Psychopathy, Borderline Personality Disorder, And Borderline Psychopathy...
Similar words, vast differences
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It goes without saying that the above chart is completely incorrect. However, there is still a lot of misinformation regarding psychopathy in women, borderline psychopaths, and borderline personality disorder. It is time to attempt to clarify these things.
Starting with a female psychopath. A female psychopath isn’t dramatically different from a male psychopath. How do I know this? I am a female psychopath, and the other psychopath that I know is a male psychopath. We have had ample opportunity to explore where we are similar, and where we are different.
You might think, “Athena, that is a cohort of two. That really doesn’t prove or demonstrate anything.” I am inclined to agree with you. However, there is this unbelievable position held by some in the research community stating that female psychopaths are those with borderline personality disorder, which is entirely inaccurate.
Over on Quora, there is a writer named Elinor Greenberg. She is the author of a book called, “Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of Love, Admiration, and Safety", and is a psychologist with a Ph.D. that specializes in treating these specific personality disorders. She also happens to come from a family where psychopathy makes a regular appearance. Her father was a psychopath, and she is very familiar with the way we think, and how we function. She has this to say on the matter of psychopathy and BPD:
Are females with BPD likely to be Psychopaths?
The Short Answer:
In my experience it is literally impossible for someone to have Borderline Personality Disorder and also be a Psychopath.
Borderline Personality Disorder has characteristics that are almost the polar opposite of those experienced by people with Psychopathic Personality Disorder.
(For a more detailed look at Psychopathy, I recommend reading Athena Walker’s excellent posts here on Quora.)
Emotions—Hot versus Cold
If we use the image of an internal thermostat to describe the emotional differences between these two groups, we could say that the Borderline group have the heat turned up high and the Psychopathic group have their internal thermostats set very low. If they were different rooms, the Borderline room would be very warm and the Psychopathic room would be very cold.
Borderline PD: My clients who are “Borderline” feel strong emotions that they sometimes find nearly intolerable. The emotional centers of their brain could be compared to the first responders to a 911 emergency call. They tend to “feel” first, quickly act, and then intellectually process what happened much later (if at all). Sometimes the next crisis occurs before they have time to process the last one.
Bruce Springsteen sings about this:
I came for you, I came for you,
But you did not need my urgency,
Your life is one long emergency.
Psychopathic PD: The “Psychopaths” that I know do not report feeling strong emotions, nor do they act emotional. Their capacity for emotion appears lower than normal. Unlike the typical person with BPD, in an emergency the intellectual processing parts of their brain appear to be the first responders, not the emotional centers. They appear to think, act, and process almost simultaneously.
Emotions do not appear to play a large role in their responses. I have seen psychopaths get angry, but it was always because someone was interfering with their plans.
Impulsive versus Calculated Manipulation
One of the marked differences between people with BPD and the Psychopaths that I know is that the “Borderlines” tend to act impulsively without thinking things through first and the “Psychopaths” tend to plan what they are doing very carefully with an eye to getting the exact results that they want.
Some people confuse the emotional manipulativeness of some Borderline clients with the manipulativeness of Psychopaths. They are quite different.
Borderline Manipulation: This is usually an emotional appeal to the other person that is spontaneously enacted. They may act needy to get someone to take care of them, or hurt to get an apology.
Psychopathic Manipulation: This type of Manipulation is carefully planned in advance with every possible detail worked out ahead of time. If it appears spontaneous, that is an act and part of the plan.
Lack of Emotional Empathy—The Heart versus the Mind
Emotional Empathy: You feel inside you something that corresponds to what the other person is feeling. Your heart is touched.
Intellectual Empathy: You do not feel what the other person is feeling. You use your mind to figure out what they are likely to be feeling and act accordingly. Your heart is silent, your mind is active.
Borderline’s have emotional empathy, Psychopaths do not. Psychopaths have intellectual empathy.
Borderline PD: A possible source of confusion here is that people with BPD often act in ways that negatively impact other people. They can appear to lack emotional empathy for the suffering they are causing—and sometimes they do lack empathy at that moment.
Usually they are in the midst of a personal crisis and the only thing they are focusing on is their own feelings. As a result, they do not care what anyone else around them is feeling about their behavior. Or they want other people to feel badly in order to punish them and because they mistakenly believe this will lead to getting more of what they want. They do not lack the capacity for emotional empathy, they are simply not using it right then.
Psychopathic PD: Most Psychopaths that I have met have little or no capacity for emotional empathy. What appears to be empathy is usually a mask or an action that expresses loyalty.
Again, the difference can be expressed in terms of hot versus cold. Emotional empathy feels “hot” and intellectual empathy is “cold.”
Punchline: If you have a Borderline Personality Adaptation, you can have some psychopathic traits, but you do not have the nervous system that would enable you to be a Psychopath.
Why is this distinction important? So long as there are researchers going forward making the absurd claim that female psychopaths as individuals with BPD, they are diluting the research into both. BPD is a personality adaptation where the emotions are greatly turned up and there is much more possibility for an emotional reaction. A woman with borderline personality disorder described it this way:
“It’s sort of like you’re standing in an empty swimming pool and then all of a sudden it just fills with water and you’re anchored to the ground and you have no warning, and that’s pretty much how my emotions hit me all at once. It’s like everything’s turned up to a thousand, but you have no opportunity to opt out.
With psychopathy, there are no extreme emotions of any kind. It doesn’t matter if you are male, or if you are female in this regard. They simply aren’t there. Another thing that both people with BPD, male and female, describe is a great deal of shame associated with it, which is something that a psychopath will never experience. Shame is one of those emotions that I have no concept of. I know what people say it is, I know what it looks like, but much like regret, it is totally foreign to me.
I would like to state in advance that I am not remotely an expert in BPD, so I won’t be diving into it deeply. I do however know enough to be able to see where they might have some similarities, but they have far more differences.
BPD in and of itself is something that should be better studied and understood by people in research, and also people who do treatment. Unless a person has done extensive training after obtaining a degree, it seems most therapists are not qualified to treat a person with BPD, and certainly, they are not qualified to diagnose psychopathy. It is unlikely that the occasion would arise that a psychopath would bother seeking treatment for anything.
Who does it help conflating these things? The researchers’ reputations, that’s who. There is nothing more to be gained by it. BPD seems to have pretty deep roots in childhood and trauma suffered therein. Psychopaths lack the ability to experience emotional trauma in the first place, so how they decided one equated the other is beyond me, but it is thinking like this that produces a lot of misinformation about bother psychopathy and borderline personality disorder.
Where are they similar?
Both are certainly misnamed. Psychopathy as a term is irredeemable. It is too heavily weighted with negative stereotypes and myths for it to be brought out of the place it is considered in the general public. Borderline Personality Disorder is lazy naming. It doesn’t describe what the person is going through at all, and it just leads to ridiculous questions like, “borderline with what?”
Both psychopaths and people with BPD can have antisocial traits. This is likely where the conflation began in the first place. Antisocial traits can be present in anyone, but ASPD and psychopathy have been problematically intertwined for some time, and using ASPD as a stand-in for psychopathy create a lot of problems. This is one of them. Because ASPD is used interchangeably with psychopathy, when someone, anyone shows antisocial traits, they are deemed “psychopathic traits” instead of properly being termed “antisocial traits”. That distinction alone would solve a lot of problems.
People with psychopathy or BPD have been called “evil” for the sake of existing. This seems to be contrary to logic, but it isn’t uncommon to hear both psychopaths and people with BPD be considered the epitome of evil.
I have heard from people that have BPD that have been fired by their therapist simply for having this adaptation, which to me is deplorable behavior. I can understand referring a person to someone more qualified, but that is not what they reported. Instead, they were dismissed from the practice because the clinician had a large amount of bias towards BPD, and those that have it. That is not a reason to not treat a person, and if a clinician has these feelings they likely shouldn’t be a therapist in the first place.
With psychopathy, it goes without saying how much people think of us as the root of all terrible things in the world.
All politicians are psychopaths.
All serial killers are psychopaths.
All abusers are psychopaths.
All CEOs are psychopaths.
The list goes on and on.
Both of these assumptions are incorrect. Having unstable emotions does not make a person evil, having very muted emotions and no empathy also does not make a person evil.
Where do they differ?
Emotional experience is of course the largest difference. The quote above about the swimming pool is not relatable to me. My emotional experience is very muted in nature. There is never a point that they will be overwhelming for me. The loudest they get is for me to be aware that they are present, but there isn’t anything there that would consume me.
Their origins would be another.
Psychopathy is born. It is genetic. Unless you are born a psychopath, you will not be a psychopath.
BPD seems to trace back to childhood experiences but may have a genetic link. Back to something Elinor Greenberg said about it:
There appears to be more than one way to end up with a Borderline Personality Disorder. In general, BPD is believed to be the result of some combination of inborn temperament and genetic factors that combine with parenting styles and childhood traumas. For one person, inborn traits might be primary, while for others abandonment or abuse may play a more central role.
Psychopathy is entirely genetic. Whether or not a person is a psychopath is determined prior to their birth. However, there can be differences in how it manifests, which we will get into in the borderline psychopath section. One is caused through experience and may have links to genetics, the other is entirely genetic, and environment can affect how a psychopath behaves, but not whether or not they are a psychopath.
BPD is treatable, psychopathy is not.
There are several types of treatment that are utilized for BPD:
Dialectical behavior therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed. DBT is the most studied treatment for BPD and the one shown to be most effective.
Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.
Transference-focused therapy (TFP) is designed to help patients understand their emotions and interpersonal problems through the relationship between the patient and therapist. Patients then apply the insights they learn to other situations.
Good Psychiatric Management: GPM provides mental health professionals an easy-to-adopt “tool box” for patients with severe personality disorders.
Medications cannot cure BPD but can help treat other conditions that often accompany BPD such as depression, impulsivity, and anxiety. Often patients are treated with several medications, but there is little evidence that this approach is necessary or effective. People with BPD are encouraged to talk with their prescribing doctor about what to expect from each medication and its side effects. 1
Self-Care activities include: regular exercise, good sleep habits, a nutritious diet, taking medications as prescribed, and healthy stress management. Good self-care can help to reduce common symptoms of BPD such as mood changes, impulsive behavior, and irritability.
None of these things would be effective in psychopathy, as what they are treating doesn’t exist in psychopathy. The only thing that a therapist could do for a psychopath is to develop better cognitive empathy by explaining how and why neurotypicals do what they do, and how to adapt to those aspects. There really isn’t anything else that therapy will do for a psychopath. You can’t change how a person is wired.
Why has this conflation happened?
I am not one to pull this card almost ever, but frankly, it’s sexism to a large degree. I know that sounds reductive, but go with me on this journey.
There is apparently a high incidence of BPD in prisons. This makes some sense to me because if you are going to commit a crime that is emotionally based, those emotions would have to be very high in order to cause that outcome. How do people end up with BPD? Apparently, it is largely associated with abuse in childhood. Guess what you find a lot in prisons? People that have suffered abuse in childhood. What causes antisocial traits? Again, childhood environment is the largest contributor. It stands to reason that there is going to be some overlap there.
Something that wasn’t uncommon to come up in my research was repeated hospitalizations, and arrests prior to diagnosis. If the crime was significant enough, it would stand to reason that the person may qualify for a diagnosis of ASPD, because they are showing antisocial traits. It may also appear that the person lacks empathy, which is termed a “psychopathic trait”, as well as a few others that may present themselves from the PCL-R.
This is why it is crucial to separate the two from one another. Having traits that are psychopathic like, doesn’t make them specifically psychopathic in nature. This is why finding the cause of the behavior or trait is far more important than researchers give it credit. Someone lacking empathy with BPD is going to have a very different cause than a psychopath lacking empathy. Both may show the trait, but the cause is where the money is.
Another reason that I think that sexism comes into play is the assumptions of how women think and act. There is this assumption that women are always highly emotional, therefore a woman that is a psychopath as designated by the PCL-R is going to, of course, be highly emotional despite this not being reality. It makes far more sense that someone that has BPD with antisocial traits will be able to be scored on the PCL-R because it is tooled for antisocial behavior, not a clear diagnostic tool.
Instead of questioning the tool that they are using for assessment, they are instead attempting to bend psychopathy to make it synonymous with borderline personality disorder:
PCL-R trait factors:
Primary psychopathy relies on factor one traits, as seen below
1 Glibness/superficial charm
2 Grandiose sense of self-worth
3 Need for stimulation/proneness to boredom
4 Pathological lying
5 Cunning/manipulative
6 Lack of remorse or guilt
7 Shallow affect [i.e. superficial experience and expression of emotions]
8 Callous/lack of empathy
ASPD relies on factor 2 traits
Factor 2.
9 Parasitic lifestyle
10 Poor behavioural controls
11 Promiscuous sexual behaviour
12 Early behaviour problems
13 Lack of realistic long-term goals
14 Impulsivity
15 Irresponsibility
16 Failure to accept responsibility for own actions
17 Many short term marital relationships
18 Juvenile delinquency
19 Revocation of conditional release
20 Criminal versatility
Psychopathy and BPD: A Double-Edged Sword for Women
The current results suggest that the interplay of the two psychopathy factors is associated with BPD symptoms in women. First, F2 traits were found to be independently associated with BPD symptoms in both men and women. This finding is not surprising, given overlapping symptom clusters in psychopathy and BPD, such as impulsivity, emotional lability, anger, and aggression. However, of even greater interest was the finding that F1 traits were also related to BPD in women, but only in the presence of high F2 traits. Conceptually, F1 traits associated with deficient emotionality and callousness seem like poor predictors of BPD, a disorder in which emotionality and affective extremes are considered hallmarks. Indeed, the simple effect of F1 was negatively or nonsignificantly associated with BPD across the college and forensic samples, respectively. Importantly, though, our results suggest that it is the presence of both F1 and F2 traits that promote liability for BPD in women, even above the influence of F2 traits alone.
If a checklist can be applied to multiple diagnoses, perhaps it is a garbage checklist as I have stated endlessly. You can look through the traits and see why they may be present in many different types of people, for many different reasons because they are identifying behavior. Broken record… I know.
Due to how people think of the female experience with emotions it is assumed that they always have a high degree of them by researchers. It isn’t even considered that the reason that they don’t find many females without high degrees of emotions is that they aren’t bothering to look in the first place. It makes sense if you are familiar with the history of psychologists and how they consider women in general. However, it is an unfortunate conflation that has very negative effects on the understanding of either.
Now let’s talk about borderline psychopathy. To me, this one seems very obvious as to what it is. Psychopathy is on a spectrum and everyone falls along that spectrum at some point or another. However, psychopathy also has a diagnostic cutoff threshold. If you don’t pass this threshold, you would not be diagnosed as a psychopath. Borderline psychopaths are those with high psychopathic traits that do not actually cross the threshold for the diagnosis itself. James Fallon would be a notable example of this, as he is an admitted borderline psychopath.
Interestingly, I believe that he and I disagree as to why he would be considered as such. His belief is that psychopathy is genetic and behavioral. He conflates the actual presence of the different brain structure and chemical processing with antisocial behavior. He says that his parents were very involved with giving him a good stable homelife, thus he never developed the antisocial aspect, and is, therefore, a borderline psychopath, not a full-blown one.
I agree that he is a borderline psychopath, but not for those reasons. My reasoning is that he had anxiety and OCD when he was younger, neither of which are able to happen in a psychopath. Both are based in the amygdala being overactive, and in psychopathy the opposite is present. The psychopathic amygdala is smaller and as Kevin Dutton states, “understaffed”. In other words, underactive. This in my mind is what makes him qualify as borderline, not actual.
What borderline psychopathy is not is a person with BPD and antisocial traits. I wish I didn’t have to make what seems like an obvious distinction, but there are plenty of people that will claim to be psychopathic because they are someone with BPD with antisocial traits. They will even go so far as to insist that is why it is called borderline psychopathy. This is untrue, and it is just going to contribute more misinformation to the already overflowing ocean of it.
A borderline psychopath may have many of the changes in the brain, but not all of them. They may be able to process oxytocin, and therefore are able to love people or bond with them. There could be many different presentations in borderline psychopathy because there are neurotypical traits playing off psychopathic ones. I could see it possible that borderline psychopaths may sometimes have a greater penchant for sadism. They could have both emotional empathy but also callousness allowing for someone that takes great pleasure in the suffering of others.
On the other hand, you could have someone that bonds deeply but has trouble with empathy in general. In reality, I think it would be a very interesting thing to explore with greater depth, but it is important to delineate the difference between someone claiming to be a psychopath because they have BPD with antisocial traits, and someone that has high psychopathic traits, but don’t cross that diagnostic line. They are quite different.
If we want to fully and fairly understand psychopathy, borderline personality disorder, and borderline psychopathy, they must first be clearly defined, and those definitions need to be carried over into research consistently, not have those lines be blurry because it is easier to assume than to investigate and challenge.
https://www.borderlinepersonalitydisorder.org/what-is-bpd/treating-bpd/
Afterthought: I wonder if there is also Borderline BPD? The lacking a consistent and integrated sense of identity thing is not something I have experienced, and the 'splitting' only at a low level. I suppose it makes sense that anything with diagnostic criteria will have some people at the margins.
If only these terms were as clear in everyone's head as they are in this article. And then replaced altogether.
I will look up Elinor Greenberg's writing.
From what you say, borderline psychopaths would be fascinating to hear more from, with that complex and individually varied interplay between the emotional and the psycopathic traits. People who straddle two worlds- cultural, psychological, neurotypes, gender, all areas really- can have a great insights and a lot to say.
I would add two comments to the BPD treatment list. Medication can be of help not just for the comorbid conditions. There's the familiar story of people quickly going off their antidepressants because they hate that their feelings are dampened just too much. Well, some of those old fashioned heavy meds will do that. And while you might not want to take them for a lifetime, the partial numbness can for quite a while be a blessed relief for someone with BPD. Brain and body healing can occur, the patient can get a hopeful glimpse of an undreamt of possible existence with less pain, and then in time, all the practical steps can be taken to improve things. Also, it is a boon if a patient is lucky enough to have or find an important relationship with a safe person who will not compound the patients emotional deregulation with their actions and responses, but is prepared to work with them.
I had not considered the sexism angle for BPD diagnosis. I made me think of an opposite example, the atypical borderline who acts inwards more than outwards, where meltdowns do occur but much of the time the patient seems composed. (And half the time the meltdowns occur because of the cumulative strain of maintaining this composure while in turmoil!) For many women, who have been trained since childhood to be nice, accommodating, a good sport, and to behave a certain way to men/perform femininity, I believe that could result in a misdiagnosis of simple depression. The therapist may misjudged the severity of the problem if they haven't enough wild material to go on.