Is HPD a a false category? Should it be seen as BPD X NPD?

Are the folks behind DSM V telling us something, namely that HPD is a false diagnostic category, and that it actually consists of people who are both BPD and NPD (=BPD X NPD)

Supposed HPD characteristics shared with BPD: emotional lability, splitting, remorse, depression, empathy.

Supposed HPD characteristics shared with NPD: selfishness, arrogance, egocentricity, manipulation, callousness.

Some of the qualities that would seem to cancel each other out might occur at different times, for example, empathy and callousness. Empathy could occur during the 'honeymoon phase' or after a break-up; callousness happening in the same person when devaluation is in progress.

Or is there some quality or some thing unique to HPD, not seen in any other PD or mental condition? If you believe this is so, please say what it is.

I don't think so.

First, BPD shouldn't be in there at all. BPD is primarily about abandonment and avoiding it, which leads to the clingy/crazy behaviour. HPD and NPD are about pathological need for attention and admiration, respectively.

I think HPD and NPD ARE related though, in that they are extreme expressions of core needs relating to self-esteem in all women (attention/being desired) and all men (admiration/being respected).

I think the way they have it laid out for us is pretty accurate, I think an HPD will have some of the same qualities as an NPD and BPD but the attention seeking is the overiding quality that makes them an HPD. They are all PD's it's just putting them into buckets as to where their most prominant disorders reside. That's my take on it anyway

crystal_richardson_ wrote:I don't think so.
First, BPD shouldn't be in there at all. BPD is primarily about abandonment and avoiding it, which leads to the clingy/crazy behaviour. HPD and NPD are about pathological need for attention and admiration, respectively.
I think HPD and NPD ARE related though, in that they are extreme expressions of core needs relating to self-esteem in all women (attention/being desired) and all men (admiration/being respected).

Why I bring up BPD...some supposed HPDs I have seen engage in the classic "I hate you, don't leave me!" behavior, especially when under stress.
A while back poster "Wisdom" put out some really interesting posts (quoting Kernberg I think), in which a borderline personality organization was said to be the initial condition behind HPD, NPD, maybe even non-schizoid AsPDs. Which has caused me to speculate that HPDs, by reason of their good looks, are able to channel into a more refined seductive manipulation as a way to avoid contemplating that underlying BP organization.
So Crystal what do you think is the sole distinguishing HPD trait...?

But borderline personality organization and BPD are not the same. They share some descriptive similarities but they are really not meaningfully related and the literature makes note of this addressing the possible confusion.

I think the sole distinguishing trait for HPD is pathological (extreme) need for attention that leads to disordered (extreme) behaviour. That is the essence of the disorder.

Hmm that is interesting...what is the diff between BP organization and BP Disorder?

Re the trait you mentioned - attention - do you think that NPDs are also after attention? If not, what else constitutes their supply form?

Good discussion.

orion8591 wrote:Hmm that is interesting...what is the diff between BP organization and BP Disorder?

Levels of Personality Organization wrote:It is important to bear in mind that in Kernberg's model the term "borderline" is used in its original psychodynamic sense to describe the middle ground (or the borderline) between neurotic and psychotic personality organization. It should not be confused with our modern use of the word "borderline" that references the DSM diagnosis of Borderline Personality Disorder. In Kernberg's model, the term "borderline disorder" is a much broader term that includes any severe personality disorder, such as Borderline, Narcissistic, Antisocial, Schizoid, and Schizotypal Personality Disorders.

*interesting to note that Kernberg actually sees HPD as operating at a slightly higher level of personality organization than many of the other PDs. I believe it is included in the BPO model though.

(Aw, yes it is: http://www.psychsystems.net/lab/dynamics_bpd.pdf - pg. 3, top right para.)

http://www.vbhcs.org/poc/view_doc.php?type=doc&id=584

orion8591 wrote:Re the trait you mentioned - attention - do you think that NPDs are also after attention? If not, what else constitutes their supply form?

Not per ce, I don't think. NPD is about garnering recognition of a positive/attractive self-image. But that also requires attention...

Both disorders - NPD and HPD - are concerned with (or rather strongly driven to) eliciting certain responses from people. And those responses can collectively be called 'attention'. But HPD desire attention in general I think, whereas NPD desire a certain form of attention (i.e. admiration).

This is why HPD will take negative attention and experience this as positive, while NPD, in its pure form, would probably experience this as negative and may even physically wince from the thought of it.

Crystal wrote

But HPD desire attention in general I think, whereas NPD desire a certain form of attention (i.e. admiration).

That's it; that's what I thought as well.
HPD: negative or postive attention will do, but positive preferred. NPD: positive attention only; negative attention (criticism or disapproval) intolerable.


Consider the effect on real people in a "post-pretty" life after 55, in which the disorders don't naturally abate:
Would it be easier for Vivacious HPDs (=most like NPD of all the HPDs), in that they can switch from physical beauty to attention derived from feigned medical conditions, eliciting either sympathy (positive attention) or frustration (negative attention) from relatives (?)

For somatic NPD (=most like HPD of all the NPDs) the physical admiration will likewise dry up after 55, and then they would have to make a switch to cerebral Narcissism, but admiration from intellectual achievement might not be so easy to fake...unless they act it out, in which case...they would be switching to HPD.

I disagree with you that HPDs are smarter. All else being equal, I would vote the Narcs the smartest - witness the deserving ones widespread success in business, and in the arts like music and film. Even the ones who don't really seem to deserve fame and admiration (i.e., media personalities, and many CEO's, etc.) have this weird staying power. In the unfairness of life HPDs seem to more end up as lower level entertainers like exotic dancers or strippers, although Monroe was an exception. In general HPDs, although paradoxically intelligent, don't seem to like to think analytically, unless they are self-aware or recovering. When it comes to math and science I think NPDs are more naturally inclined. And HPDs don't usually have that go for the jugular drive that NPDs do, IMO.

But HPDs are probably overall more agreeable than NPDs, to my personality anyway.

orion8591 wrote:Consider the effect on real people in a "post-pretty" life after 55, in which the disorders don't naturally abate:
Would it be easier for Vivacious HPDs (=most like NPD of all the HPDs), in that they can switch from physical beauty to attention derived from feigned medical conditions, eliciting either sympathy (positive attention) or frustration (negative attention) from relatives (?)

The acceptance of negative attention, in addition to positive attention, as a part of the condition (HPD) probably does make aging easier for HPDs vs NPD...

(That being said, what would you call a condition where only negative attention is sought?)

orion8591 wrote:I disagree with you that HPDs are smarter. All else being equal, I would vote the Narcs the smartest - witness the deserving ones widespread success in business, and in the arts like music and film. Even the ones who don't really seem to deserve fame and admiration (i.e., media personalities, and many CEO's, etc.) have this weird staying power. In the unfairness of life HPDs seem to more end up as lower level entertainers like exotic dancers or strippers, although Monroe was an exception. In general HPDs, although paradoxically intelligent, don't seem to like to think analytically, unless they are self-aware or recovering. When it comes to math and science I think NPDs are more naturally inclined. And HPDs don't usually have that go for the jugular drive that NPDs do, IMO.

When did I say HPDs are smarter? NPDs are more likely to be intelligent, I agree. (speaking in generalizations of course)

orion8591 wrote:But HPDs are probably overall more agreeable than NPDs, to my personality anyway.

Agree here also. (hey, maybe I'm HPD after all )

crystal_richardson_ wrote:...
I think the sole distinguishing trait for HPD is pathological (extreme) need for attention that leads to disordered (extreme) behaviour. That is the essence of the disorder.

crystal_richardson_ wrote:
I think HPD and NPD ARE related though, in that they are extreme expressions of core needs relating to self-esteem in all women (attention/being desired) and all men (admiration/being respected).

Interesting way to look at it for sure.

So a related thought. In transactional analysis human interactions are categorized into child, parent, and adult roles. So two adults can interact with each other as adult to adult, child to child, child to parent, parent to adult, etc.

Perhaps for BPD types then their core self-esteem issues and coping revolve around a pathological need to resolve child/parenting issues, so on some level there is a perpetual need to be accepted/cared-for by someone(s) in a parental (i.e., care-taker) role while the person with BPD will tend to fall-back on the child role (care for me, don't leave me, I'm feeling emotional, etc.).

Perhaps for HPD & NPD their self-esteem issues and coping revolve more around the adult female/male wants/needs you wrote above (desirability, fame/attention, admiration, respect, power, control), so they're more likely to seek affirmation from others in more adult to adult roles?

Maybe it's a bit more confusing for BPD types because they do mature physically and mentally (we all do as we age), so the adult issues are at play too.