Borderline Personality Disorder, Narcissism, and Lance Armstrong

Did you watch the Lance Armstrong interview with Oprah Winfrey? Both parts of the profound interview are available at Winfrey’s OWN website. While Lance Armstrong most likely does NOT have BPD, he does show a high degree of narcissism; witnessed throughout the interview and his long career as a top cyclist that cheated his way to fame. I’m not here to pass judgment on Mr. Armstrong: he’s in a heap of trouble now, and will spend the rest of his life atoning for his sins. What interests me more are parts of his personality that are clearly very narcissistic, bordering on sociopathy.

Joseph Burgo, PhD, wrote an interesting piece in the Atlantic about “How Aggressive Narcissism Explains Lance Armstrong”. Although Burgo’s analysis could be construed as “pop psychology”, he raises a number of valid points about the way narcissism develops in people, most of which are similar to Borderline Personality Disorder. The article produced a great comments section, full of varying opinions on the difficult subject of narcissism.

People with BPD and NPD (Narcissistic Personality Disorder) both suffer from what Burgo termed as “shaming messages” from their childhood. The messages could have been inappropriate verbal punishment from parents, shame felt from a parent abandoning them, or some form of abuse (physical, sexual, or mental). This concoction of unfortunate circumstances produces a hallow human being, needing recognition and validation from the rest of the world. In the case of Mr. Armstrong, this took the form of becoming an international cycling phenomenon and cancer survivor, only to later be exposed as a fraud, bully, and possessing sociopathic behavior.

The key difference between NPD and BPD is the degree of empathy shown for others. The NPD will show little regard for the welfare and feelings of others, stopping at nothing to achieve their goals and maintain their “status” as a superior human being. The BPD will show “selective” or “diminished” empathy, usually provoked from an extremely sensitive emotional disposition.

Borderlines feel empathy but also feel a need to be recognized for being empathetic, whereas the Narcissist wants constant recognition regardless of how he or she processes the emotions of other people.

The following chart illustrates other personality disorders comorbid with Borderline Personality Disorder, from a message board post:

The Amercican Psychiatric Association is trying to reduce this up in a revised version of the DSM (DSM-5) due to be published in 2013.

In a study of 34,653 people in the general population by the Laboratory of Epidemiology and Biometry, National Institutes of Health (NIH), Bethesda, MD, USA the incidence of comordibities with BPD were very high.  

Comorbidity with another personality disorder (Axis II) was very high at 74% (77% for men, 72% for women) and as such, the PD are being redefined.

Comorbid w/BPD———

As you can see, a whopping 47% of men with BPD also have narcissistic qualities compared to only 32% of BPD women. Comorbidity with other personality disorders was more evenly distributed among women, with Schizotypal disorder being the most common at 35%. For men, Schizotypal was second only to Narcissistic, representing 39% of the sample group. So, if you’re attempting to identify a comorbid disorder in someone with Borderline Personality Disorder, you’re most likely looking at a Narcissistic or Schizotypal person.

Does this mean people with BPD are incapable of understanding the feelings of others? I don’t think so, but if BPD comes across as pure Narcissism, it is for different reasons. Most people with BPD understand the feelings of others, but have difficulty accepting them, particularly if those feelings involve rejection, anger, or indifference. The BPD will take someone’s feelings personally and think that his or her feelings are more important. Their need for validation comes from a tortured place, and rejection is extremely painful.

The person with NPD will have more of a ruthless persona, stopping at nothing to address their own feelings of inferiority. The concept of empathy and the emotions others experience as a result of their selfish actions is lost on the true Narcissist. They are too busy promoting themselves to realize the amount of destruction they have left behind them. Maybe they’ll “wake up to it” later, but their emotional well being and material success comes first. Lance Armstrong, take a bow. 🙂

I don’t dispute people with BPD come across as narcissists at times, perhaps childish in their quest for validation. For what it’s worth, BPD is not necessarily “better” than NPD. Both disorders present serious problems for the afflicted person and others around them.

Unfortunately, I believe my comorbid disorders might include Narcissistic traits, and to a lesser extent Schizotypal and OCD. What saves me from completely falling into the Narcissism trap?

Oddly, my anxiety. I often think “big” about myself and have grandiose daydreams. If I could only become a CEO, get elected to high office, or make a billion dollars, I’d feel much better about myself. Anxiety gets in the way of these aspirations: I’m afraid of socializing, nervous about performing (academically, athletically, musically, etc) and horribly afraid of rejection. Losing an election would feel like the whole world hates me and that I have no value as a human being. I would probably resort to self destructive behaviors and even suicidal gestures. That’s a BPD reaction to narcissistic pursuits that result in failure. Meanwhile, the Narcissist would be more likely to lash out at others, punishing them for not recognizing their self-determined superiority. Their anger is directed outward to penalize others for personal gain.

There’s no doubt enhanced Narcissism is behind the personalities of some of the most successful people. If you desire wealth, power, and fame you probably have a high opinion of yourself, shrouding an actual feeling of extreme inferiority. The more success you can feed yourself, the better. Some Narcissists do good things: think of local church leaders, philanthropists, or respected celebrities. All of them have big egos but are safely self righteous opposed to purely selfish. It can be difficult to tolerate the self righteous on a day-to-day basis, but at least they’re operating with a functional moral compass.

Lance Armstrong has years of contrition ahead of him. It might be best to duck out of the limelight and spend his time in therapy and offering meaningful apologies to those he has harmed.

People dealing with Narcissistic Borderline Personality Disorder need to be patient, set boundaries, and resolute. Know that the drive for validation comes from a weak inner-self, but make it clear to anyone with BPD what will and will NOT be tolerated.

The Fifty-Seventh Inauguration: A Call for National Civility and Productive Discourse

Work obligations prevented me from watching the Presidential Inauguration today, although I did follow it online. The ceremony was uplifting, reassuring, and well organized. President Obama’s address touted his progressive agenda, but also a need for everyone to come to the table. The President said, “Our journey is not yet finished” (paraphrased), which was an acknowledgement that he is well aware of the problems facing our country. He would have been remiss if he glossed over the strife in Washington: Presidents must deal with reality and advance an agenda at the same time. The first challenge awaiting him in his second term will be getting everyone to the table and conducting meaningful deliberations about truly moving our nation “Forward”.

I’m grateful that the Affordable Care Act was passed, even if it is far from a perfect solution to healthcare problems facing the United States. The fact that 30 million more Americans will be able to get insurance is a good thing, not a cause for alarm or rebellion.

My BPD and Type 1 Diabetes make it almost impossible to get reasonably priced health insurance. When I began to apply as a sole proprietor a few years ago, I was denied outright because of my pre-existing conditions. The insurance companies never bothered to look at my medical records, which portray a healthy adult who is only guilty of being cursed with chronic illness. If you compared my blood test results to another 33 year old “healthy” male, my numbers would be the same or better. For example, my Cholesterol levels, kidney functions, and glucose levels are well within the normal ranges. Unfortunately, the USA hasn’t reached a point where individual health records are considered in premium pricing, only whether or not it would be profitable to have me in their program. They feel I would be a liability.

I hope Mr. Obama also addresses mental health in his second term. Many people go untreated because they feel embarrassed about their troubles or simply do not have the money to visit a good doctor. A decade ago, a Psychiatrist gave you an hour of their time each week and meds. Now, Psychiatry seems to be an industrial process: one big appointment upfront for legal purposes, write prescriptions, then 15 minute followups now and then. That is not an adequate standard of care, particularly for people with BPD.

Community based mental health initiatives might help pick up the slack. Licensed social workers and medical students could run support groups in their area, similar to Alcoholics Anonymous meetings that have proven very effective at battling addiction problems. Obviously a well meaning grad student or tenderhearted volunteer might not have the skill to coordinate a good DBT session, or pull someone out of a suicidal depression.

That said, we shouldn’t shoot down the idea of local support because a Medical Doctor is unavailable to run sessions. Instead, the focus should be helping people through grief, general depression, and addiction. These are the most prominent mental health problems in our country that no one talks about. Groups where people can talk to each other, share stories, and seek advice would act as a great preventative care mechanism, while those who present themselves with more serious problems can be referred to medical doctors.

Stepping back to the National Stage, our country needs to come together and find some common ground. Politicians scurry around hurling insults at one another, oblivious to the fact that they are elected to solve problems, not make them. The state of the Nation’s finances is particularly serious, and there are fair points being made on both sides of the aisle. The problem is that no one is willing to say, “Ok, I’ll cut spending here if you raise taxes there”. Politicians choose to take absolute positions and refuse to act in the country’s best interests.

Indefinite inaction is worse than compromising. People dig in deeper, yell and scream at their Congresspeople, and act unreasonably. We can’t continue to kick the can down the road on money, national security, healthcare, and many other issues. Can kicking works for bored children but it’s not a viable way to govern a nation. We’ve got too much lose with partisan gridlock and radical ideologies.

My battle with mental illness has taught me many things. One of them is that anger should be treated as a fleeting emotion, not as a constant state of mind. It’s understandable if you’re mad at your parents for the way they raised you. It’s understandable if you’re mad at your partner who cheated. It’ understandable to feel angry and betrayed when you are rejected. Express the anger, get it out of your system, and then return to reality. If you just had a BPD rage, your anger level is high and it will take a few days to calm down.

Eventually, you have to address reality in reasonable emotional terms. You also have to think about issues in your life methodically and explore all the possibilities of your actions before you go off the diving board.

I mention all that because the point is lost on our leaders, who are supposed to be sane and intelligent people. Right now, political discourse is like watching people with BPD simultaneously explode. It’s not healthy and not productive. The name calling, black or white thinking, and fight or flight emotional responses are supposed to be for us nutty people 🙂 , not lawmakers.

It’s time to get it together. Conservative or Liberal, it’s time to stop acting like brats and get the job done. You’re setting a poor example and not doing our Nation any favors.

When Asked By Pharmacy Staff, General Practitioners, or Nurses, Do You Mention BPD?

I spent much of last week transferring my prescriptions to my Florida pharmacy of choice, coordinating address changes with the insurance company, and paying medical bills due from my usual holiday visits. The prescription transfer was necessary for two reasons: 1) Now that I’m back in the USA, it’s up to me to take full responsibility for all my meds; and 2) I’ve legally left Connecticut and moved to Florida and my Connecticut doctors are hesitant about sending prescriptions to a Florida pharmacy. My psychiatrist gave me refills for January and February, but said I would need to find a local doctor to continue getting medicine at my new location. She might be bound by state law or her malpractice insurance policy to not prescribe across state lines.

For the first time in more than 10 years, I went to a new pharmacy and filled out the “new customer form”. The form asked for all the usual stuff plus any known allergies to certain types of drugs. The form had space for 6 prescriptions but I had to write another 🙂 to fit in all my diabetic and mental meds on the sheet. It also had space for a brief description of my health problems.

Naturally I wrote out “Type 1 Diabetes, insulin pump, no complications” without giving it a second thought. Then, as I was beginning to write about my mental health, I stopped midstream and thought about how I should characterize myself. Should I just write “depression”? Am I required to write “Borderline Personality”? Should I mention I was hospitalized? Obviously it’s just a pharmacy form and they’re not interested in my life story. Still, as a new face at the store, did I want the pharmacist and 6-8 technicians thinking I’m “a little unstable” or “prone to being difficult”?

Oftentimes I think pharmacies, mobile health clinics, and even emergency rooms lack the privacy and confidentiality that is found inside a good doctor’s office. Obviously the pharmacist has passed various background checks and rigorous training. They know what the medications on their shelves are for and usually don’t holler them out loud when you enter the store for a refill. They are well aware, for example, that Clonezapam is a controlled substance and used for mental health problems.

My concern is less with them and more with the 20-something pharmacy techs that are just as privy to my health profile as the pharmacist. When I was transferring my medications from Connecticut, I spoke almost exclusively with a technician entering data into a computer. Drop-off and pick-up are all done by techs or cashiers. After working a pharmacy for a few months, they can figure out who’s more off their rocker than others. I’m not exactly requesting a 1 month prescription to fight a tough cold, I’m pretty much letting anyone who works the store know that I’m heavily reliant on all sorts of medication to get by.

I know it sounds paranoid, but I actually think it really boils down to feeling embarrassed about my problems. The vast majority of pharmacy staffers are trustworthy people and conduct themselves professionally. Each time I walk through they do over $1,000 in business, so they’d better be on the stick and discreet. 🙂 They see hundreds of people every day and probably forget what orders they filled 5 minutes earlier because an elderly customer is yammering away about their arthritis. I’m well aware I’m one of the most forgettable people anyone will ever meet, so I don’t expect whispers and snickering when I make my monthly pilgrimage to pickup anti-depressants and mood enhancers.

That said, I’ll stop far short of saying I’m “proud” to be coping with mental illness. Folks coming in for their NicoDerm (stop smoking) patch can saunter up to the counter and feel happy knowing they’re making a wise decision to improve their health. Society embraces people quitting cigarettes now more than ever, and a patch on the shoulder is like wearing a commendation for bravery. Borderline Personality Disorder, on the other hand, is not-so-acceptable. The body language of the staff is always “Hmmmm” or “I wonder….” or “Wow this is a ton of meds for a 33 year old” or “Whitney Houston was on Klonopin!” (generically known as Clonezapam).

It’s none of their business, but it makes me uncomfortable around others, especially when I’m in a new area. Maybe going to a social anxiety group would help me feel more assertive, but the problem with going to a social anxiety group is that I have social anxiety about attending a social anxiety meeting. 🙂

I suppose many people have the same feelings, especially in small towns where the same pharmacy has been open for 30 years. Mr. or Mrs. Pharmacist and the same techs from the last decade see the same people coming and going, and eventually someone will mention that “Smith’s on meds” or “Susy requested the morning after pill”. In a big city pharmacy – where thousands of people are seen each day – you can be more anonymous.

I tell people about my BPD on a need-to-know basis only. It’s reasonable to inform the pharmacy, a nurse, or even a mobile health clinic that you’re on certain medications for certain problems so they can take care of you properly. I only hope that they’re able to keep their mouths shut when their shift concludes.

Humans are social animals and we’re great at picking out those who are different and then either ignoring or chastising them. We’re not quite at the point in the USA where it’s socially acceptable everywhere to talk about your psychiatric sessions or treatments openly. That’s a shame, because demonizing those who are mentally ill only makes it more difficult for them to seek the help they need.

The next time you’re in a healthcare “venue”: pharmacy, general practitioner’s office, health clinic, ER, or blood drive be discreet but honest about yourself. If the staff are known to gossip about everyone who visits, it’s time to take your business elsewhere. Your struggles are none of their concern, and they MUST treat you with the same amount of decency and respect as anyone else.