Explaining the Role of Grandiose and Vulnerable Narcissism in Borderline Personality Disorder

Patients with borderline personality disorder are known to have a clinically relevant heterogeneity in relation to severity of the disease and specific features, such as rage, rejection sensitivity, personality organization, or depression. There is little information about the importance of pathological narcissism for borderline patients (1). The limited evidence may be due in part to methodological difficulties in identifying Narcissistic clinical manifestations, which reflects disagreement among experts about this structure (2, 3). DSM diagnostic classifications appear as clusters of symptoms rather than being developed by a predetermined theory. The results are familiar but ambiguous. Classification is not effective enough. Among the dimensional models proposed to DSM to describe personality disorders, Kernberg's theory of object relations can be observed. For personality disorders, Kernberg eliminates these problems by shifting attention from borderline personality disorder to borderline personality organization (BPO). He places pathological narcissism on the subgroup of borderline personality organization. This conceptualization is a purely developmental theory, an explanation of the features of interpersonal relationships and defense mechanisms, and even including recommended therapies/treatment methods (4)A review of narcissistic descriptions based on clinical personality theories reveals that two types of vulnerable and grandiose narcissism are two areas of narcissistic personality disorder malfunction(5). Vulnerable narcissism is characterized by low self-esteem, self-criticism and devaluing , shame, social rejection sensitivity and isolation, Entitlement Rage, hiding the Self (6-8). Borderline personality disorder and vulnerable narcissism, although known as distinct structures but different qualitative structures, are interrelated (9). In fact, the characteristics of vulnerable narcissism may indicate a more general personality pathology similar to borderline personality disorder (10, 11).

The present study is descriptive and it has used of structural equation modeling and confirmatory factor analysis. In this study, 102 women and 58 men who had consulted to were client psychiatric clinics in Shiraz participated and received a BPD diagnosis of by a psychiatrist. Patients were selected by convenience sampling and voluntary selection from among those who had consulted to these centers. Explaining the principle of confidentiality of information, patients signed the consent form and then, completed the questionnaire under the supervision of a psychologist present at the center. Enterance requirements were/ to be eligible to apply included having over the age of 18 and at least holding a diploma, no use of psychiatric drugs, no experience of psychosis and mania, no significant medical problems, no mental retardation and no heavy drug use. Two questionnaires of borderline personality disorder and pathological narcissism questionnaire were used to assess the characteristics of psychopathology. Borderline Personality Disorder Questionnaire: The borderline personality disorder questionnaire was developed by Leichsenring in 1999(12) in order to assess borderline personality traits in clinical and non-clinical samples and is answered as yes or no. The questionnaire is essentially a 53-item scale based on the Kernberg concept of borderline personality organization as well as the DSM-IV diagnostic criteria.Pathological narcissism questionnaire: The Pincus’ pathological narcissism scale is a 52-item measurement tool that scores based on the 6-point Likert scale from " Not at all like me " to " Very much like me ". This tool measures the two dimensions of grandiose narcissism and vulnerable narcissism and has 7 dimensions or components including: contingent self-esteem (CSE), Self-Sacrificing Self-Enhancement (SSSE), Exploitativeness (EXP), Hiding the Self (HS), Grandiose Fantasy (GF), Devaluing (DV), and Entitlement Rage (ER).

Fit indicators show that all indicators are in the desired range, so the structural model of the research is approved. Findings showed that the variables of vulnerable narcissism have a positive and significant effect on fear of intimacy (0.37), damaged reality testing (0.55), primary defense mechanisms (0.62) and identity difiussion (0.69). Also, the grandiose narcissistic pathway coefficient with fear of intimacy (0.71), damaged reality testing (0.64), primary defense mechanisms (0.38) and identity disorder (0.26) is positive and significant. In other words, vulnerable narcissism and grandiose narcissism predict the dimensions of borderline personality disorder.

In this study, pathological narcissism, a recent German version of the scale showing that the vulnerable and grandiose type is associated with borderline disorder was assessed (1, 13). Research shows that great grandiose and vulnerable traits in personality disorders are commonly reported together (14). This research is consistent with the studies of Miller, 2008 and Euler and Stubby, 2018 Kampe et al. 2021(1, 10, 15). In Melanie Klein's theory, the concept of envy and the mechanism of splitting has been used. Envy is one of the most primitive and fundamental emotions. Envy is a two-way relationship that aims to seize the whole goodness that can be pulled out of the object regardless of the consequences. This can lead to the destruction and contamination of its good. Envy wants to be as good as object, but when this is considered impossible, it tries to tarnish the goodness of the object in order to eliminate the source of these envious feelings. Due to the sources of excessive threat to the child's environment, the mechanism of the primary splitting which is vital to the child's development and is associated with the idealization of the good object, destroyed and the very good source on which the baby depends on growth is attacked and lost. As a result, the possibility of obtaining good introspection is eliminated, and what is internalized is only the bad part of the object. The ego will inevitably be damaged. In this case, a gap is created between the person and the object, and this vulnerability may lead to a person turning away from one’s grandiose narcissistic traits from any connection and intimacy.Kernberg, 1976 emphasizes confronting or exposure to the patient's pathological defenses that weaken the ego and reduce its ability to reality testing. Vulnerable narcissism is negatively correlated with the use of mature defenses. From pathological perspective, defense mechanisms in narcissism are perceived as a developmental consequence of early experiences of rejection and devaling by the child's primary caregivers (15, 16).Instability in identity and narcissistic traits are significantly related to eachother (17); The grandiose narcissist has a relatively accurate view of oneself. If failure occurs due to the loss or frustration of the love object, because of the connection between one’s self-image and one's image of the object, Object-focused aggression will also have targeted oneself.Aggressive devaluation of the object leads to self-humiliation and degeneration of self-esteem, and the loss of self-esteem leads to latent narcissistic conflict. Regression to the previous stages of development causes the person's emotional fluctuation in loving parents with absolute power and despair of the love objects and is seen in the form of disturbances in the identification, inability and feeling of emptiness in the borderline or psychotic person.The main essence of narcissistic personality is the existence of a deficit in its structure, which arises from the incompleteness of the process and the coherence and integration of grandiose self and ideal object in ego reality-focused structure. The patient is not fully aware of the pathological nature and state of consciousness and this is due to the feeling of incompleteness and imperfection of his reality and the world around the self. This constant narcissistic structure in borderline disorder suffers from psychological incoherence and resorts to delusions and even illusions to cope with the unbearable feeling of splitting and loss of ideal objects (18).