Paranoid Personality or Borderline Personality? | The Unstable Duo

Paranoid personality disorder can often look like borderline personality disorder, and can be extremely tricky to distinguish between the two. Even Millon¹ noted that there are times when the only way to differentiate between paranoid personalities and borderline personalities is to understand their childhoods, attachments, and initial fears. How in the world can two vastly different personality types look so similar? Let’s take a closer look.

Paranoid Personality vs. Borderline Personality Emotions

Anger

Both paranoids and borderlines can struggle with anger, and both use anger as a protective mechanism. But borderlines use anger to protect themselves from attachment-related distress, and their anger is often triggered by interpersonal stress, as it’s not a core characteristic. They are also more impulsive and self-destructive with their anger. In contrast, paranoids use anger to protect themselves from being destroyed by a world they believe is out to get them. Anger is a core part of the paranoid, along with fear, because they are fighting to survive. Their anger is consistent, not impulsive, and directed towards others instead of being directed toward the self.

Shame

Both paranoids and borderlines can have intense shame. The main difference is that borderlines consciously feel their shame. They feel like they’re not enough, bully themselves, and have low self-esteem. They can sit in their shame, looking more like Eeyore by sitting in their victimhood and helplessness. In contrast, paranoids use their defenses so strongly that they can’t actually access their shame.² Shame is rejected and projected (put on others). There’s something inauthentic about a paranoid’s expression of pain that lacks shame (because they don’t want you to truly know them), but you can feel the authenticity of a borderline’s shame-related pain.

Fear

Both paranoids and borderlines are fearful, but that fear is quite different. Borderlines fear losing attachments (being abandoned) but also fear being overtaken by others if they are too close.² It’s a difficult conflict. Meanwhile, a paranoid’s biggest fear is annihilation anxiety, or the fear of disappearing, being destroyed, or falling apart.² They feel like they’re always in danger and that the world is out to get them, so they react to that fear with irritability and aggression.

Paranoid Personality vs. Borderline Personality Symptoms and Features

Transient Psychotic Episodes and Paranoia

Both paranoids and borderlines can have some flavors of psychosis and paranoia, but it’s vastly different. Borderline delusions/paranoia happen when there’s a lot of emotional distress but disappear when they can tap back into their logical side. Their delusions are irrational, unconvincing, and time-limited.¹ It reminds me of a child tantruming with intense emotions who cannot hear any adult logic, at least not until their emotions regulate and their attachment is again secured. For example, a borderline might think their partner doesn’t like them, so they impulsively plan to run away, but they don’t because they end up back in their partner’s arms. In contrast, paranoid delusions are rational and convincing because they truly believe them.¹ It’s a consistent delusion that cannot be challenged. A paranoid will leave without a trace and won’t look back, especially if it matches with their delusion.

Dependency and Relationships

Both paranoids and borderlines are able to engage in relationships and attachment. Borderlines are often more favorable to relationships because they crave attachment, as long as it’s not too close. They swing between dependency and avoidance. In contrast, paranoids reject their dependency needs because others could humiliate them. They keep the attachment and can be anxious-ambivalent, but it’s a hesitant, surface level, inauthentic attachment where you never actually get to know them.² Paranoids often don’t have many friends, and if they do have a few, it is a rather limited social circle.

Defenses

Both paranoids and borderlines can use the defense mechanism of projection, borderlines use more lower level defenses in comparison to paranoids.² This is because the borderline’s core wound happened during early attachment, so their defenses are more infantile. Their projection comes off as more pouty and emotional. In contrast, paranoids use projection in a destructive, sophisticated manner that can head into sadistic territory. Because for the paranoid, it’s about surviving the dangerous world, not keeping attachments.

Personality Structure

According to Millon¹, both paranoids and borderlines are more severely disintegrated personalities but in very different ways. Borderlines are very inconsistent and changeable with constant conflicts between being active or passive, pursuing pain or pleasure, and focusing on self or others. In contrast, paranoids are very rigid and inflexible in their conflicts between active/passive, pain/pleasure, and self/others.¹ They cannot take in any outside data because they don’t believe the world is safe. Everything outside of themselves could be a lie. So borderlines are too malleable, and paranoids are not malleable enough.

Paranoid Personality vs. Borderline Personality Treatment and Pain Dynamics

Dramatics, Pain, and Treatment

Both paranoids and borderlines can be quite dramatic in telling their stories, traumas, and symptoms. However, borderlines over endorse things because everything genuinely hurts. Similar to a child, they will act out, yell, cry, and be intensely dramatic so you understand that they are in pain. They run to treatment like a child runs to a parent when injured. Paranoids are dramatic, but contradictorily, they send you on a wild goose chase about what to believe. They don’t want you to know them because that’s too scary. You could use that information to hurt them, but they also need you to know they’re the victim of the world, since everyone is out to get them. Paranoids usually avoid treatment unless in extreme distress or if someone makes them go. This is because they don’t trust anyone, let alone a therapist. They are afraid a therapist will see who they truly are, and then destroy them.²

Countertransference

Countertransference happens with every personality type at any level of severity. It’s the therapists’ reactions to the dynamics that the client brings into the room. With borderlines, there is often a pull to rescue them and attach to them quickly. They need you, so you want to save them. In contrast, paranoids often elicit feelings of anxiety, hostility, and distrust.² They don’t trust you, and you become suspicious of them.

Suicidality

Both paranoids and borderlines can have chronic suicidality, but again, it’s vastly different.¹ Borderlines have a depressive, impulsive component to their suicidal ideation and behaviors that stems from intense emotional pain. On the other hand, paranoids can be suicidal to feel power over someone else or over life itself. They will destroy themselves so someone else will not destroy them, for the purpose of hurting the other person. For example, after a breakup, a borderline might express that they want to die, but a paranoid will express that they hope their partner dies (projection). Paranoids are known to have completed suicide to punish others.¹

On the outside, paranoid personalities and borderline personalities can look very similar, and they are difficult to tease apart. It has taken Doc Bok and me years to understand personality disorders, and we’re still learning!! Constantly! If you’re a clinician who is stuck, and you’re in a PsyPact state, we are here to help you. We provide consultations if you would like help with a challenging case, diagnoses, or case conceptualization.

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