Key Difference: Borderline Personality Disorder is a mental condition in which people experience reckless and impulsive behavior, unstable moods and relationships. Narcissistic Personality Disorder (NPD) is a medical disorder in which people exhibit unstable and intensive emotions. The patient experiences an inflated sense of self-importance and superiority compared to others.

There are various medical conditions that exist, which are often similar in nature and require a screening process in order to distinguish them apart. As any medical show would tell you, doctors go through an extensive process of elimination in order to separate medical conditions based on the symptoms exhibited by the patient. Many time two conditions may co-exist making diagnosis and treatment very difficult. Borderline and Narcissistic are two conditions that are often hard to diagnose as they have a few similar symptoms.

Borderline Personality Disorder is a mental condition in which people experience reckless and impulsive behavior, unstable moods and relationships. The disorder was not considered as a medical condition until the 1980s, when the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed this condition as a medical diagnosable illness. BPD patients usually suffer brief psychotic mood swings that often change in minutes or hours. Experts state that people suffering from BPD also often suffer from other mental disorders such as depression, anxiety disorders, substance abuse, eating disorder, suicidal behaviors, etc. The overlapping of these disorders makes it difficult to properly diagnose and treat the disease.

According to research, BPD is known to occur three times more in women than in men. In women, the disorder is believed to co-occur with depression, anxiety and eating disorders. In men, it co-occurs with substance abuse and personality disorder. The disorder usually begins at a young age during adolescence or early childhood. Some childhood experiences have also been known to cause or trigger the disorder. Causes for the disorder include history of childhood trauma, brain abnormalities, genetic predisposition, neurobiological factors, environmental factors, executive function, family environment, self-complexity and thought suppression.

According to the DSM Fourth Edition, for a person to be diagnosed with BPD, they must exhibit at least five of the following symptoms: Extreme reactions of panic, depression, rage, etc., intense and stormy relationships, unstable self-image, impulsive and reckless behavior, suicidal tendencies, self-harming behavior, feelings of emptiness, uncontrollable anger and rage,  paranoia, losing touch with reality, etc.

BPD has been unofficially divided into four subtypes by American psychologist, Theodore Million. He proposes that an individual diagnosed with the disorder can be classified into one oof the four categories depending on their symptoms. Wikipedia lists the four subtypes as:

• Discouraged borderline — including avoidant, depressive or dependent features
• Impulsive borderline – including histrionic or antisocial features
• Petulant borderline – including negativistic (passive-aggressive) features
• Self-destructive borderline – including depressive or masochistic features

Psychotherapy has been a proven to help treat patients with BPD. It has shown to help relieve some symptoms. Different types of therapy that are used include cognitive behavioral therapy, dialectical behavior therapy, and schema-focused therapy. Cognitive behavioral therapy (CBT) helps people identify and change core beliefs and behaviors that the patient may have about themselves along with addressing mood, anxiety problems and suicidal behaviors. Dialectical behavior therapy (DBT) focuses on helping the patient being aware and attentive to the present situation and allowing them to control and take charge of their emotions. Schema-focused therapy combines CBT with other forms of therapy and focuses on altering the way the patient views themselves. Medications are also used along with psychotherapy to relieve certain symptoms. Other treatments that have shown positive effect includes an omega-3 healthy diet for women.

 Narcissistic Personality Disorder (NPD) is a medical disorder in which people exhibit unstable and intensive emotions. The patient experiences an inflated sense of self-importance and superiority compared to others. Web MD defines the disorder as, “Narcissistic personality disorder is further characterized by an abnormal love of self, an exaggerated sense of superiority and importance, and a preoccupation with success and power.”  Patients suffering from this disorder actually suffer from insecurity and a fragile self-esteem and are believed to be use self-absorption to conceal these issues. These patients also lack empathy for other people.

Narcissistic personality disorder was discovered in 1968 and was originally referred to as megalomania. The term ‘narcissistic’ is derived from the Greek youth Narcissus, who fell in love with his own reflection on the banks of a river. Similarly, people that are associated with his condition are often believed to exhibit symptoms like falling in love or having an obsession with oneself. Research suggests that men are more prone to be diagnosed with this condition than women. NPD patients often exhibit behavioral traits such as arrogance, lack of empathy, dominance, superiority and crave power. They are also less likely to commit to relationships and will often leave a person who they believe is going to leave them.

The DSM Fourth Edition lists the symptoms as:

• Reacting to criticism with anger, shame, or humiliation
• Taking advantage of others to reach own goals
• Exaggerating own importance, achievements, and talents
• Imagining unrealistic fantasies of success, beauty, power, intelligence, or romance
• Requiring constant attention and positive reinforcement from others
• Becoming jealous easily
• Lacking empathy and disregarding the feelings of others
• Being obsessed with self
• Pursuing mainly selfish goals
• Trouble keeping healthy relationships
• Becoming easily hurt and rejected
• Setting goals that are unrealistic
• Wanting "the best" of everything
• Appearing unemotional

There are no known causes of the NPD; however, psychologists Leonard C. Groopman and Arnold M. Cooper compiled a list of causes based on various different researches. A variety of different situations such as childhood trauma, relationship with parents, environmental factors are all known to affect the patient. The list of causes is as follows:

• An oversensitive temperament at birth
• Excessive admiration that is never balanced with realistic feedback
• Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood
• Overindulgence and overvaluation by parents, other family members, or peers
• Being praised for perceived exceptional looks or abilities by adults
• Severe emotional abuse in childhood
• Unpredictable or unreliable caregiving from parents
• Valued by parents as a means to regulate their own self-esteem

Theodore Million divided the NPD into five subtypes. Wikipedia lists these subtypes as:

• Unprincipled narcissist – including antisocial features. A charlatan who is a fraudulent, exploitative, deceptive and unscrupulous individual.
• Amorous narcissist – including histrionic features. The Don Juan or Casanova of our times who is erotic, exhibitionist.
• Compensatory narcissist – including negativistic (passive-aggressive), avoidant features.
• Elitist narcissist – variant of pure pattern. Corresponds to Wilhelm Reich's "phallic narcissistic" personality type.
• Fanatic narcissist – including paranoid features. An individual whose self-esteem was severely arrested during childhood, who usually displays major paranoid tendencies, and who holds on to an illusion of omnipotence. These people are fighting delusions of insignificance and lost value, and trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition or support from others, they take on the role of a heroic or worshipped person with a grandiose mission.

Psychotherapy has been proven the most effective when trying to deal with the disorder. Schema therapy and cognitive therapy are two types of therapies that have been used to help people cope with the disorder. Though NPD is not curable, it can be treated to the point that it does not disrupt the patient’s daily life and activities. Medication may also be used for certain symptoms.

Image Courtesy: moemasala.de, minddisorders.com