Are you doing in my bathroom? Do you have no limits? No inhibitions? No boundaries?

I know. I know how irresistible I am. Still, you know, let me take you to my office and answer some of your persistent questions and disentangle your bafflement.

So many of you have asked me about my recent video. You said, “If the borderline becomes a secondary psychopath, does she also transition from purposefulness to intentionality? Does she then act intentionally?” Similarly, the narcissist doesn’t have a self. The psychopath has a self. The narcissist is interested only in narcissistic supply. The psychopath is interested in many other things, sex, power, money, etc., etc.

What happens when the narcissist transitions to a psychopathic self-state or becomes a psychopath? Does he then develop overnight an instantaneous self and does he then become interested in, I don’t know, money, power, sex, etc. Cool your heels. Let me explain to you the source of your confusion.

Every mental health diagnosis has three elements. One is known as etiology, the causation, the reason for the evolution and development of the mental illness. The second part is the psychodynamics, the psychological internal processes which bring on the manifested illness, the way the illness manifests in specific cognitions, specific emotions or lack thereof, no emotions, etc.

So these are the psychodynamics. And the third element is behavioral, behaviors that are intimately and sometimes exclusively linked to highly specific mental health issues, disorders and illnesses.

To satisfy your diagnosis, all three elements must be present.

Etiology, how did the disorder or the illness come about? The personal history of the patient, an amnesis, the childhood, adverse childhood experiences, parental background, etc., etc.

So etiology, the psychodynamics, cognitions of the patient, emotions of the patient, impulses, inhibitions, etc., all the internal mechanism of the patient.

And the third element, how does the patient behave? Does the behavior of the patient conform to the behaviors expected in this particular disorder or illness? And usually these behaviors are listed in diagnostic manuals, such as the Diagnostic and Statistical Manual and the International Classification of Diseases, the ICD and the DSM.

Okay, that’s the background.

What happens when we have comorbidities, when two or more mental illnesses, for example, when two or more personality disorders are diagnosed in the same person? For example, what happens when the patient is diagnosed with both narcissistic personality disorder and antisocial personality disorder or psychopathy?

Which of the two prevail? And the answer is that there is always a dominant disorder and a recessive disorder. There’s always a disorder that defines the patient’s psychodynamic and dictates most of the patient’s behaviors.

And there’s a disorder that is in the background and that contributes to the behaviors of the patient only when the patient is exposed to extreme stress, anxiety, crisis, circumstances, and changing environments.

So this is the background.

Now, let’s, for example, take a psychopathic narcissist, a malignant narcissist. That is considered to be a comorbidity of narcissism, psychopathy, and sadism.

How can we tell when the person is a sadist, when this kind of person, the malignant narcissist, is a psychopath, when he’s a narcissist, and so on?

The answer is that the dominant disorder in this case is actually narcissism. Gradiosity, entitlement, envy, exploitativeness, etc. Narcissism dominates. And the main goal or motivation of the patient is to secure a regular flow of narcissistic supply.

However, the malignant narcissist secures the supply by deploying, employing, leveraging, and using psychopathic behaviors. So the malignant narcissist would behave the way a psychopath does, but with a goal of obtaining narcissistic supply.

It’s an example of how a comorbidity operates. Similarly, someone with a borderline personality disorder is likely to transition to a secondary psychopathic self-state when she decompensates or acts out.

That’s very common, actually. Well, in this case, does she become a full-fledged psychopath? Of course not. Her dominant disorder is borderline personality. Her personality organization is a borderline organization. However, when she transitions to a secondary psychopathic self-state, she is likely to behave the way a psychopath does. She is likely even to display traits of a psychopath to some extent.

For example, she is likely to become reckless or defined, but she still would be a borderline. She would experience shame and guilt after the episode. Throughout the episode, she would depersonalize, derealize, dissociate, etc. These are all hallmarks of borderline, not of psychopathy.

Similarly, a question about reality.

The psychopath is reality-attuned. His reality testing is relatively intact. Not fully intact, but relatively intact. Compared to the narcissist, the psychopath is fully grounded in reality and can tell the difference between reality and fantasy, which a narcissist cannot.

So when we have a malignant narcissist, a psychopathic narcissist, can he or can’t he tell when he is in reality and when he is in fantasy?

The answer is it’s a narcissist, so he cannot tell the difference between reality and fantasy. His reality testing is severely impaired, is unable to grasp reality as it is. He distorts reality cognitively.

So when we have comorbidities, one of the disorders is the major disorder. It is the outcome of the patient’s etiology and an amnesis and personal history and autobiography. This dominant disorder dictates the psychological dynamics inside the patient, inner processes, thought processes, cognitions, emotions, and so on.

And yet the patient is capable of behaving in ways which are typical of another disorder.

So if we have a narcissist who is a malignant narcissist, a psychopathic narcissist, is capable of behaving the way a psychopath does. And so does the borderline. So when we talk about transitioning to self-states, when we talk about narcissists who can become a psychopath, a borderline who can become a psychopath, a psychopath who can become a narcissist, when we talk about these kind of transitions, especially after states of collapse, we are talking merely and only and exclusively about behaviors, coping strategies.

So we are not talking about etiology, we are not talking about psychological processes and dynamics. We are therefore not talking about the totality of the disorder. We are talking only about behaviors.

A narcissist could begin to behave as a psychopath does, and yet it doesn’t make the narcissist a psychopath. A borderline can display psychopathic behaviors and even attitudes and even traits. It doesn’t make her a psychopath. A psychopath can suddenly become super grandiose entitled, indulge in fantasy, extract narcissistic supply, etc. These are all narcissistic behaviors. They don’t render the psychopath a narcissist.

I hope you got a picture. In a variety of mental health disorders, especially personality disorders, in times of crisis, in times of anxiety, of stress, of tension, changing circumstances, adverse environment, in these situations, the person transitions, but the patient does not transition from one personality disorder to another personality disorder. He doesn’t develop full fledged alternative. He simply adopts behaviors borrowed from other disorders.

Similarly, the narcissist, when he’s exposed to narcissistic modification, becomes as dysregulated as a borderline, emotionally dysregulated, develops suicidal ideation.

So these are borderline behaviors and traits, and yet it doesn’t make the narcissist a borderline. He just borrows borderline mechanisms or borderline behaviors temporarily.

And the last point, and very important point, is these self-states are temporary. They’re not permanent.

When the narcissist begins to behave like a psychopath, he doesn’t become a psychopath. It’s a phase. It passes. It’s transitional.

When a borderline decompensates and acts out and switches to a secondary psychopathic state, it’s temporary. It can take a day or two, a few hours, and she’s back to her old self. When a psychopath becomes a narcissist, it’s reactive. It takes a few hours and he’s back to being a psychopath.

And when a narcissist’s following modification begins to dysregulate emotionally, it’s again limited in time. It’s self-limiting. It’s limited in time. It may take a few weeks, a few months, a few days, and it’s over. And he’s again, his old grandiose, intractable, untreatable, hopeless, incorrigible self.

In short, mwah.