What personality disorder type is the most abusive between narcissistic, histrionic, borderline, and ASPD?

The most abusive is a BPD ASPD co-morbidity. These are the most violent people in cluster B.

The more dangerous the cohort of prison inmates, the more likely you are to find this combination.

Those who have this co-morbidity commit four times the number of violent crimes than those with ASPD alone.

Four times.

Of those people who have the most severe personality disorders in Maximum Security prisons, the number of BPD ASPD is around 75%.

BPD is thought to hemorrhage into ASPD when it is serious enough, particularly when combined with adolescent alcohol abuse.

This co-morbidity is also seen as the dark side of androgyny. With the externalisation of violence that tends to be found in men, and the emotional lability more common in women, the BPD ASPD has the worst of both worlds — a volatile inner life with the need for violent catharsis.

The more you know,



A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder – Borderline Personality Disorder and Emotion Dysregulation
Background Some evidence suggests that the prevalence of Borderline Personality Disorder (BPD) is elevated among male criminal offenders. It is not presently known whether offending, and violent offending, are limited to those presenting comorbid Antisocial Personality Disorder (ASPD) who have a childhood history of conduct problems and whether offending is linked to psychopathic traits. Methods A community sample of 311 males followed from age 6 to 33 years, one third of whom had a criminal charge between ages 18 and 24, completed diagnostic interviews and the Psychopathy Checklist-Revised interview. Information on childhood included parent-reported family characteristics and teacher-rated of hurtful and uncaring behaviours, conduct problems, hyperactivity and inattention, and anxiety at age 6, 10, and 12 years. Health files were obtained as were records of criminal convictions from age 12 to 33. Results At age 33, 4% of the men presented BPD and not ASPD, 16% ASPD and not BPD, 8% BPD + ASPD, and 72% neither disorder (ND). Comorbid disorders were common: BPD were distinguished by high levels of anxiety disorders, BPD and BPD + ASPD by depression disorders, and BPD, BPD + ASPD, and ASPD by substance dependence. Official files indicated use of health services by all participants. One-third of participants with BPD and BPD + ASPD acquired a diagnosis of a personality disorder. More than one-third of participants with BPD + ASPD obtained scores indicative of the syndrome of psychopathy. Convictions for violent crimes varied across groups: In adolescence, BPD none, BPD + ASPD 16%, ASPD 16%, and ND 3.6%; from age 18 to 33, BPD 18%, ASPD 19%, BPD + ASPD 52%, and ND 4.4%. Offenders with BPD + ASPD were convicted, on average, for four times more violent crimes than offenders with ASPD and seven times more than ND offenders. In childhood, men with BPD + ASPD and with ASPD had obtained similarly elevated ratings for disruptive behaviours as compared to ND. Conclusion BPD comorbid with ASPD was associated with violent criminal offending in adolescence and most strongly in adulthood, elevated levels of psychopathic traits, and childhood disruptive behaviour. BPD showed similar characteristics but to a much less degree.
Antisocial personality co-morbid with borderline personality disorder: A pathological expression of androgyny?
Personality and Mental Health (2014) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI 10.1002/pmh.1279 Commentary RICHARD C. HOWARD, Institute of Mental Health, Nottingham, UK …

What is High Conflict Personality?

In most cases, psychotherapy is the treatment of choice for HCP, whether in an individual or group setting. Since HCP Clients have been helped by both psychodynamic and cognitive-behavioral treatment modalities, therapists have several tools at their disposal. One, in particular, dialectical behavioral therapy (DBT), a method of psychotherapy originally developed to treat Borderline Personality Disorder, has been effective for Clients with HCP, as the two disorders have many characteristics in common. While medication may not be the treatment of first resort, it can be appropriate for some Clients, especially for those who may be suffering from other psychological issues, especially mood disorders, in addition to HCP.

Five Types of High-Conflict Personalities

High-conflict personalities are fundamentally adversarial personalities. They don’t see their part in their own problems and instead are preoccupied with blaming others—possibly you. In this blog series, I offer many tips for dealing with high-conflict people (HCPs). Today, I describe the basic features of 5 types of high-conflict personalities, so that you can be aware of them, in order to avoid them or deal with them more effectively.

They all have the basic HCP pattern of:

1) Targets of Blame,

2) a lot of all-or-nothing thinking,

3) unmanaged emotions and

4) extreme behaviors.

In addition, they also have traits of 5 personality disorders. Some may just have traits and others have a full disorder. This can make them very difficult, but also more predictable. Here is a very brief overview of some of their common patterns of behavior:

1. Antisocial HCPs: These are also known as sociopaths or psychopathsaggressive people without a conscience. Antisocial personalities can be extremely charming and deceptive, combined with being extremely cruel to get what they want. Antisocial HCPs blame their Targets for causing their many frustrations, interfering with their schemes or simply because they got in the way. They are con artists, often involved in criminal schemes and loyal to no one—not even each other. (This does not include people who just “don’t feel social” this weekend.)

They punish their Targets in relationships and then expect sex and affection even after hurting them. They seem to be more biologically energized to harm people without remorse. For example, the Texas shooter in yesterday’s mass church shooting was reportedly angry at his estranged wife’s parents, and so went to kill everyone at the church they attended. Would he fit here?

2. Narcissistic HCPs: Most people are familiar with the self-absorption of narcissistic personalities, but narcissistic HCPs focus intensely on their Targets of Blame. They are constantly putting them down, often in public, in an effort to prove they are superior beings. They use a lot of insults with their partners, yet at the same time they demand admiration and affection. They claim their behavior is justified because others treat them so unfairly. Yet they have no real empathy for their Targets of Blame or anyone else. In the workplace, they are known for “kicking down” (on those below them) and “kissing up” (to those above them), so that management won’t realize how bad they really are. Bullying and sexual harassment may fit right into their drive for power and superiority.

3. Borderline HCPs: They are preoccupied with their close relationships and cling to them. However, sooner or later they will treat their partners, children, parents, co-workers, bosses, and others as Targets of Blame for any perceived abandonment. Their rages can be quite dangerous: physically, emotionally, legally, financially, reputationally or otherwise. Yet their moods swing both ways, so you may feel whip-sawed by how quickly they go from friendly to rage to friendly again (and then rage again).

As a therapist and lawyer, I have seen many borderline HCPs fighting for custody in family court against their Targets of Blame with extreme behavior including domestic violence, child alienation and/or false allegations. They are both men and women, driven to cling to their children (and each other) to avoid feelings of abandonment.

4. Paranoid HCPs: They can be suspicious of everyone around them, and believe there are conspiracies to block their careers at work, their friendships and their family relationships. They can carry grudges for years, and then punish their Targets of Blame. Paranoid HCPs may believe that those around them are about to harm them, so they may pre-emptively attack their Targets. They easily feel treated unjustly and in the workplace, some experts say “the majority of lawsuits are filed by this type of coworker.” (Cavaiola & Lavender, 2000)

5. Histrionic HCPs: This personality is most often associated with drama and endless emotional stories. Yet histrionic HCPs often accuse their Targets of Blame of exaggerated or fabricated behavior, to hurt them or to manipulate them. They assume relationships are deeper than they are so that they are constantly feeling surprised and hurt by how others react to them. They demand to be the center of attention and attack their Targets of Blame when they are not. They often involve others in their many complaints, which can lead to public accusations and humiliation for their Targets of Blame.

Overview: None of these HCP personality patterns have anything to do with intelligence, as they range from super smart to not very smart at all, like the rest of the population. There are some personality disorders in every occupation, geographic region (although slightly more in urban areas) and income group (although lower income has slightly more, the higher income ones can attract more attention).

It’s important to note that many people with personality disorders are not HCPs, which means that they do not have Targets of Blame who they attack or purposely injure. But if you see someone with a high-conflict personality, the fact that they also have traits of a personality disorder means that they are unlikely to have insight into their own behavior and unlikely to change. This means that you should be careful to avoid the mistakes I mentioned in my last blog. You also may want to consider using the methods I describe in the coming weeks.