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No, especially if you add drugs into the mix. As there currently happens to be a lethal epidemic of very strong drugs across the country. Car accidents, formerly the leading cause of death under age 25, has now been obliterated by ODs. Last year, approx. 65,000 people died of OD’s in this country.As the country becomes more and more oriented to please businesses and increase their profits, and less people oriented, there is no impetus to stop extremely profitable corporations like the tobacco and alcohol manufacturers to provide education and warnings to users. Schools rarely provide early interventions by giving up to date, effective classes on the risks of using tobacco, alcohol and drugs before use starts (now at approx. age 11).Interventions against use of these has focused on arrest and incarceration. As someone with 25 years’ experience with addicts and alcoholics, I can tell you that jail time never stopped anyone from picking up their habit right where they left it before jail. JAIL IS NOT A DETERRENT.Laws surrounding legal drugs (tobacco and alcohol) are lax. Because taxation of these items provides a huge amount of revenue to states and cities, they’re not anxious to see people stop using them.There are other very important reasons why people began using alcohol and drugs that are NEVER addressed. If you don’t have the desire or money to go to college, you can bet you’ll probably end up in a minimum wage, mindless job, often with a lot of physical strain. You won’t be able to support a family, buy a house, or even keep a car running on minimum wage.Prior to the 1970’s, there had always been some kind of job for people who did not attend college but were hard workers and motivated. No longer. Computers have replaced many positions; companies are quick to let employees go during slow periods, and hire anyone back when they’re needed. Benefits are getting rarer and rarer.Strong family ties in the US are now the exception, not the rule. People often do not have even basic emotional support as family ties loosen.If you’re old enough to remember what life was like growing up in the restrictive 50’s and 60’s, yes, there were many negatives to adhering to the values of that time. If you watch TCM and are a classic movie fan, you see what qualities were of most value. Being respected and liked, less emphasis on status-y purchases, and being part of a community were important. Touting yourself on social media would have been incomprehensible.To this day, I think my daughter’s life is greatly diminished because so much of it is on line, without humans present. I cannot understand why she does not talk to her BF as much as she texts him.Read Nick Reading’s book “Methland.” It’s an excellent book which describes the meth epidemic in the midwest. He goes beyond numbers, and describes the disappearance of good jobs, reliable jobs, ability to maintain a family, and the impossibility of maintaining a family farm as agribusiness buys up huge chunks of farmland. It’s heartbreaking.Huge amounts of research have been done which identify the factors that lead to becoming an alcoholic/addict. Early education is the most effective deterrent, along with identification of certain personality traits.For those adults already addicted to nicotine, alcohol and drugs, there is nearly no public treatment for addiction. CT, a very wealthy state, cuts the number of detox and rehab beds every year. In the meantime, the state is dealing with rampant addiction problems, OD’s, and social problems. But do we have trouble giving $22M to a private investor with a promise that he will provide an unnamed number of jobs eventually in a new company? No.No kid dreams of being an alcoholic, an addict, or dying of lung cancer. Modest jobs they may dream of (fireman, policeman, even sanitation worker) may be so difficult to get (NYC had ?? 190,000 applications for 600 positions as sanitation workers) that life becomes futile.While I don’t excuse individuals from all responsibility for harm they may do because of their drug use, it’s primarily the lack of caring on the part of our society. I’ve seen hundreds of people who might have been modest successes and valued members of society at one time not so long ago, who were condemned to nothing but blotting out failure.

In order to understand why a narcissist cannot be borderline, it is useful to know something about the history of personality disorders and what modern psychotherapists usually mean by these diagnoses.A Very Brief History of the Borderline DiagnosisIn 1884, C.H. Hughes wrote that: The borderline of insanity is occupied by many persons who pass their whole life near that line, sometimes on one side and sometimes on the other. This is one of the earliest usages of the term “borderline” to describe a group of patients.Over time this concept of Borderline became further refined to describe large groups of individuals who were neither psychotic (out of touch with reality for long periods of time) nor neurotic (in touch with reality, but troubled by symptoms of inner conflict). This middle group of individuals were collectively described as suffering from “personality disorders” because their problems were broader and more pervasive than the neurotic clients’ and affected many aspects of their sense of identity, their personality, and their relationships with other people.Division of the Borderline Diagnosis into Additional CategoriesSince the 1970’s, this large group of so-called “borderline” individuals has been further refined into many different categories. I prefer James F. Masterson’s categorization of these non-neurotic and non-psychotic clients into three basic groups: Borderline, Narcissistic, and Schizoid based on their aims, fears, and reactions to therapeutic interventions. These diagnoses can be considered as the result of once useful adaptations to early childhood situations that are now out of date and interfering with them living as happy functioning adults.Differential Diagnosis by Motive: The Short VersionBorderline Clients: These clients are fixated on getting the love and nurturing and permission to self-activate and individuate that they somehow missed as a child. They are afraid of abandonment and/or engulfment by the emotional needs of others. Sometimes they are so ambivalent that they sabotage relationships by alternately clinging and distancing from the other person.Clients who have made Borderline adaptations often report being unable to organize their life so as to meet their adult responsibilities. They may try and get their parenting needs met through romantic or sexual relationships. In their eagerness to connect and their fear of being abandoned, they often overlook significant details that would tell them that the person that they are fixated on is disinterested in them or a poor choice.Narcissistic Clients: These clients are perpetually trying to stabilize their shaky self-esteem by seeking public approval and admiration. They vacillate between viewing themselves as special, unique and perfect or worthless, defective garbage. They have not internalized a stable, realistic, and integrated sense of self. No matter how much praise they get, they are like a car with a leaky gas tank and always need more proof that they special. Their greatest fear is being exposed as a fake.Schizoid Clients: These clients usually have known early intrusion and have been treated like a “thing,” not a person with emotions and needs. Although they long for love and connection, their main interpersonal goal is to feel safe. They use a variety of strategies to achieve this. Usually, being in intimate relationships is very scary because they believe that no negotiation is possible and that they either have to accept the other person’s terms or leave. They are subject to existential dread and are the only clients that ever talk about the fear that they will become so disconnected from other people by their distancing defenses that they will never be able to reconnect again.SummaryA Narcissist cannot be Borderline any more than a car can be a truck. Like a car and a truck, both diagnoses have certain things in common: the lack of whole object relations (the ability to see themselves and others as integrated beings simultaneously possessing both liked and disliked characteristics) and difficulties forming satisfying and stable personal relationships. Both are impulsive as well, and have difficulties soothing themselves without the help of others.However, these two diagnostic categories are essentially so different in what they are seeking--the Borderline client wants love and reparenting, while the Narcissistic client is preoccupied with self-esteem regulation and avoiding public humiliation—that they cannot be both at the same time, nor does one turn into the other.Elinor Greenberg, PhD, CGPIn private practice in NYC and the author of the book: Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of Love, Admiration and Safety.www.elinorgreenberg.com

The Treatment of Schizoid Personality DisorderThe most effective treatment for Schizoid PD is one that evaluates each particular client’s needs and addresses the issues as they present in therapy. There is no one treatment that has been developed and widely taught for Schizoid PD in the way Dialectical Behavior Therapy (DBT) was developed for Borderline PD.Something to keep in mind: Many people with Schizoid issues are extremely intelligent and high functioning. They often manage to find a way to adapt to their personal challenges on their own and may not ever come for psychotherapy. The people that I generally see with Schizoid PD have not been able to find a compromise that works for them.Symptoms: Often my clients have some form of post-traumatic-stress disorder, a pervasive sense of alienation from everyday life, a lack of intimate relationships, and feelings of dissociation from their physical body.Abuse: It is also important to understand that Schizoid PD develops as a response to early and prolonged types of abuse or neglect. The specific abuse and its aftermath must also be addressed in the psychotherapy.Primary Interpersonal Need: SafetyIn general, Schizoid individuals have a great deal of interpersonal anxiety because of their traumatic childhood experiences. They are continually attempting to find a safe way to have contact with other people. They often alternate between using distancing defenses which leads to them feeling isolated or getting overinvolved with someone too quickly and then feeling trapped in the relationship.OVERALL TREATMENT PRINCIPLESThere are some overall principles that target commonly encountered Schizoid issues that can be extremely helpful to keep in my mind. I will describe a few of these here.Negotiation of DifferencesMost of my Schizoid clients grew up in homes where the adults treated them like things, not real people with feelings. They were taught that they had no right to have preferences. After a while, they stopped expecting other people to care what they wanted. In adult relationships this manifested as believing that they have to accept whatever the other person wants or their only other choice would be to leave the relationship. It could also work in reverse: whoever has the power set the terms of the relationship.Some Examples: One client described it this way: “My parents treated me as if I were on the same level as the vacuum cleaner, just a mindless tool without feelings that was there to be used as needed.” Another client reported that her mother would rearrange her room and throw out some of her things without asking her.These children grow up without knowing that negotiation between people is possible.INTERVENTIONS:Offer Choices: I have many seating options in my office and my lights are on dimmers. At the very beginning of the first session, I offer the client some choices to get them used to making their preferences known to me in small, everyday ways.Example: A new client enters my office where there are multiple possible seating options: there is a sofa, a rocking chair, a deep padded chair and another chair against the wall, in addition to my chair and its ottoman.Step 1: I say something like: “I am sitting here (pointing to my chair). Please feel free to sit wherever you like. All these chairs are movable and there are extra pillows around you can use as well. Please make yourself comfortable and sit wherever you like.” This is my first intervention. Now I wait and see what my client does in response.Analysis: My client now knows that here, with me, they have choices.Step 2: In later sessions I may continue this theme by asking how they feel about the lighting. Everything is on dimmers. I suggest that if ever something is too bright or dim, they can adjust it as well. I also say that if it doesn’t suit me, I will tell them and we can go back and forth till we find a solution that suits both of us.Analysis: Now I have introduced the idea that negotiation is possible.Be PredictableMany of my Schizoid clients value predictability and will tense up or startle as soon as I do something unexpected. These clients often came from chaotic and abusive households where all surprises tended to be painfully negative. These clients do best when they can set their own physical distance from me and can predict my likely behavior. That is why in the above example the first thing I did was tell the client exactly where I would be seated.Another Example: I had a client who had been so abused as a child and young adult that he was very sensitive to any unexpected movements by me. Therefore, I started to telegraph my intentions before I moved so that he would not feel startled, especially when my movement would be towards him: “I am going to get up now to open the window behind you.”Use Language that Shows You See Them as a Separate PersonRalph Klein, the former Director of Training at The Masterson Institute taught me this very interesting tip. He said that you can say almost anything you want to a Schizoid individual as long as you make it very clear that it is your thought. This teaches that you respect their individuality and do not assume you know what is true for them. It also avoids being intrusive, another sensitive area for Schizoid clients.Example: “I had a thought about what you just said. Would you be interested in hearing it?”Or: “I was thinking about the issue you brought up last week and something occurred to me that, perhaps, you might find useful. Are you interested in hearing it?”Note: This is almost the opposite of what I might do with Narcissistic clients. Narcissists like to feel that you are exactly on the same page as them. Narcissistic clients tend to view differentiation as criticism instead of finding it reassuring.Respect their Privacy: Do Not Be IntrusiveMost of my Schizoid clients tell me stories about their childhood in which the adults were inappropriately intrusive and allowed them no privacy.Physical Intrusiveness: Some clients had no lock on the bathroom door, and one did not have a door. Their parents came in and out without knockIng or waiting for permission to enter. They were mocked if they objected. A few reported their patents saying things like: “What’s the big deal? I diapered you.” These parents refused to acknowledge that it is one thing to see a 2 year old child naked and quite another to walk in on your teenager in the bathroom.Mental Intrusiveness: Many of my clients’ parents believed that they had the right to know every single detail of my clients’ life, even in their teens or when they were young adults. The parents would offer their opinions and advice and acted offended if my clients did not exactly follow their advice. This led many of my clients to believe that the only way to protect themselves was to become very secretive, hide whatever they were doing or thinking, and never ask for guidance.In Therapy: Many of my Schizoid clients have developed a variety of ways to protect their privacy and autonomy that may not be immediately obvious to the therapist.An Example: One of my Schizoid clients used to only tell me about events in her life two weeks after they happened. When I finally realized this, I asked her “why?” She said: “This way I can be sure that you won’t be able to influence what I decide to do.”Another Example: Other clients have asked to come every other week, instead of weekly. This was their way of maintaining what felt like a safe distance and controlling the intensity of the therapy.Intervention—Use Words, not ActionsI suggest very gently, without insisting, that they experiment with telling me what they want in words as it is happening. For example, if something I ask feels too intrusive and they don't want to answer, they can say: “I prefer not to tell you that right now,” and I will back off. If their therapy session feels as if it is too intense for them, I encourage them to tell me so, instead of cutting down on their sessions. Then we can work together to find ways to adjust the intensity of their session to be a better fit for their needs.Punchline: Schizoid clients have difficulty trusting other people. They generally believe that they have to take care of all their needs by themselves. Therapists can help modify this belief by demonstrating that negotiation is possible and that there are other useful strategies besides distancing and hiding. Contact does not have to be inherently frightening or painful.Elinor Greenberg, PhD, CGPIn private practice in NYC and the author of the book: Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of Love, Admiration, and Safety.www.elinorgreenberg.com