Autism, Borderline, Narcissism: Some Similarities and Differences
Channel: Prof. Sam Vaknin
Date: 2022-06-23

Comorbidities and Differential Diagnoses playlist https://www.youtube.com/watch?v=SPyvPdFhI0o&list=PLsh_y_ett4o2ejYzWDxEBw_8C7LYe2Udp

There is an affinity between low functioning autism and borderline personality disorder.

In both cases, the sufferer is overwhelmed by stimuli, external (autism) or internal (the borderline's dysregulated affects).

In both cases, self-harm serves to fulfill three self-soothing functions:

1. Reassert control over the dynamic of irritation and aggravation (via the elective act of self-mutilation);

2. Drown out sources of frustration and pain with even greater agony; and

3. Reawaken and feel alive as the self-inflicted hurt negates the erstwhile numbing.

The narcissist experiences periods of collapse: failure to obtain narcissistic supply. 

The collapse can be subclinical (protracted and incremental as barely sufficient maintenance levels of supply are at hand) or traumatic (when he loses all his sources of supply simultaneously). 

As long as the supply keeps coming, the narcissist is ego-syntonic. The collapse results in severe ego-dystony and dysphoria (often, depression). It resembles decompensation in borderlines (BPD) but, with the narcissist, there is no emotional dysregulation. 

The narcissist then transitions from one type to another: cerebral to somatic or overt to covert. This is akin to the borderline switching between self-states when she is abandoned, rejected, humiliated, or stressed.

In the cerebral type, sexual abstinence is a form of self-supply: it makes him feel superior. It is the collapse-induced depression that drives him to become sexually voracious in a somatic phase.

So, contrary to the rest of humanity, in narcissists depression leads to enhanced libido (sex drive). 

The types are highly dissociative self-states, almost distinct personalities.

For example: the somatic mourns the years of cerebral sexlessness while the cerebral grieves over the time wasted by the somatic in the relentless pursuit of sexual conquests.

Both of these types fail to recall the bliss they had experienced during the time spent as the other type, regardless of the “sacrifices” made. They misattribute the depression brought on by imminent or actual collapse to the compulsive behavioral constriction of the other type (“I was depressed as a cerebral because I didn’t have sex” or “I didn’t have sex because I was depressed”). 

Finally, both borderlines and narcissists experience separation insecurity (abandonment anxiety) owing to object inconstancy. Both also merge and fuse with an intimate partner in a symbiotic phase (the shared fantasy).

But the borderline distances herself from her partner owing to an overwhelming engulfment anxiety while the narcissist devalues and discards his partner owing to his need to separate from a maternal figure.

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