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Journal of Personality Disorders, 5(3), 225-232, 1991
1991 The Guilford Press
DIFFERENTIATING BORDERLINE PERSONALITY DISORDER FROM NARCISSISTIC
PERSONALITY DISORDER
Elsa Ronningstam, PhD, and John Gunderson, MD
This paper reports a differential diagnostic study of
narcissistic personality disorder (NPD) and borderline
personality disorder (BPD). The semistructured Diagnostic
Interview for Narcissism (DIN) was used on 24 patients clinically diagnosed with NPD and 20 with BPD to assess 33
characteristics imputed to pathological narcissism. The results
show that it is possible to discriminate NPD from BPD, and that the most useful discriminators are the criteria describing grandiosity in narcissistic patients.
Since the early 1970s enormous interest has been focused on the diagnoses
of narcissistic personality disorder (NPD) and borderline personality dis order (BPD). The question of whether and how these personality disorders
are related has stimulated theoretical and clinicai controversies.
Adler (1981) believes these disorders constitute a developmental-based
continuum wherein narcissistic patients have greater self-cohesiveness, stability in selfobject relatedness, and more capacity for aloneness than
borderline patients. Kernberg (1975) asserts that narcissistic and border
line personality disorders share the same low levei of structured intrapsych
ic organization with severe identity disturbances and reliance upon similar
defences. Gunderson (1984) has reported a difference between the grandiose self of narcissists as opposite to the devalued self of the borderlines.
Similarly, Masterson (1988) believes these categories reflect two major types
of false selves, which are polar opposites: the deflated false self in borderline
patients and the inflated false self in narcissistic patients. Finally, Millon (1981) states that the descriptive similarities between the narcissistic and
borderline syndromes are minor and that the disorders are clearly de
lineated and easily separable. In the American Psychatric Associations
(APA) Diagnostic and Statistical Manual of Mental Disorders DSM-III
(1980) amd DSM-III-R (1987)the two disorders are lumped into the same
"dramatic cluster of Axis II personality disorders, meaning that both are
dramatic, emotional, and erratic.
Plakun (1987) used the DSM-III criteria sets for NPD and BPD to retro-
From McLean Hospital, Belmont, Massachusetts. Presented at the American Psychatric
Association Annual Meeting in San Francisco, 1989.
Address correspondence to the first author at McLean Hospital, The Psychosocial Research
Program. 115 Mill Street. Belmont, MA 02178.
225
226 RONNINGSTAM AND GUNDERSON
inpatient sample. He investigated how well the presence...