August 17 2010

Are the Diagnoses of Borderline, Narcissistic, Histrionic or Antisocial Personality Disorder Helpful or Harmful for Non’s?

August 17, 2010

What’s in a Name?

W hen it comes to the Cluster B personality disorders
(Borderline Personality Disorder, Narcissistic Personality
Disorder, Histrionic Personality Disorder and Antisocial
Personality Disorder), I sometimes question w hether an
actual psychiatric diagnosis is helpful or detrimental
—detrimental to “Non’s” (the person without the
personality disorder; not detrimental to individuals with
the disorder[s]). W hen mental health professionals use
the terms HPD/BPD/NPD/APD; it’s mental shorthand. I
hear the term “borderline” or “narcissist” and it conjures
an immediate recognition and understanding. Just like
w hen I use the w ord “chocolate,” I know w hat the
general flavor, smell and texture w ill be, taking into
account individual differences like quality of ingredients,
cacao ratio and type of confection in w hich it’s used.
The label “mentally ill” has been co-opted by Cluster B’s,
primarily by Borderline Personality Disorder activist groups
such as NAMI and, much to my horror, TARA, in a w ay that seems to enable the disordered
individuals and perpetuate the abuse of Non’s. These organizations goals generally include:
educating the general public and friends/families of BPD’s about the disorder as they
define it painting a rosy and unrealistic picture of treatment outcomes
legitimizing and enshrining BPD’s professional victimhood status
instructing the Non’s on how they should behave lest they “trigger” the BPD’s myriad
insecurities, fears, paranoia and jealousies (w hich pretty much absolves the BPD from any
personal responsibility for her behaviors)
preventing self-identified BPD’s from being stigmatized
protecting the rights of BPD’s

BPD’s don’t w ant to be “stigmatized.” Okay. Then how about treating others w ith the same
respect and consideration for their rights and feelings that you demand from everyone else? If
I treated my loved ones the w ay most Cluster B’s treat their nearest and dearest, I w ould be
profoundly ashamed of myself and deserving of social censure and stigma. As for BPD’s
insisting on having their rights protected—snort! That’s very rich considering that
Borderlines/Narcissists/Histrionics/Sociopaths are the biggest offenders w hen it comes to
violating the rights of others.

Giving these individuals the protective cloak of “mental illness” makes it far easier for self-
identified Borderlines to manipulate and guilt others into enabling and tolerating their w orst
behaviors, w hich I believe are fundamentally sociopathic. Specifically, when we identify
someone as physically or mentally ill, most people feel compassion and make excuses and
adjustments for their strange behaviors and limitations. When an individual’s strange
behaviors and limitations include purposefully and maliciously hurting others (I don’t care
if it’s because they’re feeling hurt or not validated), having zero empathy for anyone but
themselves and consistently blaming others for their bad behavior we m ust not make
allowances and excuses for them. We need to get as far aw ay from them as w e possibly can
and stay aw ay.

One of the hallmark characteristics of Cluster B disordered individuals is that they rarely see
their ow n behavior as the problem. They don’t think there’s anything w rong w ith them
—someone else is alw ays to blame for their unhappiness and failures. On the rare occasions
w hen they’re actually w illing to admit that something they said or did w as hurtful, it’s alw ays
follow ed by a “but,” w hich then reassigns their personal responsibility to another party. These
individuals typically only seek treatment if they’re a) court-ordered; b) trying to manipulate or
gain a therapeutic ally to abuse their partner; or c) experiencing a severe consequence that
they can’t blame aw ay w ith their usual mental gymnastics. Therefore, if they’re not bothered
by their behavior and you are, then it’s just too bad for you. You’re the one w ith the problem
and you should be in therapy to learn how to accept them as they are. Is your brain spinning
yet? Treatment resistant? You bet.
Are Borderlines, Narcissists, Histrionics and Sociopaths Really Mentally Ill?
Cluster B’s aren’t “mentally ill” like Schizophrenics and Bipolars are mentally ill. Schizophrenics
and Bipolars can’t control their bizarre thoughts, behaviors, impulses and/or hallucinations
w ithout medication and deserve our compassion and sympathy. Many self-identified BPD’s and
other Cluster B’s plaintively bleat the follow ing statements w ith great regularity:

“But I can’t help the way I am!”

“I didn’t ask to be BPD!” (Reminds me of a disaffected teen shouting, “I didn’t ask to be
born!” Yeah, w ell, you’re here now , so w hat’re you gonna do about it?)
“Don’t lump us all in the same category! We’re not all the same, you fraud! Boy, some
woman must have really hurt you to make you so bitter, you misogynistic lesbian!” (Erm, by
virtue of your diagnosis for w hich you’re a self-appointed spokesperson, you’ve already
been lumped into a diagnostic category and, by the w ay, attacking people w ho don’t see
things your w ay is, w ell, kind of proving my point. Oh, and not a lesbian and not bitter. Just
trying to help people protect themselves from predators, w hich understandably makes
things more difficult for you, but I digress. Oh and one last thing; ‘misogynistic lesbian,’
seriously? First, have you ever heard of the term ‘oxymoron’ and, second, I’m ‘misogynistic’
because I believe it’s equally w rong w hen w omen abuse men as w hen men abuse w omen?
Grow up, you perpetual infants, but now I’ve really digressed.)

W henever a BPD offers up these tw o chestnuts (or some variation of them), w hat she’s
actually saying is:

“Unlike other adults, I’m not responsible for my actions.”
“I don’t have to be responsible for my actions because I’m ‘sick’ (or in the case of
NPD’s/HPD’s/APD’s, “because I’m special.”)
“You must tolerate my bad behavior because something you did or didn’t do triggered it.”
This is all nonsense, of course. Unless a Cluster B is actually experiencing a psychotic break,
most are quite capable of controlling their bizarre and abusive behaviors w hen it suits them.
Specifically, a Cluster B can control her external behavior w hen:

She is love bombing you.
She is trying to hoover you back into the relationship.
She is in the presence of people w hom she fears and/or w ants to impress.
She is trying to manipulate you into giving her money, paying off her debts, marrying her,
letting her move in w ith you or putting her name on your house or bank accounts, for

Most Cluster B’s only mistreat and abuse people w ho they’re certain w ill let them get aw ay
w ith it. Validating their emotions, beliefs, assertions and accusations just because they’re
having them, w hich often have no basis in reality, only enables them to continue to jerk you

Personality “Disorder” or Just Bad People?
Cluster B personality disorder individuals are not mentally ill. Many of their behaviors and
beliefs are counter to societal norms, but they’re not crazy in the sense that they’re not
responsible for their actions due to insanity. Having zero impulse control doesn’t make you
insane; it makes you an out of control child. Why do we insist on referring to a woman who
has no empathy, no conscience, no sense of fair play, no personal accountability, who
takes malicious pleasure in deliberately hurting the people who are closest to her, who
believes the people she harms or takes advantage of “deserve it” and who believes she is
entitled to take the material assets others based on nothing more than an unfounded
belief that she “deserves it” or that she is “owed it” because of some mis-perceived sense
of “specialness” or victimhood as “sick” or “mentally ill?” These may be aberrant social
behaviors and attitudes, but it doesn’t make them sick or incapable of controlling their outw ard

Instead, let’s call them w hat they are; sociopaths. All the Cluster B disorders are just similar
flavors of sociopathy. Giving Cluster B individuals and their ilk the protective cloak of “mental
illness” provides them w ith a “get out of jail free card” and allays our existential dilemma on
the concept of evil. Instead, w e tell ourselves, “She has problems. She’s sick. We have to be
patient and understanding.” Not so surprisingly, w e don’t afford men w ith the same aberrant
behaviors the same compassion, slap on the w rist justice and material and legal entitlements;
w e label them as sociopaths or deviants and put them in lockdow n facilities w here they can’t
hurt anyone.

Cluster B’s, both male and female, are ultimately sociopaths (i.e., no conscience or
empathy for those whom they have hurt). They lack the higher level brain functioning that
makes having ethics, morals, empathy, good judgment, introspection and impulse control
possible. Recent research show s that the low er brain (the old reptilian or “alligator brain”) is
more active in sociopaths and borderlines than the neocortex. This means the “fight or flight”
mode of thinking is perpetually on—eff over or be effed over; I w in you lose. This is their w orld
view and they see nothing w rong w ith it. They also believe everyone else thinks and feels the
same, w hich seems to allow them to justify even their w orst behaviors.
Furthermore, “sick” implies that there’s some cure. Last time I checked, no real illness w as
cured by the love and patience of a second, third or fourth party. People w ith anxiety disorders
have to take active behavioral and cognitive steps to reduce their anxiety in order to treat it
successfully. People w ith depressive disorders have to take active behavioral and cognitive

steps in order to treat it successfully. Borderline activists insist that part of their “successful”
treatment is to have their emotions validated. Even w hen they can occasionally acknow ledge
that many of their emotions, fears, suspicions and insecurities have no basis in reality, that’s
w hen they claim it’s especially important for Non’s to validate their one-sided, chaotic
emotional BS.

Validating Cluster B’s emotions that have no basis in reality and being tolerant of the spiteful
acts that spring from their faulty emotional reasoning is collusion. W hen you do so, you
become a w illing victim and a participant in a folie à deux.

Is It Time for New Labels?

There’s a lobby of BPD activists w ho w ant the psychiatric community to change the term
“Borderline Personality Disorder” to Emotional Dysregulation Disorder. Aside from having to
edit all of my previous posts, I say a rose by any other name w ould still have nasty, hooky little
thorns. Pardon my language, but I think the terms crazy asshole, mean jerk, toxic person
or bad person are better than diagnostic labels. Why ? Because everyone knows that you
should avoid crazy assholes at all costs and whenever possible.

Fundamentally, Cluster B disordered individuals are primitive, predatory personality structures.
I don’t even like the term “personality disorder.” “Character disorder” is better. These people
have poor characters. It’s like my mom used to tell me w hen I w as occasionally bullied at
school, “There are just some mean, bad people in the world and you’re better off staying away
from them. If you can’t find someone to help you, then run away.” She didn’t encourage me to try
to figure out w hat w as w rong w ith them or to have sympathy for them. She basically said
they’re jerks and here’s how to protect yourself. Same goes for Borderlines, Narcissists, users
and bullies or w hatever society w ants to call them. Frankly, I’d rather spend time w ith
schizophrenics. They’re typically not vicious and, unlike Cluster B’s, their pathology primarily
affects them the w orst instead of anyone w ho gets too close to them.

Postscript: Yes, I realize that many individual w ith Cluster B personality disorders w ere
abused as children and I am truly sorry for that. How ever, that does not make it okay for them
to abuse other people as adults. Their needs and feelings do not trump others because they
w ere abused as kids. It just makes them another physical/emotional abuser in a long line of

by Dr Tara J. Palmatier, PsyD

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