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A personality disorder a severe, distressing illness

Wednesday, August 13, 2014
Caroline C Ravello

While contemplating this week’s instalment, I passed my television and, without context, overheard this statement, “We cannot make psychotic narcissism a disease. If we do we’d have to put the entire government away for good.” It was not a local channel.

We’re discussing the last two of the dramatic, emotional, and erratic Cluster B category of the Personality Disorders (PD), which are Narcissistic PD, and Borderline PD. These disorders share problems with impulse control and emotional regulation.

A number of people you know may seem to be Narcissistic Personality Disorders (NPDs) so remember that it’s only pathological if a person demonstrates significant and enduring difficulties in at least two of the four defining features of PDs, which are:—

• Distorted thinking patterns 

• Problematic emotional responses 

• Over- or under-regulated impulse control and

• Interpersonal difficulties

Narcissistic PD is a condition in which people have an excessive sense of self-importance, an extreme preoccupation with themselves, and lack of empathy for others. Their need to be powerful, and admired, coupled with a lack of empathy for others, make for conflictual relationships that are often superficial and devoid of intimacy and caring. Status is very important to people with this disorder. 

They have significant problems with their sense of self-worth stemming from a powerful sense of entitlement, which leads them to act in ways that disregard and disrespect the worth of those around them. They believe they deserve special treatment, assume they have special powers, or are uniquely talented, or that they are especially brilliant or attractive. 

They are preoccupied with fantasies of unlimited success and power, and may display an arrogant and haughty attitude. This can create conflict with other people who feel exploited and who dislike being treated condescendingly. 

Despite their boldness, people with Narcissistic PD require a lot of admiration from other people in order to bolster their own fragile self-esteem. They can be quite manipulative in extracting the necessary attention from those around them.

Borderline Personality Disorder (BPD) is one of the most widely studied personality disorders. People with BPD tend to experience intense and unstable emotions and moods that can shift fairly quickly. They generally have a hard time calming down once they’ve become upset. 

Consequently, they frequently have angry outbursts and engage in impulsive behaviours such as substance abuse, risky sexual liaisons, self-injury, overspending, or binge eating. These behaviours often function to sooth them in the short-term, but harm them in the longer term.

People with BPD tend to see the world in polarised, over-simplified, black or white, all-or-nothing terms. They apply their harsh either/or judgments to others and to themselves and their perceptions of themselves and others may quickly vacillate between “all good” and “all bad.” This tendency leads to inconsistency and an unstable sense of self. They can impulsively and frequently change careers, relationships, life goals, or residences, often without advance preparation.

Their polarised manner makes it easy for them to misinterpret the actions and motivations of others leading them to experience intense emotional reactions, which in turn interact with their difficulties in regulating these intense emotions. 

Clearly, the Borderline Personality Disorder with its combination of distorted thought patterns, intense and under-regulated emotions, and poor impulse control is practically designed to wreak havoc on any interpersonal relationship.

BPD is “characterised by pervasive instability in moods, interpersonal relationships, self-image, and behaviour. While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last for only a few hours to a day (

Diagnostic information courtesy:


About BPD

Seventy-five per cent of people diagnosed with BPD are women (that’s a ratio of three women to every one man diagnosed with BPD). Women are far more likely to be diagnosed with BPD than men but researchers do not know why there is this gender difference (

Borderline personality disorder is also known as emotional regulation disorder (ERD). ERD is a debilitating biological disorder.

• two per cent of adults have this disorder.

• 50 per cent experience clinical depression

• Of dual-diagnosed people, 50-67 per cent have ERD.

• Between 40 and 71 per cent of ERD patients report having been sexually abused, usually by a non-caregiver. (


“While BPD is a serious mental illness, it is by no means a life sentence. Research has shown that the prognosis for BPD is actually not as bad as once thought. Almost half of people who are diagnosed with BPD will not meet the criteria for diagnosis just two years later. Ten years later, 88 per cent of people who were once diagnosed with BPD no longer meet criteria for a diagnosis.” 



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