5 Personality Disorders That People Mistake For Narcissism

Inflexibility, having a very narrow emotional expression, and having a lot of difficulty establishing close relationships and maintaining those close relationships. A lot of it because of this rigidity and this um, and sort of this need to garner all of their identity through work.

Now, borderline personality disorder has a lot of relationship to narcissism in general, and you're going to see, even as I describe borderline personality styles in general, you'll see where some of the overlaps are, but you're also going to see where it's quite distinct.

Borderline personality disorder is really characterized by one word, and that one word is instability. It's instability in identity, instability in how a person views themselves, instability in a person's goals, instability in relationships, instability in emotions. And then that instability is also accompanied by other behavioral issues such as impulsivity, risk-taking, and chronic manifestations of hostility and difficulties with anger management.

When we look at the overall symptomatology of borderline personality disorder, we're looking at patterns such as abandonment. Abandonment is a major issue. People with borderline personality are frequently engaging in frantic efforts to avoid any form of abandonment, real or imagined. There's a pattern of very unstable interpersonal relationships, and these relationships tend to be characterized by going between two sorts of poles: between an extreme of idealizing somebody – they're the best thing, they're the best thing that ever happened to them – and utter devaluation, but a lot of going between the two.

Another common element of borderline personality that we see is disturbances in identity. A person with this personality style will have a very unstable sense of self and a very unstable just general self-image. We see tendency towards impulsivity, and impulsivity can be in a variety of areas, and usually areas that are self-damaging. This would be things like risky sex with potentially dangerous partners, reckless driving, substance use, indiscriminate spending, behaving, having discontrol behavior with food, that sort of thing. We can see recurrent suicidal behavior, recurrent suicidal gestures, recurring suicidal threats, or self-harming behavior, for example, self-mutilation.

We tend to see overall emotional instability, and this most likely manifests through a reactivity of mood. So the person has very strong emotional reactions to situations, and this can be intense episodes of depression, intense episodes of irritability, and these can last for just a few hours all the way to a few days. People who have borderline personality styles will often say that they feel empty. There will be issues with being a very major difficulty with controlling anger. They can have inappropriate, intense anger and lots of trouble controlling or holding back on displays of that anger. And in some cases, you can also see what we call transient, um, transient means sort of passing, stress-related paranoid ideation due to stress. So that's the kind of thing where a person really starts to feel paranoid, and that gets intensified under conditions of stress, really feeling that people are out to harm them, out to get them. Or you might even see dissociative symptoms in people with borderline personality when they're under stress. So as you can see, this is generally a pattern of instability, anger, acting out, and despair.

Now, when we think about borderline personality disorder in line with narcissistic abuse, let's start, let's start by talking about what happens when a person who has borderline personality style is in a narcissistically abusive relationship. In a word, it is a volatile, very messy, potentially very dangerous situation. The narcissistic relationship, as we know, has this cycle, right? Love bombing, devaluation, discarding. Can you imagine how that plays out for somebody who really, really struggles with abandonment?

So, as a result, when a person with a borderline personality style gets into a relationship with somebody who has a very strong narcissistic personality style, you'll see numerous volatile crises play out around abandonment, around how, um, different shows of cruelty from one to the other, very strong outbursts of emotion. These relationships can be so volatile that it's actually quite dangerous for children to witness them or be in the presence of them. Sometimes they can escalate to violence, but there's a tremendous amount of chaos, and the narcissistic abuse can actually culminate in significant crisis for a person who has borderline personality and frequently feels abandoned.

In a relationship with a narcissistic partner, or in a relationship characterized by narcissistic abuse, both when we see, um, when we see people who are narcissistic and we see people with borderline personality styles, we see that dysregulation, right? And that dysregulation can really play out. So, in fact, when sometimes when people are in a relationship with somebody with borderline personality, they'll report that the impacts of the dysregulation really take a toll on them.

There's another interesting overlap. Is that there are overlaps in terms of abandonment. Abandonment is an issue for people who are narcissistic. Abandonment is a very big issue for people with borderline personality. And as a result, you'll really see the sort of approach-avoidance style. People who really go in and almost get like too intensely enmeshed with each other, and then they, as soon as they feel like they're getting too close, somebody always runs away. The other one tries to pull the other one back. And it really seems almost like this senseless, chaotic carousel of breaking up and getting back together, breaking up and getting back together.

Because people who are narcissistic are so contemptuous, that contemptuousness for anybody really stings. It feels awful because it really does feel like someone's almost disgusted with us. Well, in situations of narcissistic abuse, that sort of contemptuous, rejecting, disgusted emotion that gets expressed, if a person with borderline symptomatology is in a narcissistically abusive relationship, just that contemptuous disregard can trigger those abandonment symptoms and an abandonment crisis.

The suicidal acting out that is not uncommon in borderline personality can make these relationships very dangerous when they're characterized by narcissistic abuse. Because what can often happen is that the abandonment crisis can set off a suicidal acting out, suicidal gestures, suicidal thoughts. Because abandonment crises are such a classical part of a narcissistically abusive relationship, that can set off these suicidal crises more and more often. And there's a real danger to that. But in that, an attempt could escalate to the point, obviously, where a person could lose their life or do significant, such significant harm to themselves that it cannot be, it cannot be turned back. It could do severe damage to themselves physically, for example. So, in a nutshell, narcissistic abuse within the context of borderline personality is really, really a messy, potentially dangerous clinical space.

No, when we think about narcissism and borderline personality disorder, there are definitely overlaps. If we were to look at all the personality disorders sort of on a related continuum, borderline and narcissistic personalities are contiguous. They touch each other. Theorists like Otto Kernberg, quite frankly, when he described, and he's a major theorist when it comes to narcissism and narcissistic personality disorder, if you read his writings, the way he describes narcissism and narcissistic personality, it actually resembles borderline personality as it's described in the DSM. So the overlap has often been well known.

What we do see, for example, in borderline personality is a real variability in empathy. There are times when there's no significant stress present, and where there's not an abandonment crisis being activated, a person with borderline personality actually will often have excessive empathy, be deeply attuned to other people, very caring, almost to a fault, like where they're actually giving up too much of themselves to be present for another. However, when stress or abandonment or some other crisis gets activated, that empathy really dissipates. It's as though then the person's entirely focused on trying to stave off abandonment, and then it can turn into a place of rage. And that rage isn't always rage out at other people. In borderline personality, it can also be rage inward, which is where we hear the terrible negative things that people with borderline personality will say about themselves or think about themselves, or the self-harming behavior.

But there can be some overlap. When we look at what I call sort of pure borderline personality styles, we see a lot of despair, we see a lot of internal pain, the ability to express that pain, a sense of helplessness with the symptomatology, wishing there was a way to address it, very aware of the harm this is causing to other people, almost sometimes actually quite insightful at moments of what we call lucidity, when they'll say, "I recognize what I'm doing is not okay, and I'm going to burn this relationship up with all my fears that you're cheating on me, or going away from me, or abandoning me. I'm aware of that, and I'm so sorry for all the chaos I'm causing." That's the kind of reflection you can hear from somebody with pure borderline.

It starts getting messy when both borderline and narcissistic symptoms are present in the same individual. When you see both narcissistic and borderline symptoms in the same person, we may see less insight, much more externalized anger, the screaming, the yelling, the raging at others, more manipulative behavior, more entitlement, so, and a subsequently more boundary violations. Still that despair, but a lot of other patterns that are interpersonally much, much more challenging. So yes, there is a relationship between the two. And again, this gets into much, much deeper theoretical musings about this topic. But when you really think of it as a continuum, pure narcissism, we know that the lack of empathy, entitlement, arrogance, all that. Pure borderline, very despairing. But that overlap can often result in this rather panicky, angry, acting out, manipulative style that is often, interestingly, often viewed in line with how a lot of people think of borderline personality, but in fact, is a little bit different. It's not that purest type that's much, much more despair-oriented.

Now, when we think about the treatment of borderline personality disorder, actually, the treatment outcomes here may be better than they are for any personality disorder. There is Marshall Linehan's work in the development of dialectical behavior therapy, and that has definitely shown some good outcomes, and particularly on the more severe elements of borderline personality, such as emotional regulation around suicidal behavior. There have been numerous clinical studies that show that the use of DBT, dialectical behavior therapy, with people who have borderline personality or borderline personality disorder, does decrease the number of suicidal attempts and events.

Cognitive behavioral therapy has also been shown to be useful, helping people understand better their thoughts and their beliefs and their subsequent behavior. This idea, for example, a person with borderline personality can really, really assume that people are going to leave them, and then communicate with another person as though they are, when they're not. Teaching people about those patterns.

Medications are often brought to bear in borderline personality. People who prescribe medications may use a combination of things, including antidepressants, mood stabilizing medications, antipsychotic medications, and anti-anxiety medications. For that, you'd have to see a psychiatrist or a psychiatric nurse practitioner who can engage in more education specific to the symptoms somebody's having to come up with sort of the perfect medication balance, if that's what's indicated. And there's always a need for long-term psychotherapy. This is not something that's going to be knocked out in five or six or eight or ten sessions. This is often longer-term clinical work, a combination of individual therapy, group therapy, doing long-term work, doing work between sessions and workbooks and homework and all of that. So it's a long-term commitment. However, it does work. And many people who really have the right treatment for borderline personality really do see changes. They're able to regulate emotion better and manage relationships in a better way.

Another important piece of borderline personality disorder is that the vast majority of people with borderline personality disorder have a co-occurring mental health condition, like a mood disorder, or an anxiety disorder, or substance use disorder. So a big part of the treatment is also managing those co-occurring conditions, which can get worse in light of having co-occurring borderline personality occurring with them.

So, histrionic personality disorder is, is a, is a personality disorder that's actually about to probably be retired. As they're making decisions in the DSM about which personality disorders are going to keep, this one looks like it's going to get the ax. It's a rather unfortunately named disorder. The disorder is basically a pathologization of a woman's body. Histrionic comes from hysteria, which comes from wandering uterus, and you know the rest of that story. So it's a problematic word, but it's the word we've got because it's the word they use. And I'm very aware that it's a problematic word. So let's talk a little bit about what this thing called histrionic personality disorder is.

In a word, this is a disorder that's very much characterized by shallowness. It's a person who's excessively and exaggeratedly emotional, constantly attention-seeking. And these are these, the patterns we say here are things like a person who's very uncomfortable when they're not the center of attention. Their interactions with other people are often characterized by being seductive or inappropriately sexual, very, very, very flirtatious. It feels like boundary-violating flirtatious. Their emotions are very rapidly shifting. They use their physical appearance to draw attention to themselves. They will enhance themselves, they'll be very dressed, they'll often dress quite provocatively in a way that would attract attention, or outlandishly. Their speech is very, um, it's very impressionistic. And that's what that really means when we say something is impressionistic. What we mean is that it's very, how do I put it? Like it'd be someone like saying, "I met someone and we had the most magical connection, and I feel this magic energy between us." I'm like, what does that mean? So there's no there there when these folks are talking. Very, it lacks details. They talk in these sort of big broad strokes, but you're, you want to say to them, "What exactly do you mean?"

This is a very self-dramatizing kind of a personality, so a very theatrical, very exaggerated. I guess like I'm doing that, lots of gesturing, you know, the, there again, theatrical is really the best word. Very suggestible. It's very easy for them to be influenced by other people, and in this way, they can actually fall for all kinds of cons and scams and even conspiracies of all kinds. Like they can easily be influenced, and they can be easily tricked. And as a result, sometimes may spend money on things that are, um, they're being told, "This is a magical cure for something." And like, "Sign me up." Or, "If you take this class, you'll learn all the secrets for the rest of life." "Sure, sign me up." And so they're very vulnerable to those kinds of mechanisms. And they actually consider relationships to be closer than they actually are. So they'll meet someone once and think, "This is my best friend." Or they'll tell you after meeting you once, "I love you." And you'll say, "Wow, okay." And so there's, there's a real assumption of intimacy and closeness, which obviously can't be the case when you've known someone a short time. And it really speaks to the deficits we see in intimacy in people with a histrionic personality style.

Folks like this are very inappropriate. And it's interesting because this is a pattern that has been called by some researchers as what we call ego-syntonic. People who have this histrionic personality style actually don't have much insight into the idea that these patterns are a problem, and they're actually a little bit surprised when other people are bothered by them or their relationships start going south. The prevalence of this is about two to three percent, just like we see across most of the personality disorders.

Now, this time I'm going to go in the other direction and talk about how narcissism links to histrionic personality style, because it'll help us talk about narcissistic abuse a little bit more clearly. I have always believed that histrionic personality and is really sort of narcissism light. It's a reason I think it actually probably does need to be retired, because I think a lot of these patterns might almost be sort of the mildest levels of narcissistic personality styles. They're very, very close in presentation. Now, obviously, much more in line with the grandiose narcissistic style. Think about it. The histrionic style has amongst its diagnostic criteria things like being attention-seeking, not and and feeling uncomfortable when they're not the center of attention, being seductive, having shallow emotions, being overly focused on their appearance, talking in the sort of shallow way where they're not really saying anything, being grandiose, being overly concerned about other people, having poor boundaries. This definitely feels like narcissism light.

And there's another pattern we tend to see in people who are histrionic. They tend to be psychologically immature for their entire life. Not just as like young adults, like they'll be 70 and still have this very, very childish, immature presentation, youthful in ways that sort of seem like that ship has kind of sailed. And so again, it's a real kind of a psychological immaturity that we see in them, a stuntedness of growth, which can be fine on a happy summer's afternoon, but in the day-to-day, it's really unsustainable. Like I said, this is a diagnostic group, a diagnostic style, I should say, this personality disorder that's probably going to get booted from the DSM, but it really is, a lot of this gets absorbed by the narcissistic style and might be more of a stylistic issue, this sort of attention-seeking shallow style, more than a disorder per se.

When people with histrionic personality sort of find themselves having more of the disorder issues, where it's causing impairment or it's causing distress, it's because it's usually blowing up their relationships, and they're going from relationship to relationship, and people are leaving them because they find this to be a very immature kind of a relationship style.

Now, when we shift gears to narcissistic abuse, given how much of an overlap there is between histrionic personality and narcissism, you can see that somebody's going to, it's going to have similar impacts on someone in a relationship with them. Maybe not as severe, because as I said, histrionic personality almost feels like narcissism light. So let's start with, if this is your parent, you have a parent who has more of a histrionic presentation. Many times, people will then feel like they are becoming the parent to this person, even as a child. Because, like, let's say you have a mom like this, it's always the mom show, it's always the dad show, the drama, their passions, their stuff, and you're always feeling like you're always having to indulge this really immature parent.

A child with a parent like this can feel sometimes even ashamed and embarrassed around their parent's attention-seeking behavior, their immaturity, their inappropriateness, or even their flirtatiousness or their seductiveness. It can be really, sort of, again, shame-inducing for someone. And because these are parents who often don't have deep empathy or have the capacity to make a deep connection, they can really be emotionally unavailable parents. But then these are parental, these really big, strong emotions, like, "Hey everyone, let's turn the house into a circus today!" And so it'll feel fun, like, "Okay, we'll have a circus." But at the same time, you're thinking, "But tomorrow is a school day, and I still need to get my homework done." So there's this always this push-pull. If you live in this fun, fun place, but a child can sort of start feeling panicky if there's really no adult kind of keeping the trains running on time. And so a child may feel that they need to parent their image or a parent and say, "Mom, it's coming to dinner time." It'll be 10 o'clock, and they'll still be setting up the darn circus.

So for those of you who grew up like this, you know it. And while it may not have the same "you're not enough" that we see in narcissistic abuse, it's still the sense of confusion, a still a sense of, um, sometimes shame, and still a sense of, "What is going on here?" Like a sense of self-doubt, because a child is really having to step in and sort of parent their parent. In a close intimate relationship, the histrionic personality symptoms can result in a greater likelihood of patterns we also see in narcissistically abusive relationships, like infidelity, or really, really uncomfortable, embarrassing lack of boundaries on the behalf of a histrionic partner. A person, once again, may feel like they're in a relationship with sort of an adolescent, even though it's an adult relationship.

And because we know that in some cases, you can have a lot of this sort of shallow, immature, theatrical, emotional histrionic stuff alongside traditional narcissism, and if you have both of those things happening at the same time, it actually does feel like really toxic narcissistic abuse and incredibly frustrating. It's actually not unusual for a person with histrionic personality disorder or histrionic patterns to end up in relationships with narcissistic people. The grandiose "razzle-dazzle" of a narcissistic person is actually quite appealing to a person who has a histrionic personality style. And when that sort of grandiose, arrogant, controlling, unempathic narcissism meets up with the superficial emotionality but the equal incapacity for intimacy we see in a histrionic person, it's sort of interesting. Especially in the love bombing phase, we can see a lot of talk of twin flames and magical relationships and magical connections, and this is a, you know, this is something that's transcendent and no one's ever experienced this before. It's like you've got two people in this sort of shared strange space with each other.

But as is often the case in any narcissistic relationship, at some point, the narcissistic person will probably lose patience with the histrionic style person, and then these end up becoming very, very volatile relationships where the histrionic, for example, a narcissistic partner will become very jealous of a histrionic partner going out there, drawing attention to themselves and flirting. So you can see where this goes, isn't it? It's very, very explosive.

In terms of treatment, like most personality patterns and personality disorders, histrionic personality can be pretty treatment-resistant, mostly because of the lack of insight. Because unless something else goes wrong in the life of somebody with histrionic personality, they are not likely to come in for therapy, and they're not likely to turn this style off. They think there's nothing wrong, and they actually think everyone else is like, "Oh, you're such a, you're such a big old, you know, wet blanket, you're not fun." And, you know, "Gosh, why do you have to be so stodgy?" And this, so you always feel like you have to be the grown-up when you're around this person.

It's interesting when you see people with histrionic personalities and they get into later life, like 70s and 80s, they remain sort of childlike and shallow and attention-seeking all the way through. There's still that sort of strange theatrical quality to them. And, and it's the, but it's interesting, that theatrical part is more ridiculous, but it's not the part that's disruptive in this relation, in this, um, personality style. It's the shallowness of their emotions and their inability to connect with other people with any kind, with other people with any kind of depth, that's what causes problems for them. So as a result, people with histrionic personalities may go into later life, sometimes will continue to date pretty vigorously into their older age, but it's hard because they may not have consistent relationships, consistent caregivers. And you may find, if you're the adult child of a histrionic, a histrionic parent, or a parent with histrionic personality style, you feel very frustrated that you feel like you're babysitting a teenager, but in fact, this teenager is 85 years old.

But treatment, not so much. I mean, again, if they start experiencing some other mental health issue, they may go in for that, but it's hard work for the therapist who's still often having to bat up against this more histrionic personality style.

Let's talk a little bit about this passive-aggressive negativistic personality. Some of you might say, "I didn't know that this was a thing in the mental health realm." And it is. Interestingly, it's not something that has sort of an official diagnosis. There's no official diagnosis of passive-aggressive personality disorder. There was some consideration of it at a time, but it's not there. But I think it's really important to understand these themes. You'll see that they overlap into a lot of the other personality disorders, but it helps you, especially, you'll see, to understand narcissism.

So when we think of a passive-aggressive style or a negativistic style, the patterns we're looking at is a person who chronically feels a sense of being misunderstood. They feel chronically unappreciated. They're often very sullen, they're very argumentative. They often want to defy authority and they don't like authority figures telling them what to do. They resent the success and the good fortune of other people. They often complain of their own misfortune, and they vacillate between what we call defiance and contrition. So they vacillate between, "I'm not going to follow the rules," to, "Oh, I don't want to get in trouble for not following the rules. Sorry about that." Because as much as they have a lot of bite, they don't like to get caught. And some of you, I know, are sitting and watching this and saying, "You're talking about covert narcissists." Yeah, kinda sorta. And this is very much a strong theme in that presentation.

Now, as I said, this is not a diagnostic category in the DSM or the ICD in any of the diagnostic manuals. It didn't get taken into sort of its own phenomenon. I think that's unfortunate because I think that list of patterns really are problematic from a personality style. But I also have to say, the overlap in that list is very heavy with personality styles, including the narcissistic style, the paranoid style, and the obsessive-compulsive personality style.

Someone who's a very famous personality researcher, he's since passed, but people are still doing the work on his sort of what we call taxonomy or organizing system, is a guy named Theodore Millon. And he was somebody who really kind of punched out this particular style. And I actually appreciate his work in this area because I think it's important to understand it for those of us who are therapists, but also those of you who may be on the receiving end.

Now, this is one of those times I'm going to talk about narcissism and its relation to this pattern first, because then I'm going to be able to explain the narcissistic abuse piece of this. Now, again, you just listened to this and you're saying, "Well, that's everything that happens with a covert narcissist, isn't it?" Yeah, it is. And we know that passive aggressiveness is a massive part of the presentation of covert narcissism. I would actually say, and I think other people have written about this too, that the grandiose and the malignant narcissist, in particular, could be called actively aggressive. And the covert narcissist is more passively aggressive, right? So they're not, you know, they may not culminate, you know, as much of the screaming in your face as this sort of sullen, resentful kind of rage. But then they really bristle against people telling them what to do.

I often liken it to them being sort of the, um, the adolescent boy who doesn't want to empty the dishwasher. If you ask them even to do something simple, "I don't want to do that." I mean, it's annoying enough from a 15-year-old boy, it's really annoying when it's from a 45-year-old boy man. So the many things that are that comprise this sort of covert narcissist, that constant brooding anger at the world, the entitled victimization, their unrealized grandiosity and not being able to do the next big thing, all of that fosters the holding of grudges and then subsequently even more insidious abuse at everybody because they feel like the world has conspired to stop them from reaching their grandiose sorts of goals. It also overlaps with that oppositional defiant style and, and again, this constant argumentativeness and their unwillingness to follow rules. Like they will do, they'll even do things that are almost like little violations of rules, usually not enough to get into trouble or be afoul of breaking the law, but enough to cause distress or problems for other people.

Much more importantly, let's talk about then narcissistic abuse in light of this passive-aggressive negativistic style. This style, this personality style, because it's so often in line with narcissism, is what makes narcissistic abuse so exhausting. Okay? Because many of you are exhausted. This stuff is what makes it so exhausting. And it's a really big contributor to stuff like that walking on eggshells and the having to validate them just to keep the trains running, just because they constantly feel like sullen, sad victims. It really drives things like the silent treatment. It drives the constant arguments about every little thing, like emptying the dishwasher. It's anger about being told what to do. Once again, those little things you might ask them to do, "Well, I don't have to do that. I don't want to do that." It's a lot of that this sort of contemptuous spoiled teenager kind of stuff. Very big on, "Don't tell me what to do." That's a very passive-aggressive style. They don't like that sense that somebody else. And this is why these people don't do well at jobs, because because they really resent, and they always think that the workplace is deeply unfair. Very much part of this passive-aggressive style.

These folks tend to have this low-grade anger. They're almost like chronic mouthy all the time. Initially, because the passive-aggressive style, because it's in covert narcissism, often sits alongside sort of a certain level of anxiety. You may have even tried to appease them, like, "Oh, come on now, life isn't that bad," or "It's all going to be fine." You might have actually tried to appease them, try to tell them, "No, things will be okay for them." Nothing you say is going to change this. And when you're in a relationship with somebody who may have a narcissistic style, very much tinged by this passive-aggressive and negativistic style, you may have actually become more isolated as a result of a relationship, because it's actually embarrassing their behavior. They're so sullen, they're so grumpy, they make everyone around them miserable, that it's embarrassing to be with them and be associated with them in public. They can be very, very impolite with other people because of the style. It's always sort of a grumbling under their breath, and again, this anger that never quite, quite dissipates.

Now, it's a, um, when we look at the passive-aggressive negativistic style, what we know is that because they're so difficult, many times life doesn't go the way that they want. Sometimes it does, but usually it doesn't, which only fuels more of the passive aggression. But because this sort of passive-aggressive overlay on top of narcissism results in people with who are narcissistic with this style are even less socially skilled. They're not going to be the ones who can build strong collegial relationships in the workplace. They're not able to sort of play politics at work and sort of climb up the ranks that way. They are not going to be able to attract new clients or sales leads because they're kind of, again, there's sort of this underlying kind of anger. They don't have that usual charm and charisma front-facing game of your more classical grandiose narcissist. It's a very unpleasant style, thus it's called negativistic. And their lack of success for people who have this passive-aggressive negativistic style, in line with the rest of the covert narcissistic stuff, it becomes this brooding rage that they carry around with them all the time. And when, again, that plus the narcissism, they tend to blame everyone else for their all of their hardships: everyone, their partners, their families of origin, their children, and their co-workers, the people who park in front of their house, everyone. Over time, your pity, your need to rescue them, will give way to exhaustion and then potentially even disgust.

The key to trying to get out of one of these situations sooner rather than later is to not let the guilt, and that, and sometimes, yeah, the guilt more than anything, that can be evoked by these passive-aggressive styles, impede your ability to just set a boundary. There's a point at which you're like, "This is just too unpleasant." And I'm sorry, you know, all these bad things happen. It's not unusual for people with this personality style, for people to think they're depressed. Or sometimes for the passive-aggressive negativistic person to say, "I am depressed. I'm on antidepressants." Because probably a therapist didn't know what to do with them. And then people will sometimes feel bad and feel like, "Well, I can't step away from them. That's not very nice. Maybe they're angry because they're depressed." The depression never goes away. They keep being passive-aggressive. And then the longer you're in it, the harder it is to set the boundaries.

Now, in terms of treatment, not, not so much possibility as with most of these really difficult personality styles. I think there's probably some hopeful and optimistic therapists that will throw some cognitive behavioral therapy at this. When I've worked with clients like this, you know, the best I could do is sort of put a mirror in front of them and say, "You want to see what this sounds like?" By and large, they really just remain permanently stuck in their victimized thought loops, and, you know, often sort of kind of unaware of what they're doing to other people. Every so often, it'll break through. They're like, "You know, this is sort of unpleasant for other people." But again, it's very much a manifestation that we see in the covert narcissistic style, causes lots of problems in as a function of narcissistic abuse.

Today, we're going to be talking about obsessive-compulsive personality disorder. What is that, you say? Obsessive-compulsive personality disorder. And this is not obsessive-compulsive disorder. I'll talk about the difference between the two in a minute. But obsessive-compulsive personality disorder, and I'm going to call this OCPD because it's going to be a mouthful if I have to keep saying it, but OCPD is characterized by this sort of sense of workaholism, workaholicism, uh, rigid perfectionism, inflexibility, having a very narrow emotional expression, and having a lot of difficulty establishing close relationships and maintaining those close relationships. A lot of it because of this rigidity and this, um, and sort of this need to garner all of their identity through work.

So there's a, there's a preoccupation with being orderly, with perfectionism, with always being in control, mental control, relationship control. And these people do not have a capacity for being open to new perspectives or different points of view, being flexible, or being efficient. They're also very inefficient. They tend to be really mean, cheap, again, rigid, controlling, self-righteous. They're very much workaholics. They're perfectionistic, and they always choose work or work-related things over relationships.

The best way I can say to put obsessive OCPD or obsessive-compulsive personality disorder in a way you might understand it is that these are people who are really good about sending thank you notes, but they're really bad at authentic gratitude.

So I want to just also make a point between the difference between obsessive-compulsive personality and obsessive-compulsive disorder. In obsessive-compulsive disorder, the person is having these intrusive, unwanted thoughts, these compulsive behaviors, usually designed to offset those intrusive thoughts or correct them or cope with the anxiety from them. It's very time-consuming to engage in these obsessions and compulsions, but it's not this, it's not this sort of orderly obsession. Some people with OCD may have that kind of their focus is on symmetry, but not all. And people with obsessive-compulsive personality disorder may or may not be anxious, and whatever rituals they have sort of make sense. They're inefficient and strange, like they'll make these weird, strange color-coded binders and spend three days doing it, but still not make the deadline because they spent so much time doing the binder. The binder makes sense, but it was a bad use of time. That's very different than a person feeling like they have to count ceiling tiles to come down from, you know, relax from an obsessive thought. So I hope that makes sense that there's a very much a difference. It's really dumb that this is what they named this disorder. It's a very foolishly named disorder, but we're sort of stuck with it.

So when we look at this diagnostically, the kinds of patterns we see in somebody with OCPD is that they get really over-focused on rules and details and schedules and organizations, so much so that they almost lose the point of the activity. Like they'll have this, they'll be planning a birthday party, and they'll have this big binder that's all about the birthday party, and they'll get upset that something's not color-coded right, and they lose track of the whole idea that this was supposed to be a joyous birthday party. They're very perfectionistic, so much so that it gets in the way of actually getting a project done, because they're so perfectionistic. Like if it's not perfect here, it's not perfect there, then they'll just keep at it. So it's just, it's very inefficient. They're, they're completely devoted to work and being productive. They don't have any leisure time, they don't have any friendships. It's all they're about. They're very, very, um, they're rigid about matters of things like associated with being morality, values, ethics, and completely inflexible. And that's not kind of always how life works.

So, for example, they may think that divorce is very wrong, and that you have to stick out a marriage no matter what. And then sometimes a friend, you know, on this channel, a lot of you know what that territory is like, that doesn't work out. And they'll find that somebody with this personality style would say, "Well, I believe marriage is forever, and if you couldn't make that work, well, I guess you don't see through your word." And there's a lot of them, very, it feels grotesque almost interpersonally for their rigidity. Like, "Well, a person's gotta build themselves up by their bootstraps." And so you might literally have like a terrible medical bill for your child, and your insurance doesn't cover it. And you, and you ever may have a parent with this OCPD, and they have more than enough money, they'll say, "Well, it's bootstraps," and, "I don't think it's morally right to give you the money," and your family might actually go to financial ruin, even though there was the ability to provide for that.

Interestingly, they're not able to throw things out like old shoes or old clothes or anything that's worn out, not because it has sentimental value, but because they're cheap. So they'll hold on to things forever. And it may not necessarily be to a point of hoarding, but it'll be there, all this old stuff, and they'll say, "Oh, this jacket still works," and it's like from the 1960s, and it smells like, you know, mothballs and mildew. Um, they're reluctant to delegate work to other people unless that those other people do things exactly the way they want. So they won't let other people do it, and then they'll say, "It has to be this way." And so it's almost impossible. And by the time they get so involved, they might as well have done it themselves in the first place.

They're very, very miserly with money. They hoard money, and they hoard money for themselves, but they will not spend money on other people. And so it's very, again, very, very miserly, very, very not generous. Um, they will be like, they'll put like a spending limit, you know, so you might be married to someone like this, and they put, put a spending limit, like, "We don't spend more than a hundred dollars on gifts." And it's like, your 25th anniversary, and it's like, "Well, you've got that hundred dollar limit." And very cheap. They're cheap, and they're very rigid, and they're very stubborn. So you can see this is a relatively unpleasant style. Um, I don't even know why it's in the more sort of anxious-avoidant cluster of personality disorders. It is, but I really find it to be sort of an offensive kind of very difficult style, and it's not made for relationships.

Now, as you can imagine, and in this video, I'm going to start by talking about the overlaps with narcissism, because it'll set us up better to talk about how this would overlap with narcissistic abuse. The overlaps between narcissism and OCPD. Some of you are already watching this and hearing what I'm saying and saying, "Oh heck, this, wow, this, I thought this was narcissism. Is this OCPD?" The answer is, it may very well be both. Let's think about it. Let's break it down a little, right? You've got the perfectionism, you have this idea of getting identity from work and money, the choosing work and choosing status over personal relationships, that self-righteousness and that domination through moral superiority, the being controlling, the financial manipulation, and that rigidity. That all very much overlaps with narcissism.

OCPD is also a style characterized by limited empathy and an over-focus on details and on work over the feelings of other people. And there's a sort of an absolute disinterest in having interpersonal relationships. Now, one difference would be, a narcissistic person typically needs interpersonal relationships because they need supply. For people with OCPD, they get annoyed by interpersonal relationships because they not only distract them from work, they also feel like they're expensive, that it costs money. Um, some of you have heard me in other videos talk about the self-righteous narcissist and the neglectful narcissist. This OCPD pattern, when it overlaps with narcissism, this is when we see those patterns of self-righteous narcissists and the neglectful narcissist. That's a lot of this overlap.

Now, those of you who have gone through really brutal divorces with narcissistic people, you know what that felt like. They would fight you to the death so they didn't have to pay spousal support. OCPD people hate paying spousal support, even if they make a million dollars a year and you don't. There's something about making a regular payment in a divorce. It's very, very much a part of this personality style. And this, this is the kind of divorce where you were arguing down to the wire about every fork, every cup, I mean, the last, the number of miles on the car, like it's every little thing that you would have seen this, that's that OCPD overlay.

Those of you who might have had that very hyper-moral and very self-righteous parent, they always sent flowers at the right time, they'd always make sure those thank you notes got out, but they would also be very judgmental, very cold, not emotionally available as a parent. So you saw all these sorts of benchmarks getting hit: the flowers, the thank you notes, everything was sort of done in the sort of moral appearance thing, like everything's just, "Look at me, I do all the things right." That would be very important to them. That it's, although it's a family gift, they'd expect a formal thank you card after Christmas morning, kind of thing. They will be judgmental, not only of people in the family, but if people outside of the family, might be judgmental of a neighbor who is getting divorced. They also tend to be very cold and remote as parents and tend to be very, very controlling parents. So you can again see that there's an overlap there with the OCPD and with the narcissism. So that is, so those of you watching this might be saying, "Ah, this is interesting. Now, this is the puzzle piece that's helping me understand this."

Lots of narcissistic people have overlaps with this style, you know, because of the limitations with empathy, the disconnect from intimacy, the superiority. This pattern, OCPD, in a relationship feels just as bad as narcissism. And the overlap between OCPD and narcissism can actually really confuse people. Many people are used to the sort of lying, cheating, sort of libertine kind of narcissist. OCPD people, again, like that self-righteous narcissistic style. OCPD people can be coldly loyal. Like, "Family sticks together." There's no warmth, there's no love, but "Family sticks together." Like they'll, like they have these, like rules and things, and they'll act very morally superior, but you're like, "Family sticks together. You're the most emotionally abusive awful person. You're cold." But they're very big on that sticking together thing. And so they, and they do all these right things societally, but they're very judgy about it. Like, "Well, unlike those neighbors next door, we do this every night. We eat Sunday dinner." Like it's a lot of that. And it's dismissive. And yet those Sunday dinners are these really cold, awful kinds of uncomfortable experiences.

These people are also incredibly controlling people with OCPD about money. And many times people will say, "He'll get into a relationship with someone who has an OCPD style." Will say, "Well, I, because people with OCPD are obsessed with money, they love money, they love counting money, they love having money, and then they hoard it away." I don't know what they're hoarding it away for, but they do hoard it away. They think they're going to need it someday. And so, and so sometimes people who get into these relationships will say, "Well, gosh, my partner, the OCPD person, they don't quite get it yet. My partner really gets money. Like they really understand it." Or a family member, "They really get money." So I'm going to let them manage the money because they really get it. And then you don't understand your finances anymore. This is a really high-risk issue because when that time comes, for example, in a divorce, you don't quite understand where all the money is. I can promise you, people with this personality style, especially when it's alongside narcissism, will fight you to the death for every cent.

These are people, people with OCPD who are not willing to spend money on joy. They do not spend money on anything that's pleasurable, joyful, fun. They will not spend, want to spend money on a vacation. They will not want to spend money on a spontaneous fun night out. They hoard it. And you can imagine them sitting like Ebenezer Scrooge or Gollum from Lord of the Rings, just sitting and counting it. "It's mine. It's all mine." That's very OCPD styling. Nobody's going to.

Take it away, and they'll have a million passwords on financial accounts and all of that, so no one in the family can really fully understand what the money is about.

Now, when we talk about narcissistic abuse, understanding OCPD can also be very helpful. I talked about the narcissism piece first because you can see, given how this sort of coexists with narcissism, how this can result in some specific kinds of patterns with regard to narcissistic abuse: the control, the financial abuse, the rigidity, the coldness, the neglect, the being a workaholic. This is the type of narcissistic abuse where a person will literally feel invisible and eradicated in a relationship, or you'll feel that you're nothing more in a relationship than a financial burden to this person because they'll keep calling you that, and that there's nothing you can do to get them to pay attention. Like, you could honestly walk into the kitchen in some sort of really racy lingerie, and they probably won't look up from their spreadsheets.

And then you're judged a lot when these patterns are at play in narcissistic abuse. And this is what I mean by that: they will then, the person with OCPD is just always so judgmental. So they may judge you and say, "Gosh, somebody that's a new coat, what that costs, how much someone's being very spendy and careless," with lots of judgment about your spending. You'll often find yourself, potentially over time, becoming very secretive because even basic expenses, maybe you'll buy a slightly better ingredient at the grocery store, and they'll say, "Why weren't you buying generic?" And they'll really, really be, you know, again, everything. It's not even like a big high-end expenditure; it could be something as ordinary as a grocery store thing.

And this can bring out guilt in a person who's in experiencing narcissistic abuse within this context of OCPD and narcissism. And this can happen even when there's plenty of money. In fact, in, in the cases where there's not enough money, people sometimes, obviously, they get it. But when there's millions of dollars or hundreds of thousands of dollars, and somebody is grousing because you got the organic bananas, it's really uncomfortable.

They may also, a person with OCPD may also get restrictive around money for important things like life or death things, like healthcare. And they'll say things like, "Well, can't we just go to that cheaper hospital? Or why can't you use that doctor? Yeah, I understand they're not the leading person, but it's better, it's, they pay reimburse more on my insurance." And this might be for something like cancer treatment, like probably the one place you don't want to skimp, they'll skimp. You may have children who need very basic things, and it's a fight to get this.

I'm thinking of one story that comes of my to mind, and it was sort of a multi-millionaire narcissist who would only purchase his children's shoes twice a year, only twice a year, even when the shoes had holes in them and were in tatters. He didn't care. He had used a prenup to be able, you know, to really restrict how much money went to the former spouse, the co-parent. And, and she'd said, "I just have to save my money up to do things, get basic things for them like shoes." And she was getting to the point where the legal fees and everything got too much, and she ultimately had to relent.

That's the kind of stuff we see in this sort of OCPD pattern where the OCPD and narcissistic overlay get most problematic. As you can imagine, is in divorces, workplaces, and wills and estates. In divorce, you are going to have an expensive fight to the death. They hate paying spousal support, they're not thrilled about paying child support, they don't like giving money monthly to anybody. They feel that everything belongs to them. They keep financial matters secretive. That means you often have to invest in expensive forensic accounting. They literally don't understand what community property is. And they actually probably didn't even understand what getting married means, or if they did understand what it meant, they would have insisted on cruelly restrictive prenuptial agreements. People sign them. I don't know, maybe they think it's going to last forever, maybe they think, I don't know what they think. But the fact is, people sign them. And that person with OCPD, even if, for example, the former partner is ill or something like that, they'll hold by that prenup because that's it, it's a contract.

In family estates and in wills, they become very rigid and controlling. You'll even notice if a person with OCPD and a narcissism overlay, they die, that family member will still control you from the grave. Or if you have a surviving family member, so a parent dies, and you have a sibling who has both this OCPD and narcissism overlay, then this may have, this, this OCPD narcissistic sibling, for example, may have really gotten themselves in close to the parent and started sort of hijacking their financial affairs, made themselves an executor or a trustee, ensure they get the most money, take money off the top for the money there, the debts they're incurring to take care of the parent. Sometimes it even falls under the the rubric of elder abuse, um, because these folks with narcissism and OCPD will be so controlling of an older family member's finances.

In the workplace, people with the OCPD and narcissism overlay are obsessed with observing and tracking the people who work for them. They are obsessed. In fact, during, during this time and last year, with all the remote working, they've hated not being able to control everything and have found ways to put software on computers to ensure people don't walk away from their computers for too long. They are convinced everybody in the workplace is stealing from them and stealing time from them and stealing resources for them. They will put in complicated systems of accountability in the workplace that are often excessive and intrusive. They'll typically expect people to work inhumane hours. The way they work, they will expect emails to have been answered in the middle of the night or on a holiday because they keep those hours. So it'll really, really be restrictive, demanding, abusive work conditions.

People with this OCPD and narcissism overlay will also be narcissistically abusive in the way that they don't pay well. They will often be too cheap to recognize excellence. And they, and then people will often leave these workplaces, or people will be stuck in these workplaces, especially if they're in smaller towns where there's fewer opportunities. And so when you have narcissism overlaying on this OCPD pattern, on top of everything else, you may also then have gaslighting, manipulation, invalidation, and frightening rage in relationships and in the workplace.

So you may be wondering, what if a person who has OCPD gets into a relationship with a narcissist? That's an interesting conundrum. There may be a lot of tension between a narcissistic person and an OCPD person because the narcissistic person may be frustrated that the OCPD person is so controlling or works too much. But they may also miss some of the red flags because they're so focused on details and perfectionism. So the OCPD person, they're not good with relationships, so they won't recognize it. These relationships may work for a minute because both of these styles are so money-focused and achievement-focused, and they're not about intimacy or depth. So they may not notice. But I think at some point, the narcissist will probably get frustrated with the OCPD person, call them too controlling, and I think the whole thing will probably fall apart. The narcissist may actually also even feel abandoned or neglected, ironically, by someone with this personality style.

And we also see that people who are narcissistically abused may develop patterns like perfectionism or an attempt to control elements of their environment just so they can have some level of mental control over the chaos and the situation of the relationship. But if this isn't accompanied by rigidity or that moral rigidity or that perfection, you have the, I'm sorry, the workaholic quality and the perfectionism and the moral superiority and the cheapness, it's not the same thing. And I've really almost never seen someone who's in a narcissistically abusive relationship start to develop these kinds of qualities, other than the perfectionism piece, to protect themselves.

You might be thinking about treatment. No, not really. There's very little evidence of any treatments that work consistently with this pattern. Some researchers looked at CBT, but the rigidity in the moral superiority of people with OCPD means that to them, therapy is a waste of time and a waste of money, and they're often quite contemptuously, contemptuously dismissive of it because they actually have little use for relationships. So when they have a divorce, their bigger issue is not the loss of the relationship, but the loss of money in a divorce. And if they have to pay child support or have children, that will often become an ongoing stress. But treatment really is not an option, least of all if there's also narcissism on board.

Drum roll. The difference between narcissism and narcissistic personality disorder. I have to understand, some people might have heard a previous video, someone didn't, so I'm going to keep bringing this up. I'm going to be really clear about this and start here. This channel is about narcissism. I don't give a rat's ass about narcissistic personality disorder. I really don't. I don't even think it should be a thing. If I was the Grand Puba of the DSM, I would have had it removed by now. But I'm not. And this whole NPD thing has confused and muddied the waters on such an important conversation. And more people waste time screaming and yelling about, "How dare you diagnose someone with NPD or narcissistic personality disorder?" Or my favorite is, "How dare you diagnose someone with narcissism?" Personally, I am not diagnosing anyone, nor are the people who are calling out toxic behavior and calling it narcissism. You can't diagnose someone with narcissism because that's not a thing, just like you can't diagnose someone with stubbornness or a bad sense of humor or a bad fashion sense or kindness. Narcissism is not a diagnosis. When you say someone is showing narcissism or is narcissistic, you're making an observation about their personality and about how they go through the world, but you aren't diagnosing them. That word narcissism was just only a descriptive word until the cabal of the DSM decided to codify it and toss it onto a diagnosis, which actually made no sense to create a diagnostic typology around something that really doesn't have an evidence base of effective treatment, nor that these folks who are like this would ever come into treatment. And it's actually a personality style that results in people making more money and being more successful and being more successful at online dating and being more likely to be your boss. Does it really make sense to diagnose that pattern?

So if you are going to use this third rail of a word, narcissism, let me only ask you this: make sure you're using it right. It is lack of empathy, grandiosity, entitlement, arrogance, superficiality, chronic egocentricity, admiration and validation seeking, envy, incapacity for intimacy, and instead exploiting and using people in relationships. It's dysregulated anger. It's the two faces, the validation seeking face in public and the abusive one in private. That's narcissism. Because keep in mind, just because a person posts selfies doesn't mean that they're narcissistic. Just because a person cares about fashion and makeup and plastic surgery and photoshopping doesn't mean that they're narcissistic. Just because a person is confident doesn't mean that they're narcissistic. You need all the stuff on that list I just read you.

I am seeing a lot of nonsense on social media from people who do not use this word right. If you're going to use it, learn what it means. It's a powerful word, but it is useless and even dangerous if you do not use the word correctly. Now, for those of you in narcissistic relationships, I've made videos about this before, I'm gonna do it again. Please stop calling them out. It doesn't work. When you roll up and say, "Yeah, right, it says," and it makes your situation so much worse. Use that laundry list of lack of empathy and entitlement and on and on if you want to call them out. And for all of you out there watching who are so angry at being called narcissistic, calm the hell down and ask the other person why they're using this term. And for a pattern, narcissism that makes people so successful, I find it fascinating when people get so bent out of shape when they're called out. It's time for you to self-reflect on why you're taking issue with being called narcissistic. Is it because you think of yourself as empathic and you're upset because someone else doesn't think you are? Why might they think you aren't empathic? If you can have that conversation without yelling at them, that's a good start. And then figure out why someone thinks you are that. It's the same with entitlement, the same with arrogance. And no, "I have the goods to back it up" is not a reason to be arrogant. It's not a nice trait, nice pattern.

I'm gonna keep coming back to this topic every few months because clearly everyone needs a bit of a refresher on this from time to time. Narcissism is a personality style, not a diagnosis. Remember that. And when you communicate about it, please be clear and stop using the word as an insult. If you're going to use the word, have the patterns to back it up and substantiate it when you're talking about it. Hope that makes that clear. And thanks again.