished business with his real mother. He needs to separate and become an individual.
These are a few of the differences between borderlines and other mental health disorders.
Again, go to the description. There's a link with the playlist. This playlist I've placed all the videos that deal with comorbidities and differential diagnosis. In other words, differences between various mental health diagnosis.
I wish you a good day despite this video. Try to recover. Don't listen to me too often. It could be harmful to your health, but exactly like cigarettes. I am addictive.
My name is Sam Vaknin. I'm the author of Malignant Self-Love, Narcissism Revisited, and the most handsome and your favorite professor of psychology. Be well.