you today you know and I have many questions for you you know I mean you know just double checking a little bit of what you thought you know it's very very interesting you know you you were the author of of Malikin self-love the book you know which is very interesting you know and I first question that I have for you doctor you know it's about the cluster B personality, you know.
And first question that I have for you, Doctor, you know, is about the cluster B personality disorders, you know, how is possible, you know, for a regular person, for the man of the streets, you know, to distinguish someone with a personality disorder, you know, in order, you know, to avoid, I don't know, just a toxic relationship? Well, obviously people with a cluster B personality disorder are toxic.
to avoid, I don't know, just a toxic relationship. Well, obviously, people with cluster B personality disorder are toxic, and their relationships are toxic as well. I think there are two points of difference. One, people with cluster B personality disorder, especially psychopaths and narcissists, and to some extent borderlines. They are incapable of perceiving other people as separate entities, as external. They perceive other people as internal objects or as internal functions. They treat other people as extensions or as service providers. They are unable to integrate themselves in a relationship of equals. They cannot grasp the fact that other people have priorities and needs and dreams and emotions and thoughts and they are so immersed in their own world, all of them, narcissists, borderlines, psychopaths, they are so immersed in their own world that they have no energy left for other people. And they would rather treat other people as instruments or as internal objects or as service providers than as full-fledged three-dimensional entities which require maintenance, require investment, require commitment,
they're depleted.
People with Class C. Personality Disorders are depleted. It's very, very tough to have such a disorder. And so they are very self-centered and self-focused. The second, I said two things, that's the first thing. The second thing is, I think, the fact that they are empty inside. They need the outside world in order to generate, regulate and maintain internal processes, whereas in healthy people, everything comes from the inside. In people with cluster B personality disorders, everything comes from the outside. The narcissist uses other people to regulate his or her sense of self-worth, self-esteem, self-confidence. The borderline uses other people to regulate her moods and her emotions. The psychopath uses other people, period, for money, for sex, for power, for anything. So there is an element of exploitation, an element of exploitation, which is compensatory.
They exploit other people in order to compensate for internal deficits, for internal dysfunctions, deficiencies, and disorder.
I think these two, there are many other things, of course, but these are the two critical facets.
It's fashionable nowadays to talk about narcissism, but I would like to go deeper into the borderline area, you know, the borderlines.
You distinguish two categories, your main area, you know, the borderlines, you know. You distinguish two categories, your main categories, you know, is the regular borderline and the covered borderline. What are the main differences between one and another?
Well, the classic regular borderline has been described in literature for well over 80 years, maybe 90. So it's very well known and very well studied. But in my work in the field, which is now in its 30th years, three decades, in my work in the field, I began to notice that there is a type of borderline which is very, very similar to a narcissists. Now we have known before about a narcissistic borderline. We've had a concept of a narcissistic borderline. But a narcissistic borderline is a classic borderline who is also grandiose, who is entitled. It's a classic borderline who is also grandiose, who is entitled. It's a classic borderline who sometimes behaves in a narcissistic way, has a few narcissistic traits, a narcissistic style, but mainly she is a borderline.
Whereas a covert borderline, which is a diagnosis that I'm proposing. A covert borderline is a hybrid between a narcissist and a borderline.
And these two elements, the borderline and the narcissism, are equal in power. They are equipotent.
So both of them play an important psychodynamic role in the covert borderline.
We have a similar situation with narcissism. We have something called malignant narcissists.
The malignant narcissist is a hybrid between a psychopath and a narcissist. So it's a narcissist who is also a psychopath.
And both of these disorders, the antisocial part and the narcissistic part, they play an equal role. Their fingerprints are recognizable in the dynamics, in the interpersonal relationships, in emotional regulation, everywhere.
The covert borderline is a classic borderline in some cases, for example, in romantic and intimate relationships. It's a classic borderline, but also a classic narcissist, an overt, grandiose narcissist in many other cases.
So when you put the two together, you get the hybrid.
And I think it's a lacuna. I think we need this diagnosis because I also received many reactions from people saying that they've been looking for this diagnosis on their lives. And this is the answer.
And in the case of a covert borderline, you were talking about a primary psychopathy, yes, in some cases, you know, in order to protect themselves, you know, would you define them as psychopaths, you know, these people are at some stage psychopaths or, or yes, when they are here?
First of all, with the exception of the United States, and to some extent, Canada, and maybe some parts of the United Kingdom, but mainly the United States. With exception of the United States, the rest of the world does no longer make a distinction between various personality disorders.
For example, in the 11th edition of the International Classification of Diseases, which is a book published by the World Health Organization and the book that the whole world uses to diagnose mental health issues. So in this book, in the ICD, there is no narcissistic personality disorder. There is no specific personality disorder. There is a general diagnosis of personality disorder with various emphasis and dimensions and overlays.
So when you're diagnosed in Europe, you're diagnosed with a personality disorder with narcissistic emphasis or personality disorder with dysregulation, emotional dysregulation emphasis, borderline, and so on.
Only in the United States, we still have this antiquated system, which is 25 years old, of differential diagnosis. And each diagnosis is a list of criteria and this list of criteria is mostly about behaviors, interpersonal relationships, how one functions in society.
That's a wrong approach. If you break rules, if you are defiant, if you're contumacious, if you reject authority, if you're criminalized, if you're antisocial, you're a bad guy, but you're not mentally ill.
To call you, to label you mentally ill just because you don't like society and its rules and just because you break them and you are defiant, or maybe just because you're a criminal, to label you, to pathologize you, to say that you're mentally ill is not professional, is not scientific.
So we have a major problem with this diagnosis.
And so when you ask me if the covert borderline can become a primary psychopath, whatever, these diagnosis are so counterfactual, so divorced from reality and from clinical practice.
Every clinician, every therapist will tell you that the same patient on Wednesday, this patient is a narcissist. On Friday, the patient had a fight with his wife, sonarcissist. On Friday, the patient had a fight with his wife, so he became a borderline. And then he had a fight with a therapist, and he became a primary psychopath.
All these disorders are artificial. People with a personality disorder are everything at once.
The covert borderline could become a primary psychopath. Absolutely. Given enough stress, enough rejection, enough heartbreak in a romantic or intimate life, enough criticism and so on, he would react the way a narcissist reacts, essentially becoming a psychopath.
A classical borderline usually becomes a secondary psychopath. When a classical borderline is subjected to stress and to rejection and to abandonment and to humiliation, a classical borderline becomes very impulsive. She loses her impulse control. She begins to act out. She goes crazy. She's crazy making. I'm saying she because until recently, the majority of people diagnosed with borderline were women.
But it's very misleading because today, half of all narcissists are women and half of all borderlines are men.
So it's true that people can transition from one type of disorder to another because of stress, because of rejection, because of a pandemic, because of panic, because of paranoia, because of many things, because of life circumstances, because of crisis, any number of things.
And so I say that everyone has a potential to be everything, subject to the environment. It's environmentally triggered.
And, you know, I'm going to ask you a question that many people who ask, you know, is it possible to maintain and sustain a relation, for example, with, I don't know, a covert borderline, for example, in the long run?
Yeah, absolutely. Covert borderlines are very committed and very invested in their relationships. They are capable of intimacy, true intimacy and true love, actually.
And in this sense, they are not narcissists. So this is the borderline side of the covert borderline.
The covert borderline is a fantasy of love and invests in this fantasy heavily, idealizes the partner. The covert borderline adores and admires children, wants to have children, and so on.
So covert borderline is a family man or a relationship man or woman.
So, and this sets apart the covert borderline from the narcissists. That's the borderline side.
The narcissistic side of the covert borderline has more to do with grandiosity, with the workplace, with ambition and competition, with winning, with standing out, with being noticed, with becoming famous or powerful.
So there are antisocial elements in the grandiose part of the covert borderline.
But the covert borderline is actually very close to an ideal partner in many respects.
And why would they discard a partner, for example, because they discard as well, yes?
Not covert borderlines.
Narcissus do. Covert borderlines don't discard.
The beauty in a covert borderline, as far as the partner is concerned, is that the covert borderline is capable of empathy and love exactly as the borderline is, the classic borderline, same.
But he does not devalue and he does not discard.
The narcissistic side of the covert borderline is not manifested in the intimate level. It's manifested in, as I said, in other things.
So the covert borderline remains embedded in a relationship and is unlikely to devalue and discard the partner unless and until the partner discards him or cheats on him or breaks his heart or destroys the relationship or something like that.
So in this sense he's not a loss.
Interesting.
And Doctor, Sam, please call me Sam. Sam. Do you think that nowadays, you know, the mental health is a main issue in our society at the moment?
People are more aware that mental health has a direct impact on our daily lives.
There are so many issues nowadays, you know, climate change, mental health, war, maybe nuclear war. There are so many issues.
But you're right that the source of all these issues, the foundation, the found, where it comes from, where everything emanates from, is mental health.
Because, for example, we have mentally ill leaders, political leaders.
Evidently, we have narcissists and psychopaths as political leaders. Not only, of course, but quite a few.
So mental illness is affecting politics.
And when you are mentally ill in a position of power, your mental illness is amplified, magnified, and affects millions. You can ask Adolf Hitler, if you don't believe me.
So here's an example of how mental health determines our lives, directly and quite directly through politics.
But mental health has infiltrated many other fields. For example, mental illness has infiltrated many other fields.
For example, gender relations are broken in large part because women have become much more narcissistic and psychopathic than in the past.
And of course, women have become more narcissistic and psychopathic because men have already been narcissistic and psychopathic.
It's a kind of reaction to what is known as toxic masculinity or patriarchy, whatever you want to call it.
But women have chosen to not be different to men. They've chosen to be exactly like men. And so they've chosen mental illness, in effect.
When you look at geopolitics, you have national movements that are essentially victimhood movements.
Victimhood is a mental health pathology. Not being a victim. People can be victims. People can be victimized.
But when your identity is that of being a victim, that's a mental health pathology.
And now when you have national movements, which are essentially victimhood movements, then you end up with Nazism. You end up with communism. These are all victimhood movements. You end up with the far right. You end up from the far left. You end up with Zionism. You know, there are quite a few victimhood movements around.
And of course, when I mentioned Zionism, the Palestinians are also not short on victimhood.
When victimhood becomes the organizing principle, it means the totality of international affairs is mentally pathologized.
So it's not true to say that mental health is only on the individual level.
You can say mental health is only depression, anxiety. We don't need to worry about it. It's a few individuals. And, you know, they take pills and they feel okay and they function and we don't need to think about it.
It's not true. Mental illness, for example, is the defining determinant of modern technology. Modern technology was created by mentally ill people, majority of them schizoids and with other mental health issues. And modern technologies amplify and magnify mental health issues.
That's why the Surgeon General in the United States wants to put a label on social media and to warn that it is dangerous to the mental health of teenagers or adolescents.
Because the technology is sick, totally sick.
So it's not true to make a distinction or the delineation and to say mental illness is in the individual realm.
We should take care of individuals. Everything is infected. We are infested with mental illness. Wherever we look.
And the outcomes of this global mental illness is what we see.
Coming back to the borderlines, you know, I wanted to ask you a very specific question, you know, it's about self-harm.
Could a covert narcissistcommit self-harm, or is it the regular borderline?
Only the classic one. A classic borderline. Self-harm in borderline also goes hand in hand with suicidal ideation. Borderlines are very much into suicide. 11% of people diagnosed with borderline personality disorder end their lives with suicide. That's a leading cause of death among people with borderline personality disorder.
And there are four reasons why borderlines harm themselves and hurt themselves and ultimately commit suicide. Four reasons.
The first reason is they are very self-punitive. They reject themselves. They hate themselves. They loathe themselves. They have what we call an internalized bad object or a primitive superego.
And so they have these voices inside that keep telling them you're not lovable. You're unlovable. You're unworthy. You are evil. You're inadequate.
So they have these voices. And so they seek to punish themselves. Because it's like if I punish myself, these voices will go silent. It's like sacrificing an animal to the gods, you know?
There is an internal god and you sacrifice yourself to this God in order to shut up the God, to avoid the anger or the wrath of the God.
The second reason is to silence the internal dialogue, the internal turmoil. Inside the borderline, there are multiple voices, conflicting voices, there's chaos, total chaos, tumult, mess. We call it disorganized personality organization. So it's a disorganized personality.
And to silence these voices, because they're always there, they're very painful, very traumatizing, very hurtful. They push the borderline to kill herself, to harm herself and so on.
So silence them, she harms herself. It's like, okay, I'm going to do what you want. Just shut up, kind of.
And also the pain, when she has physical pain, she forgets the emotional pain, the psychological pain. She focuses on the physical pain.
The third reason is a call for help, self-harm, and so it's a call for help.
And the fourth reason is that when she hurts herself physically, in most cases, but not only physically. For example, promiscuity can be a form of self-arm if you trash yourself sexually. You're punishing yourself. You are demeaning yourself. You're degrading yourself. So it's a form of self-harm.
So when she does that, when the borderline does this, she or he, they feel alive. The borderline feels dead inside. Inside the borderline, there is emptiness. There is huge emptiness. There's a void. There's a black hole. There are many metaphors. Kernberg called it emptiness. Tustin called it the black hole. Everyone came up with the name. But it's a void. And the borderline doesn't feel alive.
She feels alive only when there is drama. So she needs drama. And the drama needs to include danger and risk. So the drama needs to lead to the potential for said harm for the borderline to feel alive.
The borderline compensates for this emptiness. She has a false self, exactly like the narcissist. It's another type of false self, not the same reasons, not the same dynamics, not the same, but it's a false self.
She has a false self and she has a very rich fantasy life, exactly like the narcissist.
And this is why major scholars, like for example Otto Kernberg, suggested that borderline is a kind of reaction to narcissism. He said borderline and narcissism are first cousins. They're the same family.
And he said that borderline and narcissism are on the verge of psychosis. They're almost psychotic because the borderline really has what we call impaired reality testing. She is divorced from reality. This is also common in narcissism.
Sometimes she goes crazy. She becomes super paranoid. The borderline becomes highly paranoid. Or she under, she overestimates how much you love her. She overestimates the intimacy and the emotions in a relationship.
This is the same with histrionic personality disorder. And so all these, you put it together, sometimes the borderlines goes so far away from reality, strays from reality, so far that she is clinically psychotic. She is clinically schizophrenic.
Initially in the 70s, we thought in the profession that borderline personality disorder is an undiscovered form of schizophrenia.
And this is why it's called borderline, because Otto Kernberg said, and others, Gunderson, others, they said that borderline, this disorder is on the border with schizophrenia, on the border with psychosis. So it's borderline. That's why it's called border.
So you see, borderline is much more complex than we think. It's not just someone who is hyper-emotional and a bit crazy and very funny and hugely sexy. This is the stereotype.
But the internal landscape is highly, highly complex.
If you want, I will give you a few more elements.
I don't know if you want.
Do they feel remorseful at some stage, or do they lack empathy as a narcissist?
I mean, for example, when a regular borderline, we were talking before that the covert borderline doesn't discard. I guess a regular borderline could discard some stage, but could discard a partner. Do they feel remorseful at some stage when they have abused a partner, when they discard a decent guy, for example, you know, at some stage?
Unlike the narcissists, the borderline discards only when she feels that she had already been discarded. So it's preemptive abandonment.
The borderline has two dynamics, two internal dynamics. In her interpersonal relationship, she has two dynamics.
Her relationships are very intense. Relationship of borderline are the most intense we know. They're very intense. And they include, exactly like the narcissist, they include idealization and evaluation cycles. That part is true.
But, contra to the narcissist, the borderline is motivated by two anxieties. There is abandonment or rejection anxiety, and the clinical term is known as separation insecurity.
So the borderline is afraid to be abandoned, to be rejected, to be discarded, to be dumped. She's terrified of this, absolutely terrified.
But then, if the partner is loving and intimate and committed and tells her I will never go away, she panics because she's terrified of intimacy. She has another anxiety. It's called engulfment anxiety.
So she is like a ping pong ball. We call it approach-avoidancerepetitioncompulsion. She approaches and then avoids and approaches you again and avoids you again.
Every time she approaches you, she wants you to be there for her like a rock. She wants you to provide her with stability, with a secure base. She wants to know that you will never walk away. You will never abandon her. You will never leave her alone. She wants to know this.
She wants you as the intimate partner to regulate her moods because her moods are labile. They're up and down all the time. She cycles. She's depressed. She's elated.
So she wants you to regulate her moods. She wants you also to regulate her emotions. She has something called emotional dysregulation or affective lability. So she wants you to regulate this. She wants you to take over her mind and control her mind for her. She outsources her mind to you as the intimate partner.
And your job is to be there 24-7. You should never leave her alone, not even for five minutes. If you talk on the phone longer than five minutes, you are probably abandoning her. If you travel for work for four days, you have already abandoned. She is hysterical about abandon.
But when she gets what she wants, when she gets a partner who is helpful, who is loving, who is caring, who is compassionate, who is holding, who is always there, she panics because she feels that this kind of partner is going to consume her. This kind of partner is going to digest her. It's going to swallow her. She's going to disappear inside this partner.
So she runs away. So she doesn't discard. She runs away. There's a difference. The narcissist sends you away. The borderline sends herself away. She simply runs away.
Borderline is exactly like narcissism is relational.
And if the partner decides to discard the borderline, would the borderline hover at some stage like a narcissist?
Yes, borderlines would hover. Exactly like narcissists.
And this is part of what I just described, the approach, avoidance, repetition, compulsion.
If the borderline is discarded, abandoned, rejected, humiliated in public, for example, and so on so forth, during that process that she, you know, just moves away.
And then she would go away, but she would be back. She approaches and avoids, approaches and avoids.
Only if the partner regularly abandons her, humiliates her, rejects her, and so on, she will finally give up on me.
What I was trying to say is that if the partner feels rejected and somehow, you know, during that process, you know, doesn't understand, you know, the game, you know, and decided, you know, to cut, you know, the relation, would the borderline Hoover at some stage, you know, Yes.
The borderline would hover, even if she is discarded, even if she is rejected. But she would give a few chances.
And at some point, she would begin to regard the partner as dangerous to her, not secure base, insecure base.
Because when the borderline is abandoned and rejected, she becomes suicidal. Her moods go up and down. She cycles. Her emotions, especially negative emotions, especially anger, overtake her, overwhelm her. She drowns. She wants to die, literally wants to die. She considers suicide.
So the borderline cannot afford to be abandoned. Cannot afford to be rejected. It's life-threatening.
So she'll give you a chance or two chances or three chances. If you keep doing it all the time, then you are threatening her life. And she will walk away and forget you.
But otherwise, yes, she would go over once or twice.
Interesting.
Very interesting.
Doctor, what would you recommend, you know, to someone, you know, that is in a toxic relationship, you know, what they should do? They should walk away from this kind of relationships? Should they stay? Should they try to search for help for the partner, doctor?
Depends. Depends what we define by toxicity. Depends how all pervasive and how pernicious toxicity.
There are many forms and levels and layers of toxicity in the whole spectrum of toxicity.
But definitely if you are with a narcissist, you should walk away. There's narcissists are incorrigible. They cannot be helped. They cannot be changed. It cannot be cured or healed or modified.
If you're with a borderline, you have to understand that the borderline doesn't have an identity. She has something called identity disturbance, unstable identity.
So being with the borderline is like being with someone with multiple personality disorders. It's like being not with one person, but with 10 people or 15 people.
If you're willing to share your life with someone who is not the same from one day to the next, literally, if you're willing to share your life with someone who is reckless and impulsive, violent and aggressive, angry most of the time, if you're willing to share your life with someone who has no concept of reality, lives in fantasy, and is a big divorce from herself, she has a false self, if you are willing to live with someone who would constantly approach you, love you, and then suddenly run away in panic, because you're too much for her, the intimacy is drowning her, she's dying. She's suffocating. She needs space. She needs time. And she will vanish. And when she vanishes, she is likely to act out, sleep with other men, do crazy things. If you're willing to live with this drama, endless drama, then maybe it's not toxic. Some people need drama to feel alive. They need drama to feel excited. They need drama to get up in the morning.
While the borderline is very destructive and very dangerous, the borderline is much less toxic than the narcissists. And the psychopath is much less toxic than the narcissists.
And the psychopath is much less toxic than the narcissist because the psychopath is goal-oriented. The psychopath wants your money, wants sex, wants power, wants to be famous, and that's it. He uses you, he abuses you, and he gets rid of you.
Psychopath will not stay long enough in your life to poison you. You understand, it's transactional. He comes and he goes, he takes, he walks away. You can be angry at the psychopath, you can be furious at the psychopath, he defrauded you, he conned you, he stole your money.
But, you know, the borderline loves you. Loves you. She's empathic. She is emotional. She is wonderful to be with when she's in a good shape. And so on so forth.
And the price to pay is the fact that she is not the same person all the time, that she's dramatic. She has negative emotions, negative affects that overwhelm her. She cannot control these emotions. She's impulsive. She's reckless. She's likely to hurt you badly. She's likely to run away.
But there is a human being there. A suffering human being, a broken human being, a damage human being, but a recognizable human being.
Psychopaths are recognized, recognizable as human beings. Because psychopaths want what you want. You want sex. You want money. You want to be famous. Psychopath wants the same.
The only difference between you is willing to do anything. And you are not. You have morality. You have inhibitions. You have social. You have conscience, you have the social voice in your head.
But ultimately, you have a lot in common with the psychopath. Because he is just an exaggerated human being.
You have a lot in common with the borderline. Because you have also been sad and depressed. You've also did crazy things in your life. You also had some drama, you know, borderline and psychopath are recognizable human beings, dysfunctional, painful, dangerous. Yeah, I agree, but they are human beings.
The narcissist is not. There's a huge difference between the narcissist and borderline and psychopath.
When you look at the psychopaths, you can say, this is a horrible guy. This is a dangerous guy. I should stay away from him. He will steal all my money.
When you look at the borderline, you're going to say, she's going to hurt me. I should stay away.
But when you look at the narcissists, there's nobody there. It's an absence pretending to be a presence. I keep saying it's not fully human, not in the full-fledged sense. It's no empathy, no positive emotions, no.
All the dynamics inside the narcissist's mind are so alien, so non-human. The narcissist is so machine-like. It's terrifying. I'm much more terrified by narcissists than by any psychopath or any borderline.
Dr.
Thank you very much, Sam. Thank you very much. Interview's been very interesting. And I will send you back, you know, the interview once that is published. You know, I'm going to publish it on the Spanish media, and I hope you like it.
You know, this is, you know, a mesmerizing subject for me, you know, and very very interesting to talk.
Thank you for having me.
Just tell me, could I upload it to my channel now or would you like me to wait, an embargo until after the interview?
I would rather wait a little bit, Doctor. I'd like to publish the interview. Then I would be delighted for you to download to your channel, if you can mind, yes?
Yes, of course. I will embargo it until the interview is published. So I wait to hear from them.
Thank you. It was a pleasure. Thank you. Have a nice day.
Bye I wait to hear from them. Thank you. It was a pleasure. Thank you.
Have a nice day. Bye-bye. Bye-bye. Bye-bye.