 My name is Sam Vaknin, and yes, I am the author of Malignant Self-Love, Narcissism Revisited. I have made a series of videos about the borderline woman, the female patient with borderline personality disorder. Of course it is true that borderline is also diagnosable among men, but the way it had been defined and treated and studied was pretty frankly male chauvinistic, and several traits and behaviors attributable or attributed to borderline patients reflect cultural and societal mores of the 1950s, 60s, 70s and 80s when the borderline diagnosis was sort of coalesced around a group of scholars, all of them of course male. There are also value judgments inherent in the diagnosis, et cetera, et cetera, so consequently 75% of people diagnosed with borderline personality disorder have been historically female, and that's why I'm dedicating much more attention to the female borderline patient. Additionally, recent research, the bleeding edge research in psychology tends to demonstrate or to my mind prove conclusively that borderline personality disorder in women is actually another name for psychopathy, FACTO 2 psychopathy, not the male variant which is FACTO 1 psychopathy, not primary psychopathy, but secondary psychopathy. I discussed all these in previous videos, but in all these videos I use one term repeatedly and people have written to me and justly saw that I haven't clarified, I haven't made this term that I'm using rigorous, I'm using interchangeably terms like rejection, humiliation, abandonment, this, that, and I didn't clarify what do I mean by rejection? How do various cluster B personality disorders perceive rejection and how do they react differentially to rejection in different ways? So rejection is of course any situation where a trait, a behavior, an inner process, an external object, an internal object, an emotion, an effect, an expression of emotion, or a cognition, including an emotional cognition, for example wishes. All these are not accepted by someone who has significance in the rejected person's life. So it's not enough to be rejected, you need to be rejected by someone who means something to you. Someone who is present in your life, who feels, caters to important emotional needs, facilitates or catalyzes important psychological processes, psychodynamic processes. In all cluster B personality disorders, there's a problem in relating to an intimate partner. In some of them there's approach, avoidance, repetition, compulsion. In others there's inability to interact with other people as full-fledged human beings. So these patients prefer to interact with internal representations of their intimate partners. In yet other cluster B disorders, there's a problem of developing any kind of emotion, positive emotion like love, intimacy or loyalty, etc. So there are massive, massive problems, almost intractable and foundational problems. In the way patients with cluster B personality disorders relate to intimate partners, and this is because in all these disorders, perhaps with the exception of psychopathy, in all these disorders it's an intertwining of arrested development. The child's development was at some point stopped or seized, and so many of these patients are actually children, psychodynamically speaking, psychologically speaking, the children. A combination, an intertwining of this with attachment dysfunctions or attachment disorders, or at the very least dysfunctional attachment styles, an avoidant type of attachment, a paranoid type of attachment. You know, attachment that doesn't go all the way, attachment that doesn't dare call it, doesn't dare say its name. Combine these two, a child with attachment problems, and you get a picture of the typical cluster B patient. Now the only exception might be the psychopath, we'll come to it in a minute. But first when we say rejection by an intimate or significant other, significant intimate partner, we need to ask whether the rejection is real or perceived. Is it sufficient for the rejection to be merely imagined or anticipated, predicted? The answer is yes. Because of magical thinking in cluster B personality disorders, there is no real distinction. There is no distinction between reality, what's happening outside and what's happening inside. The patient's cognitions and emotions are perceived as external entities. And in this sense, Kembeck was right when he said that some of these disorders are on the border of psychosis. There is no, the boundary between out there and in here, this boundary is very blurred. And it's blurred because the child was not allowed to develop boundaries, was not allowed to separate from the parent and individuate. So people with cluster B personality disorders are unboundary, they have severe problems with boundaries. And consequently, everything is one big melange, everything is one big salad, the outside, the inside, external logic, internal logic. So when the cluster B patient imagines abandonment, anticipates it or predicts it, in his mind or her mind, it had already happened. Whether it had really happened or not is meaningless to ask, because the internal environment is perceived as reality, as real as reality. And so the answer is yes, both real rejection and perceived rejection are of equal status with an equivalent, they have the same power. Now this creates enormous problems. First of all, the patient reacts to internal processes which are not transparent to the intimate partner. The intimate partner doesn't know what has happened suddenly. And this is of course the source of modulability and dysregulated emotions. The reactions of the cluster B patient have to do as much with internal dynamics as they have to do with anything, with any external trigger or stimulus. So the intimate partner can be absolutely the same, can be nice and caring and loving and engulfing and ename it. And suddenly his cluster B patient intimate partner goes awar, goes awry and does crazy things, behaves recklessly, cheats on him. I mean, and he doesn't know why. He doesn't know why because of course none of us has access to anyone else's mind. So he doesn't have access to his wife for example, who is a borderline. He doesn't know what has happened to her, why has she changed so much? And in some of these disorders, I mentioned borderline, the changes could be literally from one hour to the next. So it's very, very difficult to cope with this roller coaster. That's from the intimate partner's point of view. From the patient's point of view, the patient needs to be consistently, constantly hyper-visioned. The patient needs to have a kind of radar or always on radar, scanning for possible rejections, scanning for possible humiliation, monitoring, observing, supervising, controlling, making sure that no, no, abandonment is forthcoming, no humiliation or insult, no, and so this process, this behavior is known as hyper-vigilance. Narcissists for example, are very hyper-vigilant because they, because all these patients react to internal processes. The hyper-vigilance is directed not only to the, at the outside, but it's directed at the inside. The patient monitors his or her inner landscape as though it were reality and reacts to this inner landscape magically as though it had transpired in reality, even though no one else around the patient sees anything or observes anything or realizes anything. It's totally crazy, mate. Now, each of the cluster B personalities reacts differently to actual or perceived rejection. The narcissist reacts with narcissistic rage to what he perceives to be narcissistic injury. Rejection, real or imagined, I repeat, rejection is, of course, an undermining of grandiosity, a challenge to grandiosity, because it implies, first of all, that the narcissist is not omnipotent. He cannot control everyone. He cannot micromanage behavior of people around him, and they can reject him, which is an outcome he did not want. And it challenges his omniscience. The narcissist thinks that he's all-knowing, but if he's all-knowing, how could he have, how did he fail to predict the abandonment and the rejection? So rejection challenges all the elements of the narcissist's grandiosity. It also challenges his perfection. He thinks of himself as a perfect being. He's a perfectionist, but also he thinks of himself as a perfect being, like God. So being rejected is implied criticism. It's saying, you know, you're far from perfect. Not only are you far from perfect, but I have found someone who is better than you in the case of cheating, for example. So the narcissist's grandiosity is undermined and challenged so severely and so profoundly that he reacts with panic, in effect, a panic attack, converted into aggression in the form of narcissistic rage. The primary psychopath regards rejection as a mere hindrance or obstacle. Primary psychopaths are very goal-oriented. They're called calculating, scheming, heartless, reckless and callous machines. And so they regard every rejection as a mere obstacle in the way, and they obliterate rejection. They are very vindictive. So they punish the rejecting party. They convert immediately frustration to aggression. That's the Donald hypothesis. They convert to aggression. And then they use this aggression coupled with impulsivity and defiance to punish the source of frustration and, if possible, eliminate him or her. So they go as far as needed. If the rejection is utterly detrimental to the interests of a primary psychopath, primary psychopath will not hesitate to murder the source of frustration. But usually it doesn't come to that. Primary psychopath simply damages the source of frustration and exacts retribution in order to restore the inner balance, restore the cosmic justice. As a psychopath is as grandiose as a narcissist, of course. Psychopathy includes a very pronounced dimension of grandiose. A secondary psychopath is something completely different. Remember that a secondary psychopath actually has empathy and emotions. As far as a secondary psychopath is involved, everything in life is a power play. It's about establishing power matrices. Who is on top? Who is winning? It's a competition. Who will subjugate whom to her or his will? And so rejection is perceived as checkmate, exactly like checkmate in chess. And the secondary psychopath will then become primary having been hurt, having been hurt. Rejection hurts the secondary psychopath the same way it hurts the borderline, which is one excellent reason to think that borderline is actually a secondary psychopath. The secondary psychopath is hurt by rejection, is in agony, excruciating, life-threatening existential pain. And so to revert this to survive, he becomes a primary psychopath. He or she becomes a primary psychopath and then acts as a primary psychopath. Wood, retribution, power, aggression, defiance, destruction, recklessness, hate. So the secondary psychopath is the worst of all worlds. She is as grandiose as a narcissist. As aggressive, dangerous, violent, callous and reckless as a primary psychopath. And suffers miserably is as labile and as emotionally dysregulated as a borderline. That's by far the worst, the worst manifestation of cluster B disorders. A classic borderline personality disorder patient, let's say, for example, a shy personality, a shy borderline. She would experience rejection, she would translate rejection even the slightest rejection. Honey, I can't see you this evening because I have a work dinner. I have a dinner with my boss. Or I suddenly have to travel for three days to New York, I have some things to do. She would interpret this as rejection and immediately interpret catastrophize. She would project extrapolate the rejection to full-fledged abandonment. So in the borderline's mind, every rejection, never mind how minimal, minute and justified is abandonment. And she would react to it disproportionately, catastrophically as if she were abandoned. She would split the object of frustration. She would split, for example, if she has an intimate partner and she wants to talk to him and he can't talk because he's in a meeting. She would immediately interpret this as abandonment. She would say, he doesn't love me anymore, he doesn't like me anymore, he thinks I'm bad. So she splits him, she then sees him as a dead object, a secondary object. She forgets all her love for him, all the caring, all the compassion. She hates his guts. She wants him dead. Splitting is that extreme in classic borderlines. And then the splitting would lead to objecting constancy, would be coupled, I'm sorry, with objecting constancy. Because he's far from sight, he's out of mind. He doesn't exist. She will, in other words, erase him completely. She would convert him into an evil, dangerous, unsafe figure, a villain. Then she would delete him from her life, erase him completely. And then she's capable of doing absolutely anything. She can undermine him, sabotage him, shame him interrelationally, in other words, for example, in work settings, to his colleagues. She can cheat on him. She can purposefully, ostentatiously cheat on him and let him know that she's cheating, to hurt him. She can do anything. There's no limit to what a borderline can do once she perceives rejection and converts it counterfactually to abandonment. It's a cascade and she's not in control. It's not in control. It usually becomes so extreme that many borderlines dissociate because they know they're doing wrong. They know what they're doing is wrong. They know that they're hurting a person who loves them, but they can't stop. So they forget about it. They cut it off. They dissociate it. And the next morning, the borderline can say, I don't remember what I've done. I absolutely don't remember. Really, I did this. I can't believe I did this. And she feels ashamed and guilty. So it's very ego-distoning. The histrionic, another type of class to be patient, which we increasingly think is actually a psychopath. Generally, we are looking now at class to be, and we think that there are essentially, first of all, essentially there is a spectrum. And that most people have most patients in a mixture of all what we used to call personality disorder. Most people are in a small way narcissistic, somewhat antisocial or psychopathic, somewhat borderline. We believe every class to be patient, we believe there should be a class to be personality disorder. One, with different emphasis and dimensions, not like today these distinctions because the comorbidities are enormous. Most psychopaths are narcissists. So why the distinction? Why don't we say there's a narcissist who will go that far and there's a narcissist who will go much further? And that's a psychopath. Or why don't we say there's a psychopath who has emotions? That's a borderline. Why don't we say there's a psychopath who regulates his self-esteem and self-confidence via flirtation and seduction and ostentatious displays of emotionality and her appearance? And that's the histrionic. Increasingly we think that all of them are actually one big soup, one big salad. But the histrionic would tend to interpret rejection as a blow to self-esteem. The histrionic interprets everything as having to do with her self-esteem and self-confidence. She regulates the self-esteem and self-confidence via conquest, via the chase. She's a teaser. She's not really interested in sex or intimacy. She's interested in the process of getting there, getting to sex and intimacy. Actually most histrionic women are freezy. They don't like sex. So the histrionic woman is the woman in the party who would appear half-naked and then she would flirt with all the men, including married men in front of their spouses. And then she would try to seduce some of them, also in front of their spouses. But then she would stop. She would tease them and stop. She interprets rejection as a dysregulatory. It dysregulates her sense of self-worth. It renders her sense of self-worth fluctuating. So exactly like the narcissist, she would resort to men, for example, to seduction, to flirtation, to regulate her sense of self-worth. In many ways, seduction and flirtation are her narcissistic supply. That's the way histrionics react to rejection. You reject a histrionic. Within seconds, she will find another man and she will seduce him and flirt with him in front of you. Just to show you that she's desirable, that you are wrong, how wrong you were and that she doesn't need you. She's independent. She can do anything she wants. Now, all these types, all cluster people, personality disorders, somatize. Let me talk a bit about the concept of somatization. Essentially, there are two pathways. Some people communicate with their minds through their bodies and some people communicate with their bodies through their minds. In other words, some people first think they have cognitions, they have emotions, they analyze, they have memories, and then this has effects on their bodies or they make decisions regarding their bodies, to drink, to exercise, whatever. And some people are exactly the opposite. They have no access to their minds because, for example, the mind contains too much pain. So they don't want to go there. They are dissociative. They keep forgetting everything. They are discontinuous. They have problems with the regulation of emotions. Their moods are labeled. So they don't want to go there. Their mind is like a dystopian alien universe and they don't want to enter it. What they do instead, they use their bodies to communicate with their minds. So these are the kinds of people who abuse substances, alcoholics, junkies. They introduce substances into their bodies so as to change their moods, so as to regulate their emotions, so as to provide them with certain traits, for example, sociability. So they use their bodies and their bodies' reactions to substances in order to affect changes in their psyche, in their psychology. Another example is, of course, overeating or eating disorders. It's another way to regulate moods and emotions. And then there is, of course, the whole class of what we used to call conversion symptoms. Apparently medical conditions that have no medical reason. They are psychogenic. They are created by psychology. So someone's arm suddenly becomes paralyzed. It represents something. Freud was the first to describe, not the first, but popularized the concept of conversion symptoms. Of course, in hypnosis, in hypnotic sessions, we create artificially conversion symptoms. So all class-to-be personality disorders, they use their bodies to communicate with their minds. They have no real access to their minds, ironically. They live inside their minds. But they don't have real access to their minds because they keep confusing the mind with reality with the mind. It's exactly like the psychotic. The psychotic is what we call hyperreflection. Psychotic is unable to tell what is his mind and what is reality. That's why he hears voices. His introjects, internal voices, are suddenly projected and externalized. And he hears voices as though they were coming from the outside. It's not very different in the case of class-to-be personality disorders. They are also totally confused about in and out, external and internal. So because of that, the only surefire path to regulation and access is via the body. So you would find that most class-to-be personality disorders, for example, abuse substances, they drink or do drugs. Many of them are focused on their bodies, somatic narcissists, histrionics, bodybuilding, sex. And when they are rejected, they also use their bodies to communicate. So a typical reaction would be to get drunk, or to do drugs, or to go to the gym and have a five-hour fitness session. Or to run 10 kilometers. They would use their body to regulate their internal environment. This is the panoply, the spectrum of reactions to rejection. The human mind is by far the most complex universe there is. The physical universe is not a hint of a fraction of what an average person has here inside. It's a powerful supercomputer, one million of them actually. A typical brain is equal to one million supercomputers. It has more connections than all the atoms in the universe. And it's inside each and every scour. And we don't really respect and honour it. And this is what psychology is all about, gaining this respect via getting to know this most amazing device at our disposal.