Could You Be Mistaken For Having BPD after Narcissistic Abuse?
By Dr. Betsy Usher
This question is beyond important and extremely insightful. I am currently writing a thesis on this topic and will share with you what I have discovered and what I believe during my research and experience. The answer is 100% YES.
I believe about 80% of those diagnosed with borderline personality disorder (BPD) are actually are suffering from CPTSD from Narcissistic Abuse with abandonment issues. Although they still meet criteria for BPD (mostly due to fears of abandonment from the abuse) they are not the stigmatized version of BPD that most are familiar with. Therefore, I believe there are two types of borderlines.
Type 1:A small percent (lets say 20%) of those with BPD are those who are unable to benefit from therapy, are abusive, and also have a comorbid diagnosis of narcissist personality disorder. They are unreachable in an emotional context. They have true personality disorders and are unable to change or get better. This is the stigmatized version of BPD that we mostly hear about.
Type 2:These individuals show change through therapy, have insight, growth, and may not even meet criteria for BPD in the future as research has shown. They are not the abusers; they are the survivors of covert or overt narcissist abuse.
Type 1is a true personality disorder. According to the DSM-5, personality disorders are pervasive, inflexible, and they are stable over time. Research has shown that treatment for personality disorders such as narcissistic personality disorder (NPD) and antisocial personality disorder, has little to know affect in changing symptomology. These individuals do not get better in therapy, remain abusive, and are unable to mentalize and grow.
Type 2therefore, is not a true personality disorder by definition. They are fundamentally different than all the other personality disorders because these individuals are able to grow and change through therapy. The borderline experience in these individuals is not pervasive, inflexible, and stable over time. It is the opposite. They are highly emotionally intelligent, have empathy, high sensitivity and emotional attunement. However, they still look like and meet criteria BPD. Approximately 80% of individuals with bpd that are in therapy no longer have symptoms after 6-10 years, only 11% of those in “remission” have a recurrent episode after those 6-10 years. If 80% of those diagnosed with BPD are getting better they literally do not meet criteria for a personality disorder. So, 80% of these individuals are not true borderlines, they are something else.
Let’s call it Emotional Dysregulation Abandonment Trauma Disorder!
Research has reported that 90% of those diagnosed with BPD have a history of childhood abuse (that is self-reported). Borderline personality disorder is a pattern of instability in interpersonal relationships, self-image, and affects, dissociation, and marked impulsivity that is potentially damaging such as substance use. The causes of BPD are still being studied, however, genetics and childhood environmental factors such as emotional, physical, and sexual abuse are known to be involved. According to a large number of studies childhood abuse is the most common psychological, physiological, or social risk for those with BPD. Ninety percentof those diagnoses with borderline report childhood abuse ranging from emotional neglect to physical and sexual ritual abuse. It is possible that the other 10% of those with BPD also had a form of childhood abuse, however, they do not recognize their childhood as abusive due to certain types of abuse being covert as well as children believing the abuse is normal. Moreover, these children enter into abusive relationships as adults continuing the belief that abuse is normal behavior and thus never recognizing or acknowledging they have been abused in childhood. According to Dr. Steven Farmer, author of Adult Children of Abused Parents (1989), children that come from an emotionally abusive childhood will have difficulties in adulthood. These difficulties most likely include depression, relationship issues, an inability to trust, low-self-esteem, alcohol and drug problems, and eating disorders. Each of these difficulties we see in the criteria or presentation of someone with BPD.
So, we know that abuse and BPD or Emotional Dysregulation Of Abandonment Trauma Disorder go hand in hand during childhood.
Children that were raised in homes by those with abusers with NPD or traits of NPD usually display signs of complex posttraumatic stress disorder (CPTSD). CPTSD children show signs of flashbacks, difficulty regulation emotions, hypervigilance, harsh internal critic, substance abuse issues, dissociation, anger, compromised immune systems, anxiety/depression, difficulty trusting others, and many more symptoms. A narcissistic parent disrupts a child’s ability to form healthy attachments, boundaries, self-worth, and self-love. The narcissistic parent changes from available and supportive to detached and enraged while the child unknowing is subjected to narcissistic rage and abuse. This type of abuse becomes normal to the child, increasing their tolerance for abuse and decreasing their feelings of worthiness and ability to feel loveable. Narcissistic abuse is covert, insidious, and manipulative. Idling back and forth between a disguise of love and care, to an erosion of control, dominance, intimation, rejection, gaslighting, jealousy, dishonesty, blame shifting, and complete destruction over the victim’s person sense of self-worth. The invisible scares inflected on those in relationships with a narcissists are so hidden, the victim themselves usually do not realize they are in an abusive relationship for over a decade. Survivors exposed to narcissistic abuse not only suffer from CPSTD, but many also suffer from Stockholm syndrome, as well as narcissistic abuse syndrome.
Although narcissistic abuse syndromes has yet to be added to the DSM- 5, millions of survivors and licensed mental health professionals use this diagnosis to help describe the aftermath of those who survived narcissistic abuse. Symptoms of Narcissistic Abuse Syndrome include (or Narcissistic Victim Syndrome): Fog, pacing, confusion, "loss of self", panic attacks, angry outbursts, insomnia, weight gain or weight loss, obsessive thoughts, rapid heart rate, muscle aches, throwing up, getting sick, desiring death, possibly suicidal, no interest in previous interests or even loved ones, blaming self, second guessing self, may seem desperate and trying to reach for help, fear of Narcissist annihilating them. Narcissistic Abuse is a type of soul rape.“The ongoing impact of narcissistic abuse on victims is similar to being a prisoner of war (Brown, 2016). This is the fight or flight that we commonly see in those with BPD when triggered by feelings of abandonment.
Research has found that 87% of those who have been abused re-enter into an intimate abusive relationships.
So, this abused child with BPD traits or meets full BPD criteria most likely unconsciously and unknowingly continued on into another abusive relationship with a narcissistic.
If the abuse is causing CPTSD and the expression of BPD symptoms and this person enters into another abusive relationship, the symptoms of BPD would also continue making it look like this individual who is struggling with CPTSD from narcissistic abuse and abandonment issues has borderline personality disorder. They have no idea they are being abused because this is how they were raised, the abuse is normal and they are used to being blamed for everything and they take on that projection and act in away that is borderline. This is why the therapist also believes this person has BPD and much of the time misses that there is even any abuse happening at all.
If majority of women dealing with narcissistic abuse do not recognize the abuse for over a decade, then most therapists are missing the abuse too. This is especially true if the patient has been diagnosed with BPD. If an individual is unaware that they are being abused they will not be commenting on their partner’s abusive behaviors or in ways that allude to abuse. Moreover if these individuals are diagnosed with BPD they will primarily be blaming themselves for being “borderline,” unlovable, difficult, and mentally ill, leaving them the perfect victim for someone with NPD. Although it may seem that most mental health professional would surely be able to tell is one of the borderline patients were being abused, even if their patient didn’t recognize it themselves, this is most likely untrue. Due to the stigma of BPD being known to be overly dramatic, the cause of most interpersonal conflicts, untrustworthy sources, and difficult to love, most mental health professional will be blind to the abuse. The NPD individual blames the borderline for all of the conflicts in the relationship, leading the borderline to believe the same. Her/his stories would then be narratives of the chaos she created in which she may feel that she is taking responsibility, possibly metalizing her partner and on the right road to recovery. Nothing could be further from the truth. The borderline individual is being manipulated, groomed, and abused.
Mental health professionals unfortunately have been fed the stereotype description of BPD since undergraduate training. This Instills fear, chaos, and creating the most mentally ill expression of BPD. It is extremely possible that many mental health professionals have multiple individuals with either BPD or BPD traits in their caseload and they are completely unaware. They have been training to only recognize BPD patients at the stigmatic view of the “difficult patient.” It is also probable that the “difficult patients” that are painted as the borderline patients are actually narcissistic patients with complex PTSD that expresses itself as appearing as a borderline diagnosis. In this case we could call these patients borderline personality disorder, however, they make up even a smaller portion of the original view of BPD. Meaning, these narcissistic patients with CPTSD are the ones that have low emotional intelligence, insight, boundary issues, demanding, hostile, invasive, and are usually in and out of treatment. They are more likely to be demanding, struggle with patient/ therapist boundaries, and are highly aggressive and entitled. These patients usually are not suicidal, dissociative, cutting, or struggling with affective instability. These are narcissist patients that had a traumatic childhood that are fixed, inflexible, and stable across time; they are true personality disorders. However, due to the stigma, most clinicians label them as BPD patients. The real BPD patients actually have insight, emotional intelligence, able to use mentilazation over time.
Like all disorders borderline personality disorder is on a continuum. Many individuals with BPD may have traits and some will meet full criteria for five out of the nine symptoms. However, if these individuals are meeting criteria and are improving in symptomology over time it should no longer be considered BPD because it literally is then no longer a personality disorder and instead complex posttraumatic stress disorder should be considered followed by an understanding if narcissistic abuse syndrome if present. Looking at the criteria of CPTSD we see significant overlay with the criteria of BPD. Moreover, symptoms of narcissistic abuse syndrome my account for the other unexplained symptoms that appear to have BPD qualities.
I believe once you take the individual with BPD out of the abusive relationship and environment (intimate partner, family dynamics) the individual with BPD symptomology will begin to improve. In particularly you will see marked improvement in their identity disturbance, impulsivity, recurrent suicidal behaviors, and chronic feelings of emptiness, dissociation, and anger and aggression issues. Then BPD symptoms will then present more as CPTSD with abandonment issues and emotional dysregulation still being at the heart of it. However, with the constant criticism removed, the manipulation and gaslighting gone, and the fight or flight system deactivated this person should be able to heal and begin to have a sense of self and self-worth. Through therapeutic work they will begin to understand and incorporate boundaries and learn to rebuild trust and understand distress tolerance for abandonment triggers and no longer meeting the diagnosis of BPD which leads us to the conclusion that they didn’t have a personality disorder all along. Instead they had CPTSD with abandonment issues manifesting into a symptomology of the expression of BPD from narcissist abuse. These individuals then should be given a new diagnosis since they do not just suffer from CPTSD and meet symptomology for BPD. A new diagnosis should emerge that incorporates the emotional dysregulation, the trauma, the abuse, and the fears of abandonment. Thus allowing therapist to see the problem more clearly with more empathy and compassion and with a deeper sense of education on psychological abuse.