Narcissistic Personality Disorder

Mental illness is a highly stigmatized topic in modern society. We often hear phrases like, “it’s all in your head” or “you’re just being a baby,” when we express our symptoms to a less than sympathetic individual, and people frequently confuse symptoms between certain diagnoses or make assumptions based on what they see through television and movies. Unfortunately, some diagnoses seem to weather more misnomers than others, especially borderline personality disorder. The myths about people who live with this condition are often hurtful at best, and they often leave individuals feeling isolated and scared to disclose their diagnosis because they worry what fallacies people will attach to them once they hear that label. But you know what? I think it’s time we break down some of these rumors about borderline personality disorder and stop perpetuating myths that simply aren’t true. So, here are seven myths about borderline personality disorder we need to stop believing, and the realities we can use to reframe these myths. Myth #1: BPD is just “attention-seeking” and “manipulation.” It’s not a real diagnosis. Many people (falsely) equate borderline personality disorder with manipulation. These people claim that everything someone with BPD does is just a “cry for attention.” Some people even go so far as to dismiss what people with borderline personality disorder say or do as “just an act.” Reality: Many of the symptoms of borderline personality disorder cause great distress. People with BPD experience extreme fear of abandonment, mood swings, and rapid changes in self-image. These pendulum swings can cause great distress, and when combined with a propensity toward impulsive behavior, can push individuals toward acting in ways that may not make rational sense. However, these actions aren’t meant as manipulative — they’re a means of self-preservation. In fact, people with borderline personality disorder often feel remorse and extreme shame once they realize what they’ve done or said “in the heat of the moment.” Myth #2: Only women get diagnosed with BPD. If you look up statistics on gender and borderline personality disorder, you will see a disproportionate number of women who receive the diagnosis as compared to men. This belief is further fueled by mainstream media, which typically only shows women with BPD. Reality: Both men and women receive BPD diagnosis. Many experts believe previous research stating a 3:1 ratio of women receiving a BPD diagnosis isn’t actually accurate. In fact, studies have found that the prevalence of this diagnosis between the genders is nearly identical. It’s just a matter of how the symptoms present and the assessments clinicians use to make their diagnosis. Myth #3: People with BPD are incapable of forming lasting relationships. One of the key features of the borderline personality disorder diagnosis is “a pattern of unstable intense relationships.” Because some people with BPD will rapidly shift between idealizing loved ones and distrusting them, many people assume individuals with this diagnosis cannot maintain friends or romantic partners. Reality: Anyone can learn interpersonal skills to help them form lasting relationships. Although relationships are sometimes hard for people with BPD, they are far from impossible to maintain. In fact, many people with BPD enjoy lasting friendships and romantic relationships with the right people. Most of the time, all a person needs to help them build a relationship is time and interpersonal skills to help them connect with others. These skills can help people express their needs and wants in a healthy way, learn to compromise for the sake of the relationship, and stand up for themselves when the time is right. Myth #4: People with BPD are “too dramatic.” People with borderline personality disorder are frequently seen as “dramatic” because of their emotional reactivity. In fact, some people compare their responses to tantrums children throw when they don’t get their way or become upset. Reality: People with borderline personality disorder experience emotions intensely. Marsha Linehan, the creator of dialectical behavior therapy, says that living with BPD is like having “third degree burns over 90 percent of [your] body.” Unfortunately, this means that many people with BPD lack the same type of “emotional skin” that others have, and this causes them to experience frequent discomfort and distress over seemingly small things. However, everyone experiences emotions in their own way. There’s nothing “right” or “wrong” about how people feel. In the case of someone with BPD, emotions often feel all-consuming, and that can be hard to rein in, especially if no one ever taught you how to self-regulate your emotions. Myth #5: All people with BPD are abusive. Some people with borderline personality disorder experience a symptom often called “borderline rage.” For some, this uncontrollable anger comes out in extreme ways and can cause physical damage to property and tear apart even the strongest relationships. Because of this, people often equate a borderline diagnosis to abuse — even in individuals who do not meet the criteria for that symptom. Reality: Anyone can be abusive regardless of a diagnosis. While the recent news of Amber Heard’s dual diagnosis of borderline personality disorder and narcissistic personality disorder has reignited this common myth, it still remains exactly that — a myth. Not everyone with borderline personality disorder meets all nine diagnostic criteria, and some people who experience outbursts of anger direct it inward, not outward. The fact is, anyone can be an abusive person, no matter what mental health conditions they do or do not live with. Furthermore, a diagnosis alone doesn’t make someone abusive. Their actions toward others is what makes them abusive, and we need to remember that. Myth #6: People with BPD only make “empty” suicide threats. Because people with borderline personality disorder experience rapid mood cycling and intense emotions, many people see them as “the boy who cried wolf” when they express a desire to die. Sometimes friends and family members go so far as to dismiss a loved one with BPD’s cries for help because they assume it’s “just for show.” Reality: Borderline personality disorder has one of the highest suicide rates among mental health conditions. Studies show that approximately 75 percent of individuals with borderline personality disorder will make at least one suicide attempt during their lifetime, with many of them making multiple attempts throughout their lifetime. What’s more, BPD has one of the highest mortality rates of any mental illness, with up to 10 percent of individuals with BPD dying by suicide. It’s important to take any indication of suicide seriously, regardless of a diagnosis. Everyone deserves help, and people don’t just make “empty threats” when it comes to life. Myth #7: You can’t recover from BPD. Because borderline personality disorder is a, well, a personality disorder, people often claim it cannot be treated. In fact, some people claim individuals who live with BPD can’t “change who they are” or “refuse to get help.” This is further complicated by the fact personality disorders typically cannot be treated with medications, and some people do not see therapy as a valuable treatment method. Reality: Borderline personality disorder is completely treatable. Although these studies rarely get attention, researchers have found that the majority of people with borderline personality disorder do eventually go into remission or recover once they receive an accurate diagnosis and the appropriate treatment. This can take anywhere from two to 10 years, depending on a variety of factors. What’s more, there are multiple proven treatment methods for borderline personality disorder, including dialectical behavior therapy and mentalization-based therapy. Many people with BPD also deal with other mental health conditions, like depression and anxiety, that can be treated with medication. When combined with a strong support network and a willingness to undergo treatment, medication, and psychotherapy can work as the perfect teammates for someone with BPD who is trying their best to create a life worth living.

This question comes up all the time, about all kinds of public figures and various sorts of disorders. Does Donald Trump have narcissistic personality disorder? Did Freddie Mercury have undiagnosed bipolar disorder? Do the Kardashians have body dysmorphic disorder? Does Joe Biden have dementia? Was Nancy Reagan codependent? Seven years ago, I wrote about Emily Dickinson. I said it is impossible to know whether Dickinson or any other historical personage had any psychiatric disorder and, if they did, what it was. Now I have basically the same thing to say about the “diagnoses” of public figures. It’s impossible to say whether any given celebrity — or indeed any public or private individual — has a psychiatric disorder unless that person has spoken about it publicly. We cannot assume, just from the little we know about another person, that they live with any given condition. This is true not just of psychological disorders, but also physical ones. In the past, it was easier to keep physical difficulties secret. Few knew that John F. Kennedy wore a back brace because of an old injury or that Franklin D. Roosevelt used a wheelchair because of polio. In many cases, it is only now that their memoirs or the memoirs of their friends have revealed these previously secret afflictions do we know about them. When it comes to psychiatric diagnoses, the difficulty is not that friends may or may not keep a public person’s secret, but that the public has no real right to know unless the celebrity is open about it. The relationship between a psychiatrist and a patient is confidential. Only the patient can give permission for the doctor to disregard that confidentiality. Lately, it has become common for political figures to endure public examination of their medical records and even psychological records. But this is by no means a requirement for a public office such as president. Really, a president of the U.S. only has to be over 35 years of age, be a natural born citizen, have lived in the U.S. for at least 14 years, and get the most votes. And such scrutiny is hardly a requirement — completely irrelevant — for entertainers and athletes. Speculation about the private lives of public figures has reached the level of a sport. It seems that just because a person has achieved some measure of celebrity, their life is now an open book. Their fans (and detractors, for that matter) often want to feel they have a personal connection with the public figure. Many want to believe they know the celebrity better than anyone else. They may feel a kinship with the person because they have the same disorder the public figure supposedly has. But the most you can say about a public figure is that they show some behaviors that can be associated with a certain diagnosis — not that the person actually has that condition. Some celebrated sports figures and actors have been upfront about revealing their own and their families’ stories of psychiatric illnesses. Catherine Zeta-Jones, Glenn Close, Carrie Fisher, and Michael Phelps have let such conditions be known, in hopes of reducing the stigma surrounding mental illness and encouraging others to seek help for their conditions. But I believe these people are the exception. Most people, both celebrities and the general public, struggle in silence. Basically, the only way to diagnose a person is for them to have an ongoing relationship with a psychiatrist or psychologist. A doctor who has spoken to the individual and spent time with them is the only person who can make that diagnosis. Even psychiatrists who testify at trials about the mental state of defendants may not have had any previous, personal contact with them. Yet their opinions help determine the fates of people they don’t really know. Public figures don’t belong to the public, whatever their fans or detractors may think. Their minds especially are their own. It is reckless, improper, and ultimately futile to speculate on a public or historical figure’s mental state, in my opinion. But people do so and will continue to, as long as there are celebrities and people who feel they have a right to analyze them.

I’ve written before about my concerns with the mental health impacts of social media in general and with specific trends in particular, like “reality shifting” on TikTok. But one that is a delicate double-edged sword is the burgeoning presence of therapists on social media. Many have great things to say and are doing profoundly important work in not only destigmatizing therapy, but also providing somewhere for those who cannot access therapy for whatever reasons a place to go to feel supported. I confess to following a number of therapists’ podcasts, YouTube channels, and social media profiles, and gleaning positive insights from them. But, I comprehend what they offer isn’t therapy per se and that there are potential ethical boundary violations that come with serious liability issues for therapists offering specific advice in their posts. The content created by these therapists should always come with a disclaimer stating their posts do not constitute therapeutic advice nor should they be a replacement for individual therapy. The thing is… they don’t always, and that should scare all of us. This is particularly concerning in a world where people are learning terminology used to diagnose or treat actual mental health conditions and co-opting these terms to speak colloquially about concepts that are not in fact the same things. Take this meme for example: This perfectly sums up the pervasiveness of the problem. Narcissistic personality disorder is not “narcissism” and cannot be diagnosed by anyone but a mental health professional who is actually treating a patient. There are plenty of people who behave selfishly, have inflated egos and might even exhibit complete disregard for anyone but themselves. But we cannot assume they are “narcissists” in the true definition of the word. “Trauma” or post-truamatic stress disorder (PTSD) is not code for “bad things that happen,” but rather a response some people have to things that occur that may be life-threatening. And not everyone who experiences the same event will be “traumatized” or develop PTSD. Again, this is a diagnosis that a mental health professional needs to make based on very strict criteria of presenting symptoms. “Codependency” is a very specific dysfunctional relationship where there is excessive reliability on the other individual or the relationship to feel safe or avoid being abandoned. It’s not just getting your needs met — which is something all human beings require and is a normal, healthy part of a mutually beneficial relationship. Codependency often evolves out of trauma, like growing up with an alcoholic parent, and is extremely complex and nuanced. “Healing” isn’t the same thing as “personal growth” or “self-care.” It generally refers to the process of working through traumatic experiences that have resulted in mental health conditions like PTSD, or recovering from something like substance abuse, self-harm, or an eating disorder. These processes involve tremendous time, energy, and the careful guidance of a trauma therapist or treatment center with very rigorously managed protocols. Being “happy” all the time is unrealistic and isn’t even the goal of therapy. Learning how to cope in a healthy way and ride the waves of unexpected occurrences in life without becoming emotionally dysregulated is the goal. Insisting on always being positive is toxic and can be abusive. Some things suck and the appropriate feeling is to be sad, grieve, be angry, or be frustrated. All of these feelings are instructive and “normal” which is a word I shudder to say because it is a loaded one in and of itself. And while I’ve had a therapist (ex-therapist) who constantly yapped at me about “feeling my feelings,” the reality is sometimes we all need a break. That’s why healthy distractions can be incredibly useful. None of us could have survived the uncertainty of this never-ending COVID-19 pandemic without figuring out how to escape our constant worry, fear, and hypervigilance — Thank you “Ted Lasso” and “Schitt’s Creek.” Let me be clear… everyone’s journey in life is unique and for each of us, therapy and what we need out of therapy looks different. The only people who can assess what kinds of treatment modalities you need are you and your therapist. Generalizations like these that take mental health tropes and hijack them to be used in normative terms have the danger of encouraging comparative suffering, delegitimizing actual mental health conditions, perpetuating stigmatizing labels about certain conditions. and normalizing victim blaming. Language matters now, perhaps more than ever, in this age of misinformation. Using therapy lingo to describe “life” is dangerous and promotes misinformation. It also delegitimizes the field of mental health as a necessary and integral part of our health care system, and today perhaps more than ever the majority of us are recognizing mental health is no laughing matter.