Why Are NPD Survivors Diagnosed With BPD?
By Dr. Betsy Usher
As a psychologist I believe there is a lack of education for narcissistic abuse, like a real lack. Second, there is a lack of education on C-PTSD, which looks like BPD after narcissistic abuse. In fact many people have been wrongly diagnosed with BPD during narcissistic abuse when they didn’t know they were being abused. A LOT of people actually. That’s why for many people with BPD they don’t relate to the stigmatized version of BPD that you read about. This is because they don’t have BPD they have C-PTSD. Also, most psychologists don’t use C-PTSD because it isn’t in the DSM (how we diagnose people). It is in the ICD-10, which is a medical diagnostic tool.
Let’s break it down more.
So odds are that if you were in a narcissistic abusive relationship as an adult you also had narcissistic abuse as a child. Like really high odds. You can read my other articles on that topic. Now, this isn’t always true, but I’d say most of the time. It may be difficult to see that or believe that but that’s why you weren’t able to see the abuse for so long, it was normal to you to be treated that way and to feel that way. Worthless and unlovable.
True individuals with BPD have a core of narcissism (aka egocentrism, not actually npd). Majority of abuse survivors core is the opposite. There seems to be a misunderstanding with psychologists on knowing this and therefore diagnosis someone with BPD when it’s C-PTSD. That is the real defining difference between the two diagnoses.
Since C-PTSD isn’t used for diagnosing since it isn’t in our DSM and PTSD doesn’t usually fit, someone coming out of NPD abuse, therapist get confused and think it’s BPD.
Let’s compare a list of BPD and C-PTSD to start with
C-PTSD:
Emotional Flashbacks
Tyrannical Inner &/or Outer Critic
Toxic Shame
Self-Abandonment
Social anxiety
Abject feelings of loneliness and abandonment
Fragile Self-esteem
Attachment disorder
Developmental Arrests
Relationship difficulties
Radical mood vacillations
Dissociation via distracting activities or mental processes
Hair-triggered fight/flight response
Oversensitivity to stressful situations
Suicidal Ideation
BPD:
Frantic efforts to avoid abandonment, whether the abandonment is real or imagined
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Identity disturbance, such as a significant and persistent unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Transient, stress-related paranoid thoughts or severe dissociative symptoms
These look almost identical. I mean really. It’s like the same core issues.
Some would say that what is missing for C-PTSD is abandonment issues. That is 100% wrong. The core of C-PTSD is abandonment. The core of both of these is abandonment. If you have BPD you also have C-PTSD. But no tall those who have C-PTSD have BPD.
After abuse many women are dissociative, they have lost their identity, they feel empty and lost, many of them used drugs to get through, they can feel hopeless and suicidal because their worth is so low. They are emotionally unstable because someone has been gaslighting them to make them feel insane which leads to flashbacks and emotional dysregulation. They struggle to trust people and have intimate relationships because more toxic people are attracted to them and find them and abuse them again. Anger, um ya, a lot of anger when you figure out you’ve been being abused by someone you thought you loved and loved you!
The core of both of these is toxic shame and a horrible inner critic that tells you you’re worthless, unlovable, and not seen or heard.
This trauma response is C-PTSD and yet really looks like BPD.
However, BPD starts in early childhood. Now, if you were abused by your parents (probably covertly and unnoticed to you as a child), then you have looked like you’ve had BPD this entire time! But it was C-PTSD unless you have a core of narcissism (egocentrism, not npd).
The narcissism I’m talking about is someone who takes up all the space in a conversation. They lack empathy for others. They feel entitled and everything cycles back to them. Lastly, personality disorders are rigid and stable across time. That means they aren’t flexible, they don’t grow and change, and they are like this in all areas of their life throughout their life. They can improve on some behaviors through DBT but their core is the same.
Doesn’t sound like most NPD survivors to me, but that isn’t part of the criteria for BPD so people wrongly get diagnosed with BPD if the therapist doesn’t really understand the heart of BPD. However, since they may meet criteria for BPD they believe that is what this person has and without C-PTSD being in the DSM they don’t know what else to use. It’s sad that we have to label it at all.