A 38-year-old man is evaluated for persistent interpersonal difficulties. He has a long history of unstable relationships, impulsive spending, and recurrent suicidal gestures. He reports intense fear of abandonment and cycles between idealization and devaluation of others. Which of the following is NOT a characteristic feature of Borderline Personality Disorder?

Explanation

## Distinguishing Borderline from Narcissistic Personality Disorder **Key Point:** The preoccupation with fantasies of unlimited success and power is a hallmark of **Narcissistic Personality Disorder (NPD)**, not Borderline Personality Disorder (BPD). This is a critical distinction in Cluster B personality disorders. ### Core Features of Borderline Personality Disorder (DSM-5) | Feature | Present in BPD | Present in NPD | |---------|---|---| | Frantic efforts to avoid abandonment | ✓ | ✗ | | Unstable, intense relationships | ✓ | ✗ | | Unstable self-image | ✓ | ✗ | | Recurrent suicidal behavior/self-harm | ✓ | ✗ | | Grandiose fantasies of success/power | ✗ | ✓ | | Lack of empathy | ✗ | ✓ | | Excessive need for admiration | ✗ | ✓ | **High-Yield:** BPD is characterized by **fear of abandonment and emotional dysregulation**, while NPD is characterized by **grandiosity and lack of empathy**. These are opposite poles of Cluster B pathology. **Mnemonic for BPD (SUICIDAL):** - **S**uicidal behavior / self-harm - **U**nstable relationships - **I**mpulsive behaviors (spending, substance abuse, binge eating) - **C**hronic emptiness - **I**ntense fear of abandonment - **D**issociation or paranoid ideation under stress - **A**ffective instability - **L**iability of identity **Clinical Pearl:** Patients with BPD present with **acute suicidal crises and self-harm**, while those with NPD rarely self-harm but may have narcissistic rage. The presence of recurrent suicidal behavior strongly suggests BPD over NPD.