18. Paranoid Narcissistic Borderline - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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18. Paranoid Narcissistic Borderline

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Conflict, Control, and Out of Control in Couples and Couple Therapy

Many aspects of the borderline personality or the narcissistic personality can be seen in the paranoid personality: the intense anger and sense of being betrayed over seemingly incidental and minor transgressions, extreme righteousness of the position held, and the brutal lashing out in vengeance for harm experienced.  As in other developmental disorders, the origins of the paranoid personality disorder lay deep within the individuals formative childhood experiences and may not be accessible in the present to him or herself or the therapist.  The therapist may find the following chart useful in identifying and distinguishing among these three personality disorders.

Similar to the narcissistic personality, the paranoid personality experiences his or her world perspective as ego syntonic- it all makes sense to him or her.  However, whereas the narcissist in a narcissistic rage tends to go to an ostensively cool non-emotional place that justifies every cruel act of revenge to him or her as logical, the paranoid tends to go to (stay in or stay on the edge of) an intensely emotional place of rage.  The emotional temperature in paranoid personality is hot as it is for the borderline personality when hurt, as opposed to cold as in narcissistic personality disorder.  Whereas emotions are hot for the borderline personality but then recede to a calmer state, they stay hot or simmering for the paranoid personality.  The emotional temperature for the narcissistic personality is arguably also very hot, but has been deeply suppressed to cold heat through narcissistic cognitive distortion.  While the borderline can move from the anger and the narcissist will deny his or her anger, the paranoid stays in the anger.

Every personality disorder is by definition characterological; the traits are persistent and enduring parts of the person.  Relative to the emotional reactivity and/or problematic behaviors of each personality disorder, however they can be distinguished by whether they are transitory or persistent.  The borderline personality is calm and socially appropriate but is triggered by threats of betrayal, abandonment, or rejection.  Borderline emotions or behavior may be considered transitory because they recede after the inflammatory event.  The narcissistic personality is arguably persistently vigilant to any assaults on his or her omnipotence and superiority, and thus is activated by triggers such as criticism and competition.  The paranoid personality in contrast stays in a persistent state of vigilance and arousal, hypersensitive to anything that has a whiff of insult.  Whereas, borderline and narcissistic personalities can be otherwise socially appropriate and mutually interactive, the paranoid personality has trouble being interpersonally social and intimate since "good" or neutral actions are assumed to be precursors to eventual ambush.  Similar to the borderline personality, the paranoid personality is deeply hurt by others acts, while the narcissistic personality may deny being hurt.  Whereas the borderline personality, once the pain has subsided has deep regret for what he or she then recognizes as his or her inappropriate and abusive behavior, the paranoid personality stays in the pain and anger.  He or she normally does not have either regret or awareness of his or her behavior having been inappropriate.  Or, the regret or awareness is only momentary or superficial.  Self-righteousness supersedes any awareness or regret... and subsequently any responsibility or attempts to change.

The chart above offers a conceptual set of traits to identify and distinguish these three personality disorders.  There are more nuanced differences and similarities among these personality disorders as well as with other patterns of behaviors, and even more subtleties among individuals.  For example, the cold persistence of narcissism versus the hot persistence of paranoia offers important distinctions in evaluating an individual's conditions and behaviors.  In addition, individuals without characterological dysfunction who have stimulant abuse and dependency issues with methamphetamines ("crank," "speed," "crystal"), crack, cocaine or other stimulant drugs, or with alcohol (depending on specific personality issues being dis-inhibited) will often present in the same manner as the paranoid personality.  Consideration of Clarissa's behavior and attitudes lead to the probably diagnosis of paranoid personality disorder rather than borderline or narcissistic personality disorder.  Of critical importance, accurate diagnosis guides therapy.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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