According to the American Psychiatric Association, 9% of adults have one or more personality disorders. Personality disorders are types of mental health conditions. When left untreated, they can affect someone for life. Well-known personality disorders include narcissistic personality disorder (NPD) and borderline personality disorder (BPD). People with BPD often end up in relationships with people with NPD. Can an NPD and BPD relationship work? Relationships between these individuals can be difficult. Yet, these relationships can work out with the help of a mental health professional.

If you or someone you love has BPD or NPD, you or your loved one may be struggling with romantic relationships. This guide explains why you may seek certain partners and how to get help with difficult relationships.

Understanding Narcissistic and Borderline Personality Disorder

NPD and BPD are two of the 10 personality disorders recognized in the Diagnostic and Statistical Manual (DSM) of Mental Disorders. Personality disorders feature atypical ways of thinking about the self and others.

There are three categories or clusters of personality disorders. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders.

NPD and BPD fall under “Cluster B” personality disorders alongside antisocial and histrionic personality disorders. All four share in common unpredictable behaviour and volatile, sometimes inappropriate, emotions.

There is no cure for Cluster B personality disorders currently. They can also be difficult to treat. Still, experts recommend prescription medication and counselling or therapy to ease symptoms and improve quality of life.

Therapy works marginally better for people with BPD. Cognitive behavioural therapy (CBT) is a standard BPD treatment. Yet, dialectical behavioural therapy (DBT) may be more effective for people with BPD.

How Does the DSM 5 Characterize NPD?

The DSM 5 characterizes narcissistic personality disorder (NPD) as featuring self-centredness, grandiosity, lack of empathy, need for admiration, and manipulative behaviour. People with NPD also tend to exploit others.

NPD may also lead someone to believe that others are envious of them. Yet, these individuals also tend to be highly envious of others. They may have fantasies about power, wealth, success, or fame.

To receive a diagnosis of NPD, someone must meet at least five of the following criteria:

• A grandiose sense of self-importance
• An intense preoccupation with fantasies of success, power, intelligence, beauty, or love
• A belief that the narcissist is special and should only associate with similarly special people
• An intense need for admiration
• Entitlement
• Exploitation
• Lack of empathy
• Envy of others or the belief that others envy the narcissist
• Arrogance

Experts estimate that NPD is prevalent in 1–6% of the global population. The true prevalence may be higher. Colloquially, we might refer to people with NPD as egotistical, self-absorbed, or just narcissistic.

How Does the DSM 5 Characterize BPD?

The DSM 5 characterizes borderline personality disorder (BPD) as featuring chronically erratic mood and behaviour, trouble with interpersonal relationships, and suicidal behaviour.

Common symptoms people with BPD experience include fear of abandonment and impulsivity. They may experience dissociation, especially during times of stress. Dissociation occurs when someone loses their sense of identity.

According to the DSM 5, a person must display five or more of the following symptoms:

• Intense fear of abandonment
• A pattern of unstable relationships
• An unstable or missing sense of self-identity
• Intense paranoia when under stress
• Difficulty regulating anger
• Persistent sadness and/or feelings of worthlessness
• Suicidal behaviour, including self-harm, or ideation
• Intense and re-occurring mood swings
• Impulsive behaviours

BPD is much less common than NPD. Studies show a global prevalence of only 0.7–1.8%. People may refer to individuals with this personality disorder as destructive, over-emotional, or manipulative.

Are NPD and BPD Similar?

Yes, NPD and BPD are similar since they are both Cluster B Personality Disorders. Some experts suggest that these two conditions overlap. Up to 40% of people with BPD may also have NPD.

BPD and NPD can even be confused with one another. They both feature symptoms like living in a fantasy world, struggling to admit wrongdoing, and being prone to jealousy. They also tend to showcase lower emotional IQs.

Yet, NPD and BPD are very different mental disorders and have important distinctions. These distinctions determine treatment plans. They also significantly impact how an NPD vs BPD reacts in a romantic relationship.

For example, NPD and BPD tend to have similar responses to triggers. However, the reasons they get triggered are very different. The difference may have to do with the core beliefs these conditions feature.

People with NPD may believe they are special and need constant attention and admiration to support that belief. BPD often features beliefs about worthlessness that manifest as an intense fear of abandonment. However, they also tend to crave attention.

At the same time, both personality disorders lead individuals to project their feelings onto others. They may both struggle to take responsibility and accountability for their behaviours. They may both view themselves as victims.

When someone violates an NPD’s self-image, they may go into a fit of rage. In more vulnerable (covert) types, the person may showcase extreme passive aggression instead.

When someone affirms a BPD’s feelings of worthlessness, they may become depressed or dissociate. They may also take part in self-sabotage, self-harm, or attempt suicide.

Individuals with NPD are also more likely to present with shallow emotions, entitlement, and a sense of superiority. Meanwhile, BPDs more often present with intense emotions, vulnerability, and feelings of emptiness.

NPD and BPD Relationship Similarities

A final but significant difference between these disorders is how they treat others. People with BPD tend to genuinely like other people. Meanwhile, NPDs see other people as a source of narcissistic supply.

Yet, both groups may lie, be abusive, judge others critically, hold grudges, and struggle with seeing shades of grey.

They both attempt to control their environments. That way, they can avoid the common negative feelings in both disorders.

For these reasons and more, BPDs and NPDs frequently have unstable relationships with the people in their lives. We will talk more about relationships between people with BPD and NPD next.

BPD Relationship Triggers

Someone with borderline personality disorder has a deep-seated belief that they are not worthy of love. The belief that they are worthless may stem from childhood abuse or neglect. Genetics and other factors may also play a role.

Feeling worthless drives many of the triggers people with BPD experience. For example, these individuals often report relationship problems. When they experience rejection or criticism, they may react with intense anger or fear.

People with BPD who experienced childhood or adolescent abuse are also prone to cognitive triggers. These triggers come in the form of intrusive memories. The memories may be positive or negative.

If the memory is positive, the person may feel triggered because their current circumstances are not as good as they were in the past. Negative memories are more directly distressing and can also cause intense emotional reactions.

What kind of extreme reactions are we talking about? It depends on the individual. Studies show that around 80% of people with BPD experience suicidal ideation or attempts during an episode.

Anger, depression, anxiety, paranoia, and avoidance are common during BPD episodes. Some individuals may become more impulsive to overcome feelings of emptiness.

Why Are BPD Attracted to NPD?

People with BPD are attracted to people with narcissistic qualities because they have similar relationship skills. Both types tend to get into relationships quickly. They may feel romantic emotions more intensely than others.

They also tend to seek relationships that fulfil what they view as the “missing piece” in their lives. Narcissists appear confident and sure of themselves. Borderlines crave that since they see it as what they are missing.

The narcissist craves the attention borderlines bestow. The narcissist is happy to stick around and alleviate the borderline’s abandonment anxiety as long as they continue to receive that attention.

Yet, two partners with NPD and BPD will ultimately reject the other partner for these same reasons.

People with NPD also tend to reject their vulnerability. People with BPD are the exact opposite. They showcase intense vulnerability through unstable, intense emotional reactions.

At first, the “opposites attract” quality of people with NPD and BPD may make for a relatively healthy relationship. They are usually at similar levels of intimacy, which is key to maintaining a successful relationship.

Over time, though, a BPD and NPD’s shared level of intimacy can cause significant distress and conflict. We will talk more about why this happens in the next section.

What Happens in a Relationship Between Someone With BPD and Someone With NPD?

Relationships between BPDs and NPDs can help individuals achieve their unmet needs but can also be extremely volatile. The reason for this may be due to another struggle NPDs and BPDs share.

People with NPD and BPD struggle with object constancy and whole-object relations. These skills are integral to stable intimate relationships.

Whole-object relations ability allows someone to see good and bad in the same person. They can also accept that both can coincide simultaneously in themselves and others.

Object constancy is the ability to feel positively toward someone even when upset. It also refers to someone’s ability to maintain positive emotions toward someone who moves away.

People with NPD and BPD often struggle with black-and-white thinking. When someone hurts them, they see the person as “all bad.” They tend to forget the positive qualities and experiences they have shared with that person.

These individuals also deal with viewing people as “out of sight, out of mind.” During conflicts, they may additionally struggle with maintaining an intimate connection when feeling hurt, angry, or disappointed.

A BPD and NPD relationship can work during happy times. Yet, struggles with object constancy and whole-object relations can make conflicts between the two extremely volatile.

Treatment for BPD

The good news is that BPD is treatable with medication and therapy. However, like all personality disorders, it can be difficult to treat. BPD is a complex disorder, and treatment can take time.

It may take as many as 70–120 therapy sessions to start seeing results. Attending one session a week means therapy would take nearly two years at the low end and over three years at the high end.

Another challenge with treating BPD is that patients tend to lash out at perceived criticisms. If the therapist is not trained in treating BPD, they may not understand how to approach these situations.

For this reason, it is common for BPD clients to hop from one therapist to the next. Self-sabotage is also common in people in therapy for BPD. They may stop coming to therapy or communicating with the therapist altogether.

Types of Therapy for BPD

Unlike NPD, we have a relatively high volume of research on effective therapies for BPD. The following approaches are most effective for BPD in a clinical setting:

• Dialectical behavioural therapy (DBT)
• Schema-focused therapy (SFT)
• Transference-focused therapy (TFT)

DBT is the oldest form of therapy for borderline personality disorder. It is an offshoot of cognitive behavioural therapy (CBT). DBT helps clients identify how negative thought patterns lead to unwanted behaviours.

The ultimate goal of DBT treatment is to teach clients how to cope with distressing situations. They can also learn coping mechanisms for when strong emotions arise. For example, the DBT therapist might teach the client mindfulness.

Like DBT, SFT is also an offshoot of CBT with some psychoanalytic techniques added in. This type of therapy helps clients to identify unmet needs during childhood. They then learn how those unmet needs impact their thought patterns.

The goal of SFT is to teach clients to challenge their beliefs and thoughts that stem from unmet childhood needs. Over time, they can learn to think healthier and use more positive behaviours to cope with distress.

TFT may be the best therapy option for people with BPD. This unique technique requires the therapist to uncover how the client relates to other people based on how they relate to the therapist.

The ultimate goal is for the client to be aware of negative behaviours that could exacerbate their symptoms. Then, the therapist can help the client learn how to avoid these negative behaviours in the real world.

Types of Medication for BPD

Unfortunately, we do not currently have any approved medications to treat BPD. Some medications may help alleviate certain symptoms. Others can address co-occurring conditions that may exacerbate these symptoms.

The most common drugs prescribed for BPD include antidepressants, antipsychotics, anxiolytics, and mood stabilizers.

Antipsychotics may help with the more maladaptive BPD symptoms. For example, these drugs can help reduce feelings of anger, impulsivity, and paranoia.

Mood stabilizers are also helpful for BPD symptoms. These drugs may reduce the feelings of emotional instability and impulsivity in people with BPD.

Antidepressants and anxiolytics help treat depression and anxiety. Along with post-traumatic stress disorder (PTSD) and bipolar disorder, these disorders commonly co-occur with BPD.

BPD Recovery Rate

Studies show that remission rates for people in therapy for BPD range from 33–99%. Remission refers to the signs and symptoms of a disorder decreasing or going away altogether.

In mental health, remission can mean something else. For example, it may mean that someone no longer has enough symptoms to qualify for a diagnosis of BPD.

However, symptoms of BPD will not go away on their own. People diagnosed with this disorder need to seek professional psychotherapy. In some cases, medication may also help, though therapy is the first line of defence.

Treatment for NPD

Experts believe that the most effective treatment for NPD is long-term therapy. Yet, we have limited research on NPD and the treatments that may work for it. Instead, many therapists use treatments that work for BPD.

Most individuals who have this disorder do not seek treatment. They believe that there is nothing wrong with them. They believe the problem is with other people in their life.

The first step toward treatment, then, is to provide a diagnosis. Some people eventually diagnosed with NPD may come to therapy with other complaints (e.g., mood disorders) or at the behest of a loved one.

In a clinical setting, the professional will evaluate the person with an interview. Various tests, such as The Weill Cornell Institute’s Personality Institute questionnaire, can help clinicians diagnose NPD.

Types of Therapy for NPD

Once someone receives a diagnosis, they may choose to undergo therapy. Transference-focused therapy and schema-focused therapy tend to be the most common treatments.

Transference-focused therapy for NPD focuses on the narcissist’s relationship with the therapist. As with TFP for BPD, one of the primary goals is to work on the client’s object constancy.

Schema-focused therapy is similar to cognitive behavioural therapy (CBT). It incorporates techniques from other types of therapy as well. Clients learn to change negative patterns by addressing inappropriate thoughts, behaviours, and emotions.

Other types of therapy for NPD include Gestalt therapy, mentalization-based therapy, dialectical behaviour therapy (DBT), metacognitive interpersonal therapy, and supportive psychotherapy.

Types of Medication for NPD

We currently do not have a medication that can treat NPD. However, some medications may help people with NPD regulate certain symptoms, such as:

• Mood liability
• Impulse control
• Temporary psychosis

As we mentioned, many people with NPD have co-occurring mental health disturbances like depression, attention-deficit hyperactivity disorder (ADHD), and anxiety. Treating these co-occurring conditions may help the NPD feel better.

NPD Recovery Rate

There is a common misconception that people with NPD cannot change. If the person does not seek help, this may be true. Yet, therapy can be an effective way to develop new behavioural and cognitive patterns.

An older study found that NPD has a remission rate of 52.5%. What does that mean? A little more than half of the people who seek help for NPD experience a decrease or disappearance of their symptoms.

People who enter therapy with a higher sense of self-awareness may have a higher chance of success. Without this awareness, the person may not work as hard in therapy to overcome their most problematic symptoms.

Can a NPD and a BPD Relationship Work?

Yes, an NPD and a BPD relationship can work if the two people are willing to get help. NPD and BPD treatments like therapy can help these individuals overcome negative coping skills and improve intimacy skills.

Often, partners with BPD and NPD do not have any ill intent toward one another. Instead, they get caught up in a cycle or pattern of maladaptive defence mechanisms.

Overcoming these defence mechanisms can not only improve relationships between NPDs and BPDs. If the partners have children, they can also prevent a new generation from developing the same maladaptive skills.

At Simcoe Addiction and Mental Health, we offer various programs for people who have personality disorders. Learn more about our virtual outpatient program to finally get the help you need.

Get Help for Personality Disorders in Ontario

So, can a NPD and BPD relationship work? Yes, an NPD and BPD can have a happy and fulfilling relationship together as long as both partners are willing to seek treatment.

Therapy can help you overcome negative patterns holding your relationship back. Medication may also effectively reduce the most problematic symptoms of personality disorders.

Are you searching for mental health treatment in Ontario? Simcoe Addiction and Mental Health is here for you. Contact us today to learn more about our therapy treatment programs for personality disorders like BPD.