Does Borderline Personality Disorder Overlap With Psychopathy?

Part Two

All right, here we are again, and we are going to keep plowing through this meta-analysis. Something that I have learned while going through this is that studies in general tend to be a mess regardless of what they are on. I also wonder is the people that do a lot of these studies have actually done specialized training in the things that they are studying, or if they are just taking the word of other people of what they should be looking for and operating on confirmation bias. It seems to be the case in psychopathy anyway, and BPD doesn’t appear to be a well fleshed out idea when it comes to this meta-analysis. That gives me pause about the overall environment that studies are being done in.

Back at it, here we go:

The objective of this study is to review the scientific literature on psychopathy and psychopathic traits and their relationship with borderline personality disorder.

Is it though? Because you spent a lot of time in the previous section noting that factor two traits have to do with ASPD, not psychopathy, and that BPD overlaps with factor two traits, not factor one traits. Now, in fairness, I don’t see you making a good case for this claim either. You really didn’t establish the cohorts for these studies, so I still am not sure that they aren’t incarcerated individuals, which would make your meta-analysis a waste of time. I mean… that would mean you found criminals… in prison. Well done… here’s your cookie.

Methods

The inclusion criteria for papers in this review were: 1) Publication date between 1980 and 2017; 2) English language and 3) Papers including psychopathy related to borderline personality disorder, or vice versa.

Oh, I see so many issues with this paragraph.

1. 1980s? Seriously? Did you also include papers that were done on the dinosaurs? There should be a limit to how far back you can reach when it comes to these types of things. You are talking forty some-odd years and when speaking about concepts that the understanding of have shifted wildly in the last ten years, including studies from forty years ago seems not only pointless, but also silly.

2. I don’t care about the English language thing.

3. Shouldn’t you be looking at papers about one or the other, and see where the overlaps might be, instead of trading on other people’s potentially flawed conclusions? You are basically saying, here is my hypothesis. Rocks are grey. To prove this, I am going to look at previous studies that said rocks are grey. See, I’m right. That’s not science, that’s confirmation bias.

The following keywords were used in the title, summary or full text of the papers in order to make the initial selection of the bibliographic search: "borderline personality disorder'', "borderline traits'', "borderline states'', "psychopathy '', "psychopathic".

Sounds like a Google search, but okay.

According to their importance in psychiatric and psychological research, the electronic databases used in the review were the following: Pubmed, PsycInfo, Google Scholar and Scopus. Results obtained from the initial selection for each database are shown in (Table 1 and Figure 1).

Told ya.

Ooo a flow chart… neat.

Wait, not so neat, is this saying that they claimed that this meta-analysis was reviewing fifty-two items, but the reality of it is that they reviewed eighteen? That’s a huge difference.

Regarding the BPD relationship with both of the psychopathy model factors, a closer association with factor 2 has been reported in several articles compared to factor 1. In this way, Miller, et al. [11] showed a significant correlation between vulnerable narcissism, BPD and factor 2 of psychopathy, and between BPD and F2 as well.

Sigh… I have no idea what a “vulnerable narcissist” is, so give me a moment while I go search Quora and see if Elinor Greenberg has defined this, because otherwise, I got nothing here…

Huzzah and triumph:

What is Vulnerable NPD?

Vulnerable Narcissist is Paul Wink’s (1981) term for the non-Exhibitionist person who qualifies for a diagnosis of Narcissistic Personality Disorder. James F. Masterson (1926–2010), the well known object relations theorist, termed this type of NPD a Closet Narcissistic Disorder of the Self and wrote a book on it called, The Emerging Self.

Some typical characteristics of Vulnerable or Closet Narcissists are:

They want to be special like the Exhibitionist Narcissist but are afraid of the spotlight.

They display various forms of insecurities about their status and abilities compared to other people.

They want attention and praise but feel too exposed and vulnerable when they get it.

They tend to be indirect and passive-aggressive compared to Exhibitionist Narcissists who are more openly confrontational and aggressive.

They associate themselves with people, groups, and ideas that they idealize and feel special through association.

All right, based on further searching through Elinor’s work, it sounds like vulnerable narcissism and BPD really aren’t similar at all, so the idea that they are trying to draw correlations between the three, ASPD, BPD, and vulnerable NPD (the validity of which seems to be argued among psychologists) is a bit strange. Some time ago, I made the argument that ASPD is a catchall for a bunch of negative behaviors that many people do not want to have to deal with, so they slapped a label on them and called them “untreatable”, but this seems like a much bigger mess to me. Maybe I am misreading the intentions here, but it seems like they are including waaay too much to the soup.

From another one of Elinor’s answers on this:

Why do so many people confuse BPD and NPD or describe someone as a combination of both?

All personalities disorders have certain things in common that make them fit into the personality disorder category in the first place. From an object relations theoretical point of view, people with ANY type of personality disorder share the following characteristics:

They lack whole object relations: The ability to see themselves and other people in a stable, realistic and integrated way.

They split everyone into two categories: all-good or all-bad.

They lack object constancy: The ability to maintain a positive emotional connection to someone with whom they are angry, hurt, disappointed, frustrated, or physically distant from.

They tend to have difficulty controlling their impulses.

They have difficulty with intimate relationships.

They unconsciously project their unmet needs from childhood onto their current partner and expect the person with whom they are romantically involved to be both a loving parent and romantic partner.

They have unusually strong emotional reactions to situations that may seem less important to people without their type of personality disorders.

Differential Diagnosis by Motives

One of the easiest ways to differentiate personality disorders from each other is to look at their typical underlying motives for their behavior:

What are they trying to accomplish overall?

What do they primarily want from other people?

What do they fear from other people?

Here is a very abbreviated version of these different motives:

Borderline PD

Overall Interpersonal Goal: Find unconditional love and reparenting.

Wants: To feel loved and taken care of by their mate.

Fears: Abandonment and/or engulfment by the emotional needs of the other person.

Narcissistic PD

Overall Interpersonal Goal: Wants to feel special and achieve high status.

Wants: Admiring attention and recognition as special.

Fears: Being publicly exposed as an inadequate fake, or simply as average and not at all special.

This is starting to sound, to me anyway, that the people doing this meta-analysis probably should have done a lot more reading before embarking on this journey. I also think that you should be required to have experts available for consult when studying these things, however, if the way experts in psychopathy are treated (outside of Robert Hare, as he is basically heralded as a god among men when it comes to his “contributions”), there is a lot of sniping at them.

For instance, James Fallon, an actual neurologist that studied the brains of psychopaths, found through a double-blind study that included his own scan as a control, that he was a borderline psychopath. He then does some speaking engagements regarding his own life and his own experiences, and so-called professionals come out of the woodwork and, without examining him or looking at his brain scans, announce to the world that he doesn’t know what he’s talking about with some implication that he’s lying about it for some reason. I have some disagreements with Fallon about some of his assumptions regarding psychopathy, but I wouldn’t sit there and pretend that I know neurology better than he does. He was a doctor and professor in the subject, but apparently other people know better, because reasons…

However, this study has associated this correlation to the presence of shared personality traits, so the authors controlled certain domains of Five Personality Factor Model (FFM), such as neuroticism and low acceptability, and, after this, the correlation between BPD and factor 2 psychopathy was reduced. Huchzermeier, et al. [12] reported that prisoners with BPD obtained a significantly higher score in F2 compared to the control group while in F1 there were hardly any differences.

Did I… did I just read that? Please tell me I didn’t read that…

…reported that prisoners with BPD obtained a significantly higher score in F2

They really did earn that cookie… didn’t they… Yup, go figure, when you study prisoners, they tend to be antisocial in nature. It doesn’t matter if they are neurotypical, psychopathic, have BPD, NPD, or anything else. The one thing they all have in common, save for a few that are either innocent or they committed nonviolent crimes, they are antisocial. You did not need to do a meta-analysis to come to this conclusion. It’s already baked into the cake.

In this way, Warren, et al. [18] observed, in a sample of jailed women, a significantly higher score of inmates BPD for F2. Conn, et al. [6] also found a relationship between psychopathy and BPD scores in a sample of imprisoned inmates, a relationship that is mainly due to F2 since F1 did not correlate with BPD scores. Furthermore, this significant and positive link of BPD with F2 was also found in the results of Blonigen, et al. [19], who, in addition, obtained significant correlations between BPD and lifestyle, antisocial traits and their mediating role in the link between psychopathy and post-traumatic stress disorder (PTSD).

This is the level of exasperation this paragraph induces:

Translation:

Criminals, including those with BPD, show higher tendencies toward antisocial personality disorder.

However, people with BPD so not show any overlap with factor one… in other words, actual psychopathy.

But, we like saying incorrect things, so instead of calling factor two ASPD, as it is meant to be called, or secondary psychopathy, or sociopathy, or simply sticking with factor two (they even have a handy dandy abbreviation for it that makes it faster to type, F2), no no… we will go back to calling it psychopathy because it’s fun or something.

Oh yeah, and also also, let’s throw PTSD in there for good measure. It’s like they hate everyone and are just reveling in making this unnecessarily verbose without making sense.

This positive correlation between F2-BPD and a negative correlation between F1-BPD was also demonstrated in Hunt, et al. [20] study, showing that this relationship was similar for men and women. Results indicated a moderate negative genetic and non-shared environmental factors overlap between F1 and borderline features. On the contrary, there was a genetic and non-shared environmental factors overlap between F2 and BPD. According to the authors, these results indicate that factors increasing F1 are protective against the BPD features and factors increasing F2 give rise to BPD features, and vice versa.

Oh, go figure, you mean that BPD requires some form of trauma to create it, and psychopaths can’t be traumatized, and psychopathy itself eliminates the possibility of developing BPD in the first place, but you’re going to keep claiming that there is an overlap between BPD and psychopathy? Yeah, that sounds to be about what I expected.

Following this association between BPD and psychopathy factors, Sprague, et al. [21] found a negative association of F1 and a positive association of F2 with borderline traits showing, moreover, how this BPD-F2 relationship is stronger in women than in men.

But… you studied criminals… of course they’re antisocial. You see that, right? I mean, please tell me that you see that, so I can believe, even if just for a second, that you are somewhat competent. That would just be great.

Also, what are the chances, and I mentioned this last week, that men are not diagnosed with BPD nearly as often as women. Sort of the inverse of females not being diagnosed with psychopathy very often compared to men. But bias couldn’t have anything to do with this, right? I’m sure that it couldn’t be possible.

Contrary to this, results of Verona, et al. [13] showed that BPD-F2 association is strong in both sexes, while BPD-F1 ratio only occurred in men.

All right, I looked up this study, and it is a bigger mess than the one I am dealing with. I am actually grateful that I only found an abstract, because I do not think I could claw my way through this insanity:

Women with antisocial and psychopathic traits have a more extensive history of self-directed violence, as well as borderline personality disorder (BPD) symptoms, than their male counterparts (Chapman, Specht, & Cellucci, 2005; Warren et al., 2003). To inform this area of research, we examined gender differences in the relationship between psychopathy factors and risk for self-directed violence, as measured by a history of suicidal ideation, self-harm, and suicide attempts, across 2 studies. In both studies, we found that the interaction of the interpersonal–affective (Factor 1) and impulsive–antisocial traits (Factor 2) of psychopathy, a combination considered to exemplify high psychopathy, was associated with ideation, self-harm, and suicide attempt histories specifically in women. In men, Factor 2 traits were associated with these risk indices for self-directed violence, regardless of Factor 1. In Study 2, we extended our analysis to examine whether BPD accounted for the relationship between psychopathy and self-directed violence differentially in women and men. Results suggested that BPD symptoms partially accounted for the effects of Factor 2 on self-directed violence (both self-harm and attempts) in both genders but fully accounted for Factor 1 protective effects only in men. These findings underscore the notion that the same psychopathic trait liabilities, at least as they are currently assessed, may confer risk for different forms of behavioral maladjustment in women versus men.

Translation. If you have ASPD, you have a higher chance of being suicidal or engaging in self-harm. Well, go figure, if you have ASPD you probably have a pretty dysfunctional life that fraught with difficulties. Oh, and men that have high factor one traits aren’t suicidal. It doesn’t say anything about women and factor one scores, and my guess is because they don’t consider them to be common in women, so why bother looking? As for the men that were self-harm inclined with both factor one and two, in my mind this is an excellent demonstration of why the PCL-R is garbage. Psychopaths aren’t inclined to kill themselves or engage in self-harm. People with ASPD have a high propensity to do so. This has been well studied.

The study by Khan, et al. [23] also observed a similar significant BPD-F2 association for both sexes. These results agree with those of Viljoen, et al. [24] who, using classifications of prototypes of the Psychopathic Personality disorder (PPD) and BPD of Comprehensive Assessment of Psychopathic Personality (CAPP, [25]) and the Comprehensive Assessment of the Borderline Personality (CABP, Cook, et al. [26]) found some results indicating that PPD and BPD symptoms are gender-related, but there seems to be no consistency with BPD and PPD being gender variants of the same disorder.

I looked at those citations as well. The titles?

Cook AN, Layden BK, Viljoen S, Murray AA, McGinnis CR, et al. (2013) The comprehensive assessment of Borderline Personality Disorder (CABP). Burnaby, Canada: Simon Fraser University.

Chabrol H, Leichsenring F (2017) Borderline personality organization and psychopathic traits in non clinical adolescents: Relationships of identity diffusion, primitive defense mechanisms and reality testing with callousness and impulsivity traits. Bulletin of the Menninger Clinic.

I can’t even find the first one. The link cycles back to the very paper that I am breaking down right now. The second one, and I can’t say this clearly enough:

Nope.

You do not get to call any traits in adolescents “psychopathic”. That is inappropriate for a litany of reasons. They are too young, they do not have the brain development required for psychopathy to be considered, you aren’t speaking about psychopathic traits, you’re speaking about antisocial traits, and ASPD cannot be diagnosed in anyone under the age of eighteen for a reason, pick one, I got more.

This overlap between borderline personality disorder and psychopathic features was also studied by Chabrol and Leichsenring [26] in a non-clinical sample of adolescents, using the Borderline Personality Inventory (BPI) and Levenson Self-Report Psychopathy Scale (LSRP), showing significant correlations between the core criteria of the borderline personality organization and the psychopathic features. In this way, Centifanti, et al. [27] examined the relationship between the different facets of psychopathy, psychopathic traits and the strategies used by men and women to mate. The authors concluded that egocentric psychopathic traits are related to antisocial psychopathic traits, BPD traits, strategies of retention of the couple, furtive search for partners and coercion, and that antisocial psychopathic traits show a stronger association with the borderline traits.

If you are referring to traits and strategies that men and women utilize to mate, they aren’t “psychopathic”. They are human nature. Again, and I cannot believe I have to keep repeating this, stop pathologizing normal behavior. It is a weird obsession that specialists have. They have to frame everything through their worldview. As for the first part of the paragraph, refer to the same argument as I had above. No kids.

Similarly, Newhill, et al. [28] divided borderline personality disorder into four subgroups, with different levels of psychopathy, with the aim of studying the possible benefits of each subgroup from the Dialectical Behavior Therapy (DBT). Subgroup 1, called impulse/antisocial, achieved high levels of psychopathy and, according to the study, would benefit from a greater emphasis on learning impulse control and behavior planning skills. Subgroup 2, called low psychopathic, had the lowest psychopathic score and would benefit from a traditional DBT treatment. Subgroup 3, called interpersonally exploitative/narcissistic, represents the affective and interpersonal aspects of Factor 1 of psychopathy. According to Newhill, et al. [28] this group would benefit from an interpersonal skills training of the DBT. Finally, subgroup 4, called high psychopath/antisocial, scored high on psychopathy but the authors didn't specify the possible benefits from this therapy.

Oh my good lord. None of these people are “psychopathic”. They have antisocial traits if I am to believe what they are saying, but frankly, I do not. They know that they are blurring the lines, and that is clear based on how they keep shifting the language to suit. By the way, “interpersonally exploitative/narcissistic”, is not remotely exclusive to psychopathy. A huge portion of the population is like this. If you need an example, I would suggest looking into the Nth rooms and The Doctor’s rooms formerly found on Telegram. Or, I could do a few posts on them, they are incredibly messed up, but they are an excellent example of human nature.

In this way of studying the possible relationship between these two disorders, the study by Chakhssi, et al. [29] focused on a clinical case in which a schema therapy treatment is applied to a forensic patient with psychopathic features. Schema therapy is a psychotherapeutic approach with demonstrated efficacy in patients with borderline personality disorder. After the completion of the therapy the patient recovered a high level of functionality, with a full-time job, and without interpersonal relationship problems (with his wife or his son, for example). In addition, the patient abandoned drug abuse and criminal behavior. These improvements were still observed three years after the end of treatment.

I looked into this one as well. I stopped reading when I came across this sentence:

Psychopathy, affecting 13% to 47% of the population in forensic settings…

No it doesn’t. It tops out at an estimation of fifteen percent, not forty-seven. Whatever hallucinogen created that nonsense needs to be stopped immediately. Also, their proof of their therapy working is that the dude never reoffended. Yeah, well… you were watching him, right? I mean… he would go right to prison if he did reoffend and y’all were watching, correct? Also, you can’t be certain he didn’t reoffend, you can only be certain that he wasn’t caught. Unless you’re stalkers. I mean, you might be, it’s possible, and through being stalkers you are able to account for all of his whereabouts at all times, but I am guessing that didn’t happen, sooo… you don’t know. You are just saying that he didn’t because it looks good for you and you have no evidence otherwise.

This overlap between borderline personality disorder and psychopathic features was also studied by Chabrol and Leichsenring [26] in a non-clinical sample of adolescents, using the Borderline Personality Inventory (BPI) and Levenson Self-Report Psychopathy Scale (LSRP), showing significant correlations between the core criteria of the borderline personality organization and the psychopathic features. In this way, Centifanti, et al. [27] examined the relationship between the different facets of psychopathy, psychopathic traits and the strategies used by men and women to mate. The authors concluded that egocentric psychopathic traits are related to antisocial psychopathic traits, BPD traits, strategies of retention of the couple, furtive search for partners and coercion, and that antisocial psychopathic traits show a stronger association with the borderline traits.

Oh for the love of all that is holy, leave the kids out of this. Brains still developing are volitile places. Can we meet them where they are at and not turn them into clinical research data that likely doesn’t apply to them? You cannot assess, self-assess, or diagnose psychopathy in people without a fully developed brain. Trying to do so is unfair to them. So, cut it out. Now. Whatever Centifanti thinks that they found, they did not. They are speaking about pathologically changing brains that are nowhere near set.

Similarly, Newhill, et al. [28] divided borderline personality disorder into four subgroups, with different levels of psychopathy, with the aim of studying the possible benefits of each subgroup from the Dialectical Behavior Therapy (DBT). Subgroup 1, called impulse/antisocial, achieved high levels of psychopathy and, according to the study, would benefit from a greater emphasis on learning impulse control and behavior planning skills. Subgroup 2, called low psychopathic, had the lowest psychopathic score and would benefit from a traditional DBT treatment. Subgroup 3, called interpersonally exploitative/narcissistic, represents the affective and interpersonal aspects of Factor 1 of psychopathy. According to Newhill, et al. [28] this group would benefit from an interpersonal skills training of the DBT. Finally, subgroup 4, called high psychopath/antisocial, scored high on psychopathy but the authors didn't specify the possible benefits from this therapy.

Nope, already addressed this, which means they’re repeating themselves. Do they get paid by the length or word by chance? I can’t imagine why they would say the same thing over, but I am not repeating myself. Instead I will just say, nope, see part one.

In this way of studying the possible relationship between these two disorders, the study by Chakhssi, et al. [29] focused on a clinical case in which a schema therapy treatment is applied to a forensic patient with psychopathic features. Schema therapy is a psychotherapeutic approach with demonstrated efficacy in patients with borderline personality disorder. After the completion of the therapy the patient recovered a high level of functionality, with a full-time job, and without interpersonal relationship problems (with his wife or his son, for example). In addition, the patient abandoned drug abuse and criminal behavior. These improvements were still observed three years after the end of treatment.

“Psychopathic features” appears to be a very roundabout way of saying, “antisocial traits” without saying “antisocial traits”. Why the feel the need to utilize this unnecessary language illudes me, though it is either because antisocial traits is long to write, though “psychopathic features” does not seem shorter, or they know that psychopathy holds some sort of fascination for those that grant grants, so they are trading on it’s brand recognition. I think it’s the latter, and that’s annoying.

Also, psychopathy is not treatable, yet the person that you are referring to was successfully treated. Again, your own defintion makes your argument moot, and yet here we are… sigh.

Also, this relationship is observed in the review of Murphy and Vess [30] about the overlap between Cluster B personality disorders and between these and psychopathy, within which we have found the study by Stanlenheim and von Knorring [7] whose results shown an association between BPD and psychopathy, an association that also occurs between psychopathy and APD, but while APD is limited to the behavioral descriptors of psychopathy, BPD also includes symptoms of emotional instability and interpersonal relationships problems that resemble the affective and interpersonal deficits of the psychopath. However, Herpertz, et al. [31] studied emotional processing in psychopaths and BPD patients through psychophysiological measures, indicating a general affective information deficit process, regardless of whether the stimuli were negative or positive, in the psychopaths, while BPD subjects showed adequate emotional processing.

I am at the point of fully embracing this idea that psychopathy is their cash cow. The more things that they can connect it to, the more money they get in funding. That is the only reason that they keep calling antisocial traits psychopathy. They simply have to know better but are ignoring it. Or, at least I assume that they do, and I am not one to grant the benefit of the doubt. I especially like the passage that can’t really define ASPD, psychopathy, BPD, or any of the cluster B disorders. They basically conflate them all together in a mishmash that, in the end, makes no sense.

Also, psychopaths and people with BPD do not process things remotely similarly… so there’s that as well…

Following the study about the overlap between Cluster B personality disorders and psychopathy, Vossen, et al. [32] explored the relationships between machiavellianism, narcicism and psychopathy and cluster B personality disorders, showing gender differences for all traits and disorders, with men with significantly higher scores in machiavellianism, psychopathy and APD and women in BPD, histrionic disorder of personality and narcissistic personality disorder. It was also shown that for men, psychopathy was the only significant predictor of BPD, while for women, both psychopathy and machiavellianism were the strongest BPD predictors.

Oooohhhhh noooooo…. not the dark triad… This is another relic from the past that won’t die. I think there is an obsession with “:triads” in psychology, which is why the MacDonald Triad still gets passed around like it has any validity when in reality, it was debunked in the same decade it was suggested, by the man that proposed it to begin with. Did I mention that this was in the sixties? Yeah… it was, yet we still hear about it like it has any merit at all. Much like the notion of the MacDonal Triad, the dark triad has no value. It is just a conflation of things that seem very interesting to group together from a distance, but when you get close you see it’s porcupines trying to knit lace.

Finally, the review by Sarkar, et al. [17], extended the BPD-psychopathy association through the neurobiological level, finding structural alterations in both of the cases in frontal, temporal and limbic regions, which implies executive functions and memory tasks deficits and emotional processing as well (Table 2).

Except you already demonstrated that there aren’t any repeatable findings when it comes to BPD and neurology. In other words, this section is just making things up and filling in blanks with what you want to be the case instead of waiting for real and significant data, which by the way, would be the correct thing to do. People who have BPD are relying on you for actual answers. They are not asking to be jerked around for your ego and research financing.

All right guys, that’s part two, and I didn’t even get to the dicsussion section or conclusions. Those will be next week. I am not fond of meta-analyses because of the extra research they require. I have to look at all the studies that they used to come to their conclusions, so that’s annoying. However, in this case, they actually ended up using so few, and those they did use were really dreadful, that it wasn’t too terrible. I mean, other than finding out that they care very little about the people who are dealing with what they are supposedly researching, but only care about themselves, and proving themselves right so they can pat themselves on the back while subitting their funding forms.