My name is Sam Vaknin, and I am the author of Malignant Self-Love, Narcissism Revisited, and don't tell me that you didn't miss this introduction.
Today we are going to discuss Borderline Personality Disorder and Psychopathy.
Wait a minute, you see. Borderlines are the exact opposite of psychopaths. They have emotions, they have empathy, they are dysregulated, they are not goal-oriented like psychopaths.
Well, it seems that we have all been wrong. Borderline and histrionic personality disorders may be manifestations in females, in women, of secondary type psychopathy.
Secondary type psychopathy is a variant of anti-social personality disorder, a variant of psychopathy, which is measured by factor two, factor number two, in the standard PCLR test.
In other words, borderline and histrionic women may actually be psychopaths.
A growing body of recent studies supports this extremely startling conclusion.
Let's add even more.
Survivors of CPTSD, survivors of complex post-traumatic stress disorder, victims also manifest psychopathic and narcissistic behaviors, what I call psychopathic and narcissistic overlay.
So, borderlines, victims of CPTSD and psychopaths or psychopathic narcissists or secondary psychopaths may actually be one and the same.
In the case of victims and survivors of CPTSD, the psychopathic behaviors, the narcissistic choices, the traits that develop, they're all transient.
Not so in the case of borderline women. Intimate partners of borderline women will not be surprised. They are aware of, affected by, and familiar with the borderline woman's impulsivity, her defiant grandiosity, anti-social and interpersonal aggression, her manipulativeness, her dysregulated negative emotionality, paranoia, lack of object constancy or object impermanence.
In other words, out of sight, out of mind.
Attachment dysfunctions, hostility, splitting or dichotomous thinking, all white, all black, high levels of distress, anxiety, depression and substance abuse.
This laundry list is typical of and common among secondary psychopaths, but also among borderline women.
And men, of course, but the majority of people diagnosed with borderline personality disorder are women.
These women also defy gender roles and behavioral norms. They tend to be more masculine. They tend to adopt an ideology of anything a man can do, I can do better.
And in this sense, they emulate and imitate psychopathic men.
But the borderline woman adds a twist to this extremely toxic and pernicious cocktail.
And this twist is dissociation.
Whenever her stress levels, whenever her inner dissonance, for example, feelings of guilt and shame, pain, expectation or anticipation of abandonment, whenever there's inner turmoil inside her, when it becomes intolerable, she hands over control to her inner secondary psychopath.
And then she proceeds to depersonalize, to derealize or to develop amnesia.
All three are considered dissociative phenomena. And we will discuss them at length a bit later.
As she hands over control to her inner psychopath, she becomes malicious, malevolent, some would say even evil.
When the borderline's life partner is another proud member of the cluster B tribe.
In other words, when her partner also suffers from a personality disorder, a dramatic or erratic personality disorder, when her partner is another borderline, or another psychopath, or another narcissist, he reacts with equal measures of abuse to her frequent misconduct.
And the relationship ineluctably devolves into a kind of vicious power play and with numerous warping, cruel mind games, sadism.
And this exacerbates the mental health outcomes for everyone involved.
Yes, even narcissists, borderlines and psychopaths can be traumatized often.
So let's go back to dissociation.
Dissociative depersonalization and derealization are common reactions in borderline personality disorder, but also in dissociative identity disorder, DID, formerly known as multiple personality disorder.
Similarly, dissociation is common in patients with post-traumatic stress disorder, such as PTSD or CPTSD.
The experience of derealization and depersonalization is variously described as being on autopilot, sliding into anesthesia, or reverting to the status of an empathic or sad spectator. It is provoked by intolerable dissonance, as I said.
For example, when the borderline woman cheats on her partner when she is having ambivalent sex, when she is breaking the law, or when she is breaching some deeply held mores and values. In all these cases, which are just examples of dissonance, she would tend to dissociate.
Why does she dissociate? What's the aim? What's the psychodynamic aim?
Well, by dissociating, the patient distances herself from the events, from her pain, and from anticipated abandonment and rejection. By dissociating, she is no longer there.
There are these mechanisms of estrangement and alienation. It's like when she is saying, this is not happening to me. This is just a nightmare. This is not real.
Substance abuse and ambient destructions tend to exacerbate these reactive patterns.
And so we find borderline women with borderline personality disorder bar-hopping, or getting addicted to video games, or similar distracting activities, activities that are intended to take the borderline's mind off the cataclysmic agony that she is experiencing, off the impending doom of abandonment and rejection, off the guillotine of intolerable, unbearable pain that is awaiting her once she is dumped.
And so these substance abuse and ambient destructions tend to exacerbate reactive patterns. The patient ends up usually misattributing to alcohol or to drugs the behaviors wrought by her alters, wrought by her different self-states.
So here's the sequence. She's in pain, or she anticipates pain. She can't take it. She can't tolerate it. So she distracts herself. She distracts herself by drinking, by engaging in all kinds of activities, by having sex with a stranger. She does all these things as she consumes drugs and alcohol, for example.
So then she has amnesia, or she depersonalizes, or she cuts herself off reality, derealization.
And then in an attempt to explain to herself what had happened, why she can't recall anything, she says to herself, must have been the alcohol, must have been an alcoholic blackout, must have been something the drugs did to her.
So she explains the subsequent amnesia via the substance abuse.
But that's not the truth.
The truth is that another state of self has emerged.
Once the borderline is threatened with abandonment or experience as pain and rejection, another self emerges, the equivalent of an alter, alternative personality in dissociative identity disorder. And this self that emerges is very often a secondary psychopath.
Borderline personality disorder can best be described as a subspecies of dissociative identity disorder.
The mood, lability and emotional dysregulation are merely outward manifestations of changes in self-states. They represent switching from a host personality, A and P, to an alter personality, EP.
The dissociative trigger in borderline personality disorder is typically either actual abandonment or the perceived threat of rejection and separation from an intimate partner within an interpersonal relation. And this results in unbearable abandonment or separation anxiety.
Borderline is very low tolerance of uncertainty and anxiety. She preempts, she generates the various situations that she is so fearful of. So she's afraid of being abandoned, she abandons. She's afraid of being abused, she abuses.
Indeed, severe dissociation is even now a diagnostic criterion of PPD, criterion number nine. So borderline personality disorder is diagnosed partly based on dissociative states.
When one of the alters of the borderline is a psychopath, the borderline patient will be antisocial, impulsive, dysempathic, mendacious. She will lie about everything all the time, aggressive and defiant. She will be able to go for long periods without any romantic or sexual liaisons. During these periods, she would be like a lone wolf in her lair.
This is something that borderline personality disorder patients whose alters are not psychopathic cannot ever countenance or do.
So when we want to differentiate the borderline personality disorder patient with a psychopathic self state from a borderline personality patient without a psychopathic self state with some other type of self state, let's say a grandiose self state.
All we have to do is look at the patterns of behavior and existence.
Borderlines with a psychopathy, they are lone wolves. They're schizoid. They spend a lot of time alone. And sometimes they're avoidant, they avoid social contacts or society.
And borderlines with a grandiose self state with a grandiose alter, narcissistic, they would tend actually to seek company and they are incapable of surviving even for one day without an intimate partner. They feel horrible. They feel abandoned. They feel dead. They feel dead inside. They don't feel alive unless there's someone who loves them or someone they perceive as loving and caring.
It is a myth that people with borderline personality disorder or even dissociative identity disorder cannot fully control the behaviors and the choices of their alters. They can.
This is why the courts, courts all over the world reject borderline personality disorder and dissociative identity disorder as a mitigating circumstance, as a defense. They throw people in prison, even when it is proven beyond doubt that when they had committed the felony of the crime, they were under the control of an alter, an alternative personality, not the main post personality.
According to Cavanaugh, Sullivan and Mulby in a long forgotten clinical notetitled A Clinical Note on Hysterical Psychosis in the American Journal of Psychiatry, June 1979.
Well, according to these three scholars, again, Cavanaugh, Sullivan and Mulby, some narcissistic and histrionic people, mostly women, react with a transient form of psychosis to unwanted sexual advances.
But here's the surprise. They react exactly the same way with psychopathy and psychosis.
Also, when they are interested in someone sexually, when their fervent sexual interest is not reciprocated, when they want someone and they are rejected by that person.
In the footsteps of Martin 1971, the three authors explicitly attribute such decompensation and acting out, in some cases, to oral narcissistic structures in the personality and to immature object relations.
In other words, what the three authors postulate is that in women with borderline personality disorder, they are internal narcissistic structures, which cause the borderline to decompensate and to act out sometimes psychopathically to sexual rejection or to unwanted sexual advances in both cases.
I would add to this list, women who succeed actually to bed, to have sex with the men that they desire, but are then abandoned or ignored emotionally contrary to their wishes and fantasies.
So three cases, if there's unwanted sexual advance, if the woman is interested in sex, but the man is not, or if they both end up having consensual sex, but then the man dumps her, vanishes, abandons her and ignores her emotionally. In all three cases, there is a process of decompensation.
All the defense mechanisms are switched off and acting out. Acting out means reckless behaviors, such as unprotected sex or binge drinking or reckless driving or a shopping spree. And many of these behaviors today can be described as secondary psychopathy.
The connection between brief reactive psychotic episodes and symptomatic manifestations of dissociation, including amnesia and even dissociative identity disorder, this connection is well established.
Say, for example, the definitive work Dissociation and the Dissociative Disorders, DSM-5 and Beyond, edited by Dell and O'Neill, published by Rutledge in 2009.
So when these women, borderline women, disintegrate under stress or trauma or pain or anticipation or abandonment anxiety, when there is this process of decompensation and disintegration, the transition to dissociative psychosis is abrupt and shocking. It resembles switching from the core personality, the host personality, to an alter, alternative personality in multiple personality disorder.
Patients describe it as brain fog, though they may appear to be perfectly oriented and goal focused. Very often you can't tell from the outside that this is happening to them inside.
On such occasions, behavior changes markedly, becomes disorganized and then escalates to become aggressive, impulsive, disempathic, reckless, promiscuous and antisocial.
So while you can't very often, one cannot tell when the switching took place. After the switching had taken place and your personality emerges and takes over, in this personality, as you've just heard, is a psychopath.
Amnesia sets in much later and its aim is to repress painful and acutely uncomfortable egodystonic memories, which had they remained in conscious awareness, would have provoked extreme shame, extreme guilt and remorse. Where amnesia or fear, where amnesia is absent, the borderline woman undergoes depersonalization and derealization. She fears that she was acting as an observer on autopilot.
Substance abuse such as binge drinking or getting stoned, as I said before, exacerbates all these mental health issues and defenses.
More generally, I've been arguing in the past few years to reverse Kernberg's hierarchy, Otto Kernberg. He suggested a hierarchy whereby borderlines are closer to psychosis than narcissists.
I postulate that the narcissist is far closer to psychosis. His personality is less organized than the borderline. Only the narcissist's rigid grandiosity is keeping the narcissists together.
And when this grandiosity is effectively challenged, the narcissist decompensates, acts out and disintegrates.
Grotstein postulated that the borderline is a failed narcissist. The pathology did not progress or devolve into narcissism, which is a full fledged form of binary dissociative identity disorder with two selves, the false and the true.
The narcissist's solution to this duality of selves, the narcissist's solution to having multiple personality disorder with two selves, true and false, his solution is to switch off the dilapidated, atrophied and dysfunctional true self and to relegate the true self to the deepest resources of the mind where it has no influence whatsoever on the narcissist's psychodynamics.
So what is left? The false self. Only the false self is left.
And this is the narcissist.
In contrast, the borderline fails to repress and dissociate the true self. Where the narcissist succeeds to eliminate effectively the true self, the borderline fails.
Consequently, she never becomes a narcissist. And this so-called failure causes the borderline's two selves, the true and the false, to compete for control of her identity and her memories.
There is no such competition within the narcissist. The narcissist is the false self.
Take away the false self and there's nobody there. Nobody alone.
With the borderline, there are two selves in conflict, in battle. It is this inner struggle that mimics other dissociative disorders and led scholars such as Masterson, Dell, Putnam, Ross, Ryle and many others to suggest that borderline personality disorder may merely be another label for the identity diffusion and alteration common in dissociative disorders.
So what we have in a borderline is a dissociative psychopath. A dissociative psychopath, usually with the pronounced grandiosity of the narcissist and the seductiveness, the flirtatiousness of the histrionic when they are provoked by abandonment anxiety.
Borderline personality disorder is a basket diagnosis. It is a diagnosis that unites all cluster B diagnosis and its foundation is in trauma.
Therefore, via the conduit of borderline personality disorder, we can begin to see a unifying picture. These are all post-traumatic conditions and they all involve forms of all pervasive, ubiquitous dissociation. We are getting a sniff, we're getting a hint of the future. The future will center around trauma and dissociation.
Psychopathy, borderline, narcissist, these are different behavioral modalities. They are not real clinical constructs. This is exactly what led to the abnormal phenomenon of comorbidity. This is precisely why we had to make laundry lists which overlapped so massively that we had to invent differential diagnosis because these are not real clinical entities. They are simply facets of the kaleidoscope that is the soul of a Cluster B.
Borderline is another name for dissociation, post-traumatic dissociation and some borderlines act as psychopaths, others act as narcissists and all of them usually act as histrionic.
It's time to unify all these diagnoses into a single one, a diagnosis of personality disorder with emphasis. Personality disorder with grandiose emphasis, with psychopathic or antisocial emphasis, with histrionic emphasis and with dysregulated emphasis, formerly known or called borderline.