Narcissist Or Psychotic Borderline Or Schizophrenic

Uploaded 6/22/2023, approx. 28 minute read

Those of you who follow my Instagram, narcissism with Vaknin, know that I've been on a shopping spree yesterday. I bought a secondhand copy of my own book of short fiction.

Itwon't win the 1997 award of the Ministry of Culture for pros, for maiden pros.

Me. I bought many, many other books, among them a Hebrew translation of the Quran. Yes, the Quran and a copy of the Holy Zohar, the main book of the Kabbalah.

What's going on? Is the end of the world near? Or am I going psychotic, insane?

To investigate this distinct possibility, I decided to make a video and then to watch it myself.

Why should you be the only ones to suffer?

And the topic of today's video is narcissist or psychotic, borderline or schizophrenic?

Is psychosis, psychotic disorders, schizophrenia, which is also a form of psychotic disorder, are these actually other names for borderline and narcissistic personality disorder?

Now, before you think that I really, I've really gone start raving mad. This idea has a very long provenance and pedigree.

Among those who supported this idea was Sigmund Freud, another one Otto Kernberg, prominent psychologist.

Others of the profession and the field, they were convinced that borderline and narcissistic personality disorders are attenuated, mild forms of psychosis.

Hence the name borderline personality disorder on the border between neurosis and psychosis.

But I'm going to go when no one has ventured before, when no one dare to go before me.

I'm going to investigate the various features of narcissism and borderline and compare them to current day, bleeding edge knowledge about psychotic disorders.

Before we proceed, we need to disambiguate a few terms.

There's a pop up here and I can't get rid of it for some reason. We need to disambiguate a few terms and words and so on and so forth.

So first of all, we need to make a distinction between psychosis and schizophrenia and then we will disambiguate other terms.

Psychosis and schizophrenia.

Schizophrenia is a psychotic disorder, but there are many, many others.

Now we use the word psychotic as a disparaging, derogatory, stigmatizing word.

But actually all it means is losing touch with reality.

Psychosis can and very often is brief and temporary.

A brief psychotic disorder.

Psychosis is very common in the form of micro episodes.

A psychosis that lasts a few hours to a few days.

So it's very common in a variety of other mental health disorders.

For example, bipolar disorder, major depressive disorder, disorder, all kinds of dementia and yes, you're right, borderline personality disorder.

Don't confuse psychosis with psychopathy, please.

Schizophrenia is the most extreme known psychotic disorder.

It involves delusions, hallucinations, disorganized thinking, disorganized speech, disorganized motor behavior, like spilling wine all the time all over the keyboard.

Hint, hint.

Negative symptoms. For example, a limited emotional expression clinically known as reduced affect display.

We divide all the symptoms of psychotic disorders into positive and negative. Don't ask me why.

Positive symptoms are include hallucinations, delusions, disorganized speech and so on and so forth.

Negative symptoms is the inability to experience pleasure and hedonia and lack of emotional expression, reduced affect display and so on and so forth.

I remind you, psychosis is more common than you know. Three in a hundred people, three percent of the population have experienced psychosis at one time or another in their lives.

Your mind can't tell the difference between reality and imagination, between fact and fiction.

I wanted to say reality and fantasy, but that's wrong. Fantasy is a defense mechanism.

Soon I will discuss the difference between fantasy and psychosis.

Remember, delusions, hallucinations, disorganized speech and thinking, disorganized motor behavior, diminished emotional expression, anhedonia, inability to experience pleasure, abolition, a lack of motivation, inability to get started on tasks, lack of will, losing will.

This means that you are quiet and unresponsive and in extreme cases this is known as catatonia.

And then a lability, limited interest in social interactions, very reminiscent of the schizoid condition.

Indeed, certain personality disorders are considered essentially psychotic. They were separated from other psychotic disorders and relegated to the personality disorders section in the Diagnostic and Statistical Manual.

But if you were to look at the ICD, the International Classification of Diseases, they are still listed under psychotic, under schizophrenia.

So we have, for example, schizo-tiped personality disorder, schizo-it personality disorder and paranoid personality disorder. They're all considered kind of psychotic or on the verge of psychosis or about to become psychotic, precursors of psychosis.

Now, if you want a list of psychotic disorders, the schizophrenia, we no longer use the term paranoid schizophrenia or schizophrenia paranoia. And the reason we don't use this term, this phrase, anymore, any longer, is because not all people with schizophrenia are paranoid.

Paranoia does characterize a substantial part of schizophrenics, but not all of them.

So it's very misleading to call all schizophrenics paranoid schizophrenics.

Then we have schizoaffective disorder. We have schizoaffective disorder, delusional disorder, brief psychotic disorder, which I mentioned earlier. And of course, psychotic disorders that are induced by substances or medications or reading the wrong books late at night. Or listening to Sam Vaknin, of course.

A recent study in Idaho found out that if you listen to more than 3.7 videos of Sam Vaknin per day, you are bound to end up either psychotic or very, very well educated in psychology, whichever comes first.

Okay, I mentioned that psychosis can be found in bipolar disorder, in major depressive disorder, but it is also very frequently the outcome of post-traumatic stress disorder.

And here we are beginning to see the interface between psychotic disorders and post-traumatic personality disorders, such as borderline personality disorder and narcissistic personality disorder.

You know that I've spent the last 10 years and even longer trying to redefine narcissistic personality disorder and borderline personality disorder as essentially post-traumatic conditions, not personality disorders.

And so psychosis is common in all of them.

And also following some medical conditions, such as stroke, traumatic brain injury, tumors, dementia, I mentioned, sleep disorders.

If you suffer from sleep apnea for a very long time, or if you suffer from insomnia, other insomnia disorders and so on, but I mean for a very long time, you may definitely become psychotic.

Actually, a substantial part of such people do become psychotic.

Epilepsy and Parkinson's disease also constitute part of the list.

I hope I disambiguated schizophrenia from psychosis. They're not the same.

Schizophrenia is a private case of psychosis, and psychosis is not a mental illness. It's a symptom.

Okay, what about imagination? What about fantasy? What sets them apart from psychosis?

Well, when you imagine something, you know that you're imagining it normally, if you're normal, if you're healthy, mentally healthy, you know you can tell the difference between your imagination and reality.

Even if you're possessed of magical thinking, which I will discuss a bit further, even then you can tell the difference.

Even when you have a fantasy defense, you can still tell the difference. The lines become very blurred when we discuss the fantasies of borderlines and narcissists.

Because narcissists, for example, are unable to tell the difference between a shared fantasy and reality.

That's why narcissists do not gaslight. Do not gaslight. They don't even lie. They believe that their fantasies are real, and they are trying to induct you into their fantasies.

They're trying to inculcate in you the misinformation or misbelief that the fantasy is real.

So they deceive themselves to the point that they become delusional.

The fantasy defenses of narcissists and borderlines have gone awry and have become, for all intents and purposes, psychotic.

That's where I fully agree with Otto Könberg's groundbreaking, amazing work.

The fantasy, in the case of the narcissist, feels very real, and the same goes for the borderline.

And this is a great definition of psychosis. When your perception of reality overrides reality. When you believe that your perception of reality is reality rather than reality itself.

And of course, your perception is skewed, is wrong, is biased, is imaginary, and ill-informed.

And yet you believe that the way you perceive reality is the real thing, and reality itself is the fake.

Reality is the fantasy. Reality is the imagination.

Reality is unreal.

And that is common to psychotics, people with psychotic disorder, but also common to narcissists and borderlines.

In this sense, narcissists don't have imagination. They don't daydream. They create alternative virtual realities, paracosms. They move into the fantasy. They inhabit it. They reside in it. They possess the fantasy.

And so in the most crucial aspects and respects, narcissistic personality disorder is a post-traumatic psychotic reaction.

And this goes doubly when we apply it to borderline personality disorder.

I want to read to you something that was written in 1990, that's like 33 years ago.

It's an article, it's in Croatian that I'll translate for you. It was written by Tervović.

Tervović at the time was working in the clinic for psychiatric medicine in the faculty in Zagreb, Croatia.

And that he wrote, "Depression in schizophrenia is determined by narcissistic injuries, by a collapse of narcissistic satisfactions."

Today we say narcissistic supply. "By a collapse of narcissistic satisfactions through the loss of ego functions, completeness, competitiveness and competence."

The depressive model is most frequently encountered in florid schizophrenic psychosis, the beginning of hospitalization.

But depending on the intensity and depth of narcissistic traumas and losses, it can develop also in any phase of the therapeutic process and the course of illness.

In the author's view, the depressive model in schizophrenia is not conditioned by the neuroleptic treatment. Its recognition is very important for the therapy of suicidal tendencies and for the prevention in particular.

This is one of the first, if not the first observations that I've come across, suggesting some confluence or conflation or connection between narcissistic injuries and for example narcissistic mortification, which is a thousand times narcissistic injury, between this and the emergence of psychosis to the point of schizophrenia.

What the author is suggesting is that psychotic disorders, including schizophrenia, are reactions to narcissistic mortification and narcissistic injuries.

Now, Freud suggested the same. Freud suggested that psychotic disorders are forms of narcissistic disturbances.

But Freud didn't take the extra leap of connecting psychosis to narcissistic injury and mortification.

Okay, I'm going to now touch upon several elements which are common both to psychotic disorders and personality disorders, especially erratic, dramatic, schizotypal, schizoid and paranoid personality disorders.

First to be and schizoid, schizotypal and paranoid.

Start with role play.

In all these disorders, the patient plays a role and it's a role embedded in a fantasy.

The fantasy can be erotic, aggressive, self-aggrandizing, anything.

Many patients consider themselves or view themselves as heroes, rescuers, saviors and protectors.

This is a form of role play in an extreme fantasy, a fantasy defense gone awry.

The fantasy is self-directed, whereas a typical fantasy defense refers to the environment, it modifies the environment. It changes the way we receive information and data from our surroundings and from other people.

That's a typical fantasy.

In psychotic disorders and narcissistic and borderline disorders and paranoid and all the personality disorders that I mentioned, the fantasy is not outward directed, it's not externalized, it's internalized.

The fantasy is about the self and the role of the self in a totally imaginary environment.

And the conviction is huge, enormous. The patient is convinced, for example, the patient is convinced that he is a good person, that he is convinced that he is a good person, that he is a savior or a protector or a helper or a rescuer or a healer or someone who is helpful to this or that group.

So this self-conviction is fantastic. It's also delusional. We're going to come to delusions a bit later.

And when it is self-directed, we know that we are dealing with psychosis or psychotic elements in the narcissistic disturbance or the borderline disturbance.

Now, when I say self-directed, you can immediately say, but hey, Vaknin, you taught us about the shared fantasy and shared fantasy includes other people, for example, the intimate partner.

So the shared fantasy is not self-directed. It incorporates other people. You're wrong. No, I'm not wrong because the narcissist and the borderline, they regard other people as extensions of themselves. They regard, the narcissist regards other people as internal objects inside his mind, introjects, voices similar to the psychotic patient. The borderline regards other people as outsourced functions, externalized functions.

So the fantasy of the narcissist and the fantasy of the borderline are self-directed. And by extension, it subsumes, it includes other people because everyone in the eyes of the narcissist is a part of himself.

And so this is the first connection between psychosis and narcissistic and borderline personality disorders, because in all three conditions, there is self-referential framework.

The psychotic regards himself as the world. That's why the psychotic confuses his internal environment and reality. We'll come to it a bit later.

So the fantasy is self-directed. As the fantasy is self-directed, there is a sense of self-efficacy, which is also self-directed.

In other words, the psychotic patient, the narcissist and the borderline, they all perceive themselves as self-contained, self-sufficient, self-efficacious.

Even the borderline, who needs, who depends on her partner for self-regulation, regards her partner as a tool, a mere instrument. She owns the partner. He belongs to her. He is her property.

So there is this perception of, I don't need anyone. I can accomplish anything I want if I just put my mind to it, literally.

The fantasies of the psychotic, the narcissist and the borderline involve wish fulfillment and substitutive action.

The psychotic patient, the narcissist and the borderline imagine that their wishes and dreams are fulfilled, that their fantasies are realized and actualized.

And this wish fulfillment is done or accomplished via imagining action, not real action, but imaginary action, substitutive action.

And in totality, this whole compounded mechanism is the equivalent of self-regulation in healthy people.

In other words, these patients regulate their internal environment by developing a belief or a conviction or a fantasy or a delusion that the internal environment is actually reality.

And so when they act on their internal environment, they convince themselves that they have acted on reality.

I mentioned that all three conditions are the outcome of childhood trauma, post-traumatic stress disorder.

This is the patho-etiology of all three conditions.

But this is much more pronounced in borderline personality disorder than in narcissistic personality disorder.

Some psychotics have a background of trauma.

However, everyone with trauma can develop psychosis and many do. Not everyone with psychosis comes from a background of trauma.

Now, what is common to all three conditions is hyper-reflexivity, a confusion between internal objects and external objects.

This perceives external objects as internal ones.

The psychotic perceives internal objects as external ones.

The borderline has no internal objects. She doesn't have introject constancy. So she constantly internalizes external objects on the fly, but it never holds water. It never persists.

She has this task of recreating her internal environment all the time, which is a great way to describe identity disturbance.

Now, all three conditions, psychotic, narcissistic and borderline, they have paranoid ideation. To this or that degree, hyper-vigilance is a form of paranoid ideation.

But in extreme cases of borderline narcissism and psychosis, we have paranoia. And of course, we have a form of narcissistic disturbance known as paranoid personality disorder, where paranoia is the core.

Paranoia is a narcissistic defense. The paranoid believes that he is the center of attention. The attention is malign, it's malevolent, but he is still the center of attention. He is sufficiently important for others to conspire against him.

So we are beginning again to see a connection between paranoia, narcissism and psychosis. It is a thread that connects all of them.

It is because of the paranoia that there is an innate preference for fantasy.

Reality is perceived as hostile, threatening, dangerous, risky, frightening. So rather than engage with reality on its own terms, the paranoid, the narcissist, the borderline, the psychotic, they withdraw. They retreat. They avoid reality. And they create an internal reality, which is fully manageable and controllable.

And this reduces their anxiety.

Paranoia therefore, contrary to accepted opinion, paranoia is actually anxiolytic. It reduces anxiety because it generates the false perception of I'm in control. I'm in the know. I anticipate the enemy's next moves and I'm well prepared. I'm well prepared for the conspiracy against me.

Magical thinking is a form of fantasy and paranoist often engage in magical thinking.

But magical thinking is a much bigger phenomenon. It could be persecutory. So someone with a persecretary form of magical thinking would say that he is haunted and possessed by demons who want to kill him or destroy him somehow.

But the magical thinking can be grandiose. So someone with a grandiose magical thinking would consider himself a superhero out to save humanity or to save women from their abusers or God knows what.

For example, of a grandiose magical thinking.

And all these usually believe in some higher power. They are tasked by God himself. They communicate with God or with history or with a nation or with a group with a population that requires their services and help and healing. They are out there and they are altruistic and they are charitable and they're good hearted and they're good persons and they're good people because they cater to the needs of other people.

But it's all done in a grandiose setting. The whole story is grandiose. Whatever they're doing, it's a mission, a cosmic mission almost. They are on the side of good versus evil. It's a morality play. It's something that deserves an HBO treatment or movie.

Magical thinking also involves the conviction that internal processes, for example, cognitive processes are way more important than reality and shape reality.

So if you just concentrate on something long enough, hard enough, it's going to happen. It's going to manifest. This is the infantile belief that you can alter reality via fantastic wishful thinking.

This is also very common in psychosis. We're getting very close or very near the territory of delusions.

Now there's a fierce debate in the profession whether cognitive distortions are delusions.

Cognitive biases are not delusions. They are much closer to opinions, obstinate opinions, opinions of people who are not open to new information or to countervailing opinions.

People are not delusional. They are simply, you know, a-holes.

But what about people perceive reality wrongly because their cognitions are distorted. They feed the reality through defense mechanisms and cognitions that render reality unrecognizable to other people.

So these cognitive distortions, in my opinion, do constitute delusions.

And in this sense, grandiosity, which is common to both narcissism, pathological narcissism and borderline personality organization, grandiosity is a delusion. It's a cognitive distortion that is so extreme, falsifies and refrains reality so dramatically and drastically that it is a delusion.

And here we have the first and most important element of schizophrenia.

Delusions, delusional thinking, delusional disorders, and delusions go hand in hand in psychotic disorders. They go hand in hand with hallucinations.

And yes, you got it right.

But hallucinations are part and parcel of people with borderline personality disorder diagnoses.

Well over one-third of people diagnosed with borderline have experienced, are experiencing or will experience, hallucinations. Hallucinations is seeing something that's not there, hearing something that is, has never been uttered and generating memories of events that have never happened. These are hallucinations.

So we're beginning to see that borderlines, for example, have most of the hallmarks of psychosis, including hallucinations and delusions and fantasies and paranoid ideation and hyper fluxivity and magical thingy and uni-mic.

Because for the narcissist, with the exception that narcissists are not prone to hallucinations like borderlines, but narcissists and borderlines have a feature, a clinical symptomatic feature, which is very, very reminiscent of hallucinations and delusions. And that is dissociation. Dissociation comes in three flavors, like ice cream.

One is amnesia. One is derealization. And one is depersonalization.

Amnesia is simply forgetting things. Derealization is when you experience reality as unreal, when you feel that you somehow found yourself in a movie or in a theater production, that everything that's happening around you is absolutely not real.

And so this is derealization. Depersonalization is when you feel that everything around you is real except yourself. You're not real. You're not inside your body. You're not anyone. You're not a self. You're not you.

These two forms of dissociation are very common in borderline.

Borderlines describe it as autopilot. They're very common in borderline. And they are pretty common in narcissism.

So we do have forms of hallucinations and delusions. And I would venture to suggest that derealization and depersonalization are hallucinations. They are combinations of hallucinations and delusions.

And so in this strict sense of dissociation, narcissists are also, to some extent, hallucinatory.

Now, all three, psychotic, borderline, and narcissist, they're labile, they're dysregulated, they're unpredictable, they're erratic. That's why we confine people with psychotic disorders to mental asyla.

So what am I doing here? Don't ask.

And all of them have self-perceptions that defy reality. A very common self-perception is victimhood.

Narcissists, especially covert narcissists, borderlines, and people with psychotic disorders tend to regard themselves as victims.

And so, of course, with a paranoid ideation, people are out to get me. People discriminate against me, victimize me, hate me, conspire against me, etc.

And so the victim also upholds the high moral ground and supports and buttresses grandiosity.

In this sense, this self-perception is a filter of reality that falsifies reality.

Now, in all three conditions, there's anhedonia, inability to experience pleasure. It's very common, even in psychopathy, it's common, although the psychopath experiences it as boredom, he's bored.

And so he needs excitement and drama, exactly like the borderline. And hedonia is common in psychotic disorders, especially in schizophrenia.

There is reduced affect display. Narcissists have flat affect and flat attachment, psychopaths even more so.

Now, don't confuse the narcissist's love bombing in the initial phase of the shared fantasy with affect display. There's no effect. This is a manipulative strategy, unconscious manipulative strategy to kind of lasso in or trap and then entrain an intimate partner who will then be converted into maternal figures.

So all these Cluster B personality disorders, schizoid, schizotypal, paranoid, in psychotic, they all have reduced affect display or flat affect or inappropriate affect. Problems with affect.

The narcissist has negative affectivity. There are problems with affect. And these problems in affect are very, very common in psychosis.

One could even argue, and there have been scholars who have argued, that affect problems of affect, affect disorders are actually forms of psychosis.

Now, there's avolition. Anyone who has lived with a borderline can tell you that she has long stretches of turpitude, indolence, laziness, inability to get out of bed. And this is not depression. This is avolition. She loses her will. She becomes deprived of volition. She can't embark on any new project, start anything, finish a task, and so on and so forth, even though she may not be depressed at all.

Of course, this is also a feature of depression.

And in psychosis, we have grandiose psychosis.

Most religious leaders are grandiosely psychotic. We have many types of psychosis. So we have depressive psychosis as well.

The early work in object relations, starting with Melanie Klein and others, Iacocco's others, dwelt on this, that one could cast or describe depression as a form of psychosis.

And finally, there's a sociality. A sociality is a lack of will to socialize, not social anxiety, not social shyness, and not social introversion. These are often confused. I mean, people often confuse all these.

This is a sociality.

The absolute lack of will to socialize.

And this is also common in all conditions.

Now, all these are intermittent. The borderline is sometimes hypersocial, and then she is asocial.

The narcissist has increased volition. He is almost manic. He could be easily misdiagnosed as bipolar, the manic phase. And then he reverts into a schizoid phase with avolition. And hedonia can be perceived as boredom.

There is the pursuit of pleasures, hedonism, etc. So all these are intermittent conditions, also in psychosis.

Psychosis is not an extensive disorder. It's not like every second of every minute of every hour, the psychotic person is psychotic.

There are episodes and attacks of schizophrenia which last for years and so on. That's true. But all people with psychotic disorders have long stretches of time where they're not psychotic at all. They cannot be diagnosed.

In the literature, in the description, I'm going to post the titles of several articles. And you can expand your knowledge if you wish.

But what I do want to do, I want to maybe dwell upon one or two elements.

The first one is schizotypi.

Just let me see. I want somehow to... I don't know where is the zoom function here. It's very, very small.

So, in schizotypi... I'm sorry, I'm going to be in your face because somehow the zoom is not working. So schizotypi is a general condition. It's not necessarily pathological. But it involves elements which are common to all the conditions I mentioned, common to narcissism, borderline, psychotic disorders, paranoid, schizotypal, schizoid and so on.

Schizotypi involves beliefs that are regarded as invalid and magical by conventional standards but might well be shared by certain groups, subgroups, subcultures. For example, certain esoteric beliefs, spiritual beliefs or conspiracy theories.

Schizotypi involves distortions in the perception of one's body and/or environmental stimuli, sensory hypersensitivity, diminished pleasure or discomfort in social or interpersonal situations, deficits in the ability to experience pleasure in different sensory domains or discomfort from sensory stimulation, reduction in psychomotor drive, flattened affect or reduction in emotional expressiveness, reduction in verbal expressiveness, speech deficits due to disorganized, confused thinking that do not cause grave problems in other people's understanding of the person, simultaneous experience of divergent emotions.

And so this is schizotypi.

Now schizotypi is the background process that underlies all these disorders.

Now there are many people who have schizotypi and they are not mentally ill. They cannot be diagnosed with a personality disorder or with psychosis.

So let us now compare schizotypi to psychosis.

Psychosis is a defined onset. It is a beginning date and an expiry date, each episode. So it's episodic.

It involves delusions, firm beliefs held with full conviction that are conviction and these beliefs are untrue as well as contrary to the person's educational and cultural background.

Hallucinations, perceptions experienced without an external stimulus, anhedonia in social and other activities or situations, anhedonia's inability to experience pleasure, finding pleasure in nothing, abolition, a lack of will to start or to continue doing anything, effective flattening, flat affect, reduced intensity of emotional response, attentional impairment, wandering mind, resembles very much ADHD.

So there are scholars who compare ADHD to psychosis. Allergia, formal thought disorder, disorganized speech that severely hinders other people's understanding of the person, disorganized or bizarre behavior, incongruous effect, inappropriate effect, laughing at a funeral.

And as you see, psychosis is an extreme form of schizotypal.

But schizotypal exists also in narcissism and borderline. And I refer you to the video I've made about schizotypal and neoteny.

I have a video, of course, about every imaginable topic on Earth and in some parts of the galaxy.

Okay, I hope this video hasn't rendered you psychotic. You wouldn't know until it's too late.

So we're going to discuss these issues at length in other videos later.

This was a general introduction. Those of you who want to venture further, for some oblivious reason, at your own risk and peril, just go to the literature and read the articles that I recommend.

Thank you.

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