Dr Peter Salerno

Everyone is self diagnosing their ex with Narcissism and Borderline Personality Disorder so it only makes sense to bring in an expert who can provide more information into these two disorders.  Dr. Peter Salerno discusses narcissism and borderline personality disorder, their nature, as well as if treatment is effective. Personality disorders are characterized by trait deficiencies and enduring patterns of behavior. Treatment for personality disorders requires specialized therapists who understand the unique challenges of working with this population. Diagnosing personality disorders can be challenging, as individuals with these disorders often manipulate assessments and screenings. There is a strong genetic component to personality disorders, although environmental factors can also play a role.  Points covered:

• What is NPD & BPD?
• Narcissist and projection
• Is it hereditary?
• In which gender is it more prevelant?
• Is therapy effective to treat these disorders?
• What are the biggest misconceptions?

Enjoy this very educational episode and hopefully it provides more insight.

Transcript

Robert (00:01.189)
Hey everyone and welcome back to the Dad Dads podcast. And today I am joined with Dr. Peter Salerno. Dr. Salerno, welcome to the show. Look, so award-winning author, as well as licensed psychotherapist. I was looking at some of the books. Unfortunately, I have not had a chance to order or read any of them, but the reviews are outstanding. I mean, Understanding Attachment Drama, Fit for Off Duty, A Manual for Firefighters,

Peter Salerno (00:10.743)
Thank you for having me.

Robert (00:30.957)
work-related trauma. You have one similar for law enforcement as well. Thought detox, 77 days of quotes, reflections to challenge and eliminate negative thinking habits, belief equation. Amazing. Look, just thank you for coming on the show and I'm really looking forward to this conversation.

Peter Salerno (00:50.766)
I'm really excited for it as well. Thank you for having me.

Robert (00:53.305)
Well, look, so the reason why to have you on here and I found you, of course, through social media. Um, but you have a specialty in narcissism, personality disorder, as well as borderline person, personality disorder. And that is those two, especially narcissism, I think are such hot subjects, hot topics. Everybody's calling their X and narcissist or

Peter Salerno (00:59.158)
Mm-hmm.

Robert (01:21.349)
their ex, whether it's ex spouse, ex friend, everybody's diagnosing one another. And so I just thought, you know what, let's get an expert on here and let's find out what it is and let's, let's hear it from you. Somebody that's, uh, studied it very well versed knows the ins and outs. And I'm just going to start it off. Um, what is it? What is north narcissistic personality disorder and what is borderline personality?

Peter Salerno (01:49.874)
Yeah, okay, great. Well, first I think we should preface it by, like, what is a personality disorder? Because the reason why that term exists in the first place is because these are disorders that historically nobody knew what to do with. So all of the theories of how to do therapy with people to make them feel better, to end their suffering, none of them worked with this population. Medication doesn't work with this population.

There's some overlapping symptoms of depression and anxiety in some of them that medication might help, but like, this was like an exiled classification of people. No one knew what to do with them. So they created this personality disorder category, and then it was like, well, if the treatment isn't working, then what's happening here? So to answer your question, any personality disorder, the main issue is...

It's a trait deficiency disorder. We all have traits, right? Like agreeableness, conscientiousness, you know. Um, there's, somebody told me recently, I didn't even know this, but I guess there's like 400 personality traits or something. But the disorder happens when the person is so inflexible in their traits or lacking in traits that they have like one predominant trait or... And it shows up in every aspect of their life. It's enduring, it's a pattern, it's...

Easily detectable in early childhood. A lot of people don't like to hear that but the data just show that it really is and so Borderline and narcissists those are the those are the most popular I would say because those are the most

Peter Salerno (03:40.246)
I don't mean this in an insulting way, but those are the most dramatic. So when we're talking about creating drama in relationships and in quality of life, those seem to be the ones that are the most popular because they're the most notorious for, like, the level of drama that they cause in people's lives.

Robert (03:43.461)
Yeah.

Robert (03:56.793)
Let me ask you something. So you said medicated. You mentioned medicine. So these cannot be cured through medication. Correct? I guess they can be treated or.

Peter Salerno (04:00.276)
Mm-hmm.

Peter Salerno (04:09.174)
Well we tried, historically they were, you know, doctors tried to medicate these, they don't even refer to them as symptoms because they're traits. So, you know, medication treats symptoms, you know, like...

Robert (04:24.229)
So that'd be the same thing as trying to treat agreeableness or trying to treat empathy, something like that, right? You can't treat that, right? Okay. And I'm kind of jumping ahead, but is there therapy to help with that? I mean, I'm sure I could, you could get therapy to help you with being a less, less agreeable. So I guess is there therapy and does it work? Does it, will it cure you? No. What?

Peter Salerno (04:28.434)
Yeah. There's no medication for correct, right? Yeah.

Peter Salerno (04:37.474)
Mm-hmm.

Peter Salerno (04:40.973)
Yes.

Peter Salerno (04:53.31)
I don't know about cure, there are some clinical psychologists who said they've cured some of these disorders. I would say the therapy that you use to treat the disorder is much different than the therapy that most people are aware of. You know, cognitive therapies, trauma therapies and stuff like that. But yeah, there is evidence that there are some therapies that are effective working with that population.

Robert (05:21.601)
Okay, so how do you find out? There's a lot of people out there that diagnose other people with narcissism. They read a couple articles on Google or they search on social media and they automatically say, "'Yep, that's that person, that's her, that's him.'" How is it clinically diagnosed? Is it through a test? I think there's like a, and I might have this wrong, like a PPMI or something like that or what? That's it.

Peter Salerno (05:27.284)
Mm-hmm.

Mm-hmm.

Peter Salerno (05:47.006)
Yeah, there's the MMPI, there's a couple of other inventory tests, there's screening, but honestly, like these people, they know how to take those tests too. So they don't accurately portray themselves and so they are taught or learn how to fake good and fake bad, depending on what benefits them in the moment. So that's typically not the best way to go about handling a personality disorder, is through like a screening or an assessment.

Robert (05:55.13)
Wow.

Peter Salerno (06:16.286)
There are specific therapists who specialize in treating this classification of disorders. And I would say most therapists do not know how to treat these disorders. They don't know. It's not because they're uneducated or they're not smart or anything like that. It's that they're misinformed on what's actually going on inside of the person. So a lot of these people show up in therapy once or twice. They leave.

therapist is really annoyed with them or just disturbed by them, they don't get better and then they don't come back anyway. And then they go to like ten therapists and it's the same thing over and over again. And I think one of the reasons is because mental health, I think, has failed the personality disorder population to a certain degree. But also, these people are typically, if we're talking about narcissism and borderline, they're typically not very...

Collaborative. So they don't problem-solve in therapy. They don't come saying I have symptoms. They usually come talking about how other people are Making their life difficult So it's difficult to treat them

Robert (07:29.241)
Similar to someone going into, let's just say, couples counseling, and it's usually the other person, it's that person, it's the other spouse, let's just say a married couple, it's the other spouse's fault, then when they turn, then okay, so maybe you work on that spouse that has that problem that's been identified, then when they turn on the narcissist, the narcissist, meh, I'm not gonna do it.

Peter Salerno (07:44.571)
Mm-hmm.

Robert (07:57.913)
you know, or, hey, let's, let's change therapist. The therapist looked at me funny or whatever. That's, that's interesting.

Peter Salerno (07:58.094)
Correct.

Peter Salerno (08:03.374)
Yes, that is super accurate actually. That can be enough to get someone not to come back if they think you looked at them funny, or if you hold them accountable in any way. And honestly, it's not always intentional. I mean, if you have a trait deficiency, you have a cognitive deficiency, so you're not thinking accurately. So, narcissists don't know they're narcissistic and they're just denying it. A lot of them don't know that they fit the bill, because they don't

think they have a problem in the first place, right? So, right.

Robert (08:35.013)
They're not going to admit they have a problem too, right? Okay. But they can turn it on and off. Correct. They can turn on so they can, um, you know, we'll go through the different types, kind of briefly touch on those, but they're not always, you know, you look at a, say a covert narcissist, um, where maybe they

Peter Salerno (08:51.032)
Mm-hmm.

Robert (09:01.933)
will be some way around, you know, there'll be a certain way around their spouse or their family, but then outside of the house, they might, you know, paint this wonderful bubbling image. Correct? I mean, so do they, they still don't realize it. It's just, just the way they are. Is that what you're saying?

Peter Salerno (09:08.888)
Mm-hmm.

Peter Salerno (09:15.233)
Yeah.

Peter Salerno (09:19.294)
Well, I think they're consciously and deliberately manipulating their image, but they're not necessarily thinking, I'm doing this because I know I'm wrong. They're doing it because their whole entire disorder is based on managing an image, you know, portraying themselves in such a way that's not real, and then they live a secret life and a hidden life behind this image that they portray of themselves.

Robert (09:41.157)
Gotcha.

Peter Salerno (09:47.014)
So the manipulation tactics, and this is up for debate, a lot of people don't like my opinion of this or the data, which is not my opinion at all, it's subjective. A lot of it is conscious and deliberate, the manipulation. So they know they're doing it. They don't want to collaborate, they don't want a problem solve. They want to stir up drama. They want to, you know, rehash old problems and create new problems. And a lot of that is 100% they know that they're doing it.

they still don't think that is a problem.

So

Robert (10:21.862)
That is just the way to manage or manipulate or control their surroundings. Is that correct? Yeah. Let me ask you this too. Going back to the to a couple to the couples and spouse and everything else. You know, as we were talking about kind of in my spare time I work with.

Peter Salerno (10:25.562)
Mm-hmm. Correct. Mm-hmm. Yeah, absolutely.

Robert (10:48.601)
couples are not couples, but people that have gone through a divorce or currently going through a divorce in a group setting. And a lot of what I hear is that their ex, when there is a narcissist, a diagnosed narcissist and through others too, but that they will spread rumors about that spouse, that they're the narcissist projection.

Peter Salerno (10:55.16)
Mm-hmm.

Peter Salerno (11:05.855)
Mm-hmm.

Peter Salerno (11:15.919)
Oh yeah, 100%.

Robert (11:16.545)
Is that common where they'll put the disorder, the personality disorder on the other person and go and tell everybody. And I was talking to one guy and he was saying, I basically gave up on my quote unquote friends because of that, because they all thought that, I was the one and it was actually his ex. That's common or not?

Peter Salerno (11:38.442)
Most victims of or survivors, whatever you want to call it, of this type of abuse, which I do believe the emotional manipulation and the inability to collaborate is abusive, they will label the victim as the problem, and they are typically the ones who are quick to accuse the innocent person of...

you know, gaslighting, they're the narcissist, those terms typically usually come out of the abuser's mouth more than they come out of the victim's mouth. People who are traumatized by this don't typically...

Peter Salerno (12:19.822)
talk badly about it. There's a lot of shame involved, there's a lot of self-protection. And so, the demeaning comments that are made are usually made by the person who's doing the manipulation.

Robert (12:21.453)
Yeah.

Robert (12:37.581)
Do you see narcissism and borderline personality disorder? Do you see that? Are the rates growing in the population or is it just, are we more aware of it or what?

Peter Salerno (12:46.999)
Ahem.

Peter Salerno (12:53.218)
The rates are growing in popular culture and media because we have these avenues now where anybody can diagnose anybody. The prevalence is much less than people, you know, let on. So like the general population, the prevalence of narcissism, true narcissistic personality disorder is like 1%. Borderline is like 1.6. Those are increased in clinical populations like...

in my profession because those are typically the people who are having trouble in their lives and so they either are mandated to go to therapy, court ordered, or it's like a custody issue or a marital issue. So that population increases in my profession but as far as people just walking around, there are not anywhere close to as many narcissists as people, you know, say there are in like popular media and culture.

Robert (13:52.049)
I mean, somebody might have narcissistic traits, right? I mean, we all do have those traits, right? I mean, if you take a selfie and post it on Instagram, you know, yeah, that's sort of narcissistic, right? But it's, right.

Peter Salerno (13:56.606)
Yes, right, but those...

Peter Salerno (14:05.046)
But that's different than like a disorder, right? So, and then there's this differentiation between normal narcissism, healthy narcissism, and disordered narcissism. There's also so many different definitions of narcissism. So, for example, the narcissism people claim comes from childhood, either overindulgence or neglect. That term is defined completely different than the term that's used to describe the disorder. But most people don't know that. Why would they?

you'd have to go to school and learn about it or really invest in it to notice the evolution of the term and what it's referring to. So it's used as like an umbrella term to refer to people who are just being a jerk, people who, like you said, take a selfie or are over-invested in their image or are attention-seeking. We all have traits. The disorder is a result of this predominant trait of...

grandiosity and this inability to see people as equal. That's really where it gets disordered.

Robert (15:11.025)
interesting.

Robert (15:14.845)
So I sort of touched on it. I mentioned one. There are different types of narcissism, correct? Or not?

Peter Salerno (15:22.386)
Clinically there's one type, but I think manipulation-wise people can be very unique and then that's where the subtypes come in. But those aren't actually like clinical terms for the most part. They're usually like descriptive terms. Like some people, yeah, some people, like you said, portray themselves publicly in a certain way. And then at home they're very abusive. And only the people who are being abused...

Robert (15:34.106)
Okay.

Okay.

Peter Salerno (15:48.598)
you know, see that part. Everyone else is like, no way, this person's amazing, there's no way I would ever believe that. So there's covert, there's overt, but as far as narcissism is defined clinically, there is no really, there's not really a differentiation. They, you know, they really truly believe they are better than other people in every way. I mean, that's really what, they're right, you're wrong, period. End of discussion.

Robert (16:06.778)
Gotcha.

Peter Salerno (16:19.394)
So.

Robert (16:22.025)
Let's talk also about borderline personality disorder. What is it?

Peter Salerno (16:26.35)
Mm-hmm.

So borderlines in the same group of personality disorders is narcissism, but the main difference — well, I shouldn't say the main difference, there's lots of differences — but borderlines have an emotional instability deficiency, like, or emotional stability deficiency. So all of their problems come from this, what's called splitting, or this dichotomous experience of all good, all bad.

Peter Salerno (16:57.618)
typically in interpersonal relationships. So they just can't seem to regulate, they're preoccupied with feeling like they're gonna be abandoned. And so there's a lot of manipulation that takes place trying to avoid this perceived abandonment, but the abandonment can be as subtle as like you look to the left and you've abandoned them. You know, I mean, they're very, you know, preoccupied with this abandonment. Borderlines...

Robert (17:07.249)
Thank you.

Robert (17:24.005)
So it can be lack of eye contact. Is that what you're saying?

Peter Salerno (17:27.354)
I mean, they're looking for ways to arrange for you to abandon them. Not necessarily on purpose, but that's what their MO is. But it's really this emotional instability. The difference between borderline and narcissism... Narcissists are always right. Borderlines will blame themselves. They're all bad sometimes, and then you're all good. Then you're all bad, and they're all good. Narcissists never redirect the attention to them, like I'm...

Robert (17:33.445)
Right.

Peter Salerno (17:55.03)
bad, they're always right. So that's like one of the major distinctions. If you know, if you're dealing with a borderline, they do feel shame, they feel profound self-hatred. And then they discard that and then you're the one who's, you know, the hateful one.

Robert (17:58.042)
you

Robert (18:15.793)
Wow. That's something. All right. So I'm going to ask you, um, something I want to know. And I know you kind of stirred up the internet a little bit with this. Is it hereditary? How do you get this? You don't, it's not like the flu. You it's not, you know, it's, it's not a virus. It's not COVID. Um, is it nature nurture? Give me the facts, doctor.

Peter Salerno (18:20.567)
Mm-hmm.

Peter Salerno (18:30.819)
No, you don't catch it. No.

Peter Salerno (18:40.07)
Yeah, I want to preface this by saying I was miseducated and misinformed in my own degree programs, and all my research that I did, including some of the research in my dissertation, I'll admit, was wrong because I was taught wrong about these disorders. So good science is about upsetting the status quo, you know? Sometimes you have to get a little upset when you realize the truth, so there's a lot of people who get defensive about this.

Robert (18:55.409)
There you go.

Peter Salerno (19:07.85)
Like, how could you say people are born this way? It's nurture, it's been proven. Here's the problem. All of the data that show it's nurture only has nothing to do with nature. It's called anecdotal data. What that means is, stories were told in therapy, and then interpretations were made by therapists about those stories. Now we have brain scans. Now we have neuroimaging technology. So...

Back then, there was no way to know, you know, you just took people at face value. The problem is, narcissists, borderlines, there's a couple other in that category, histrionics, antisocial, the psychopath, they notoriously lie pathologically. So all the data was taking them at face value. And everybody knows that when you go to therapy, you talk about your childhood. That's just what people know to do. That's the first thing. Even people who've, like,

don't know much about therapy. They know that, you know, people talk about their childhoods in therapy, right? Well, of course narcissistic people know that. So when they talk about how their lives are unmanageable because of the chaos that's been brewed up, and the therapist says, tell me about your upbringing, they're gonna be like, oh, well yeah. I mean, I had a terrible upbringing. That's why I do what I do.

Robert (20:14.829)
Right, right.

Robert (20:35.701)
Yeah.

Peter Salerno (20:38.507)
I mean, so once we started doing research where we could scan brains and all that kind of stuff, the empirical evidence that this is nurture really does go out the window. That's not to say that there's not an influence. There's always a social and environmental influence. But the predisposition is already there. So one myth about child abuse, for example, is that people who are abused in childhood grow up to be abusers.

Robert (20:39.042)
Interesting.

Peter Salerno (21:07.61)
80% of people abused in childhood do not grow up to be abusers in adulthood. So the most, let's say, empirical research, like we're talking about clinical research, we're not talking about stories told, shows that the genetic influence is much more prominent than people originally suspected. I mean it's...

Robert (21:11.024)
Right.

Robert (21:26.607)
Right.

Robert (21:33.561)
What, what percentage is that? What is that? Is that 60, 70? Do you know or.

Peter Salerno (21:36.522)
Well, that's another thing. Yeah, so we have ten personality disorders, by the way. So these aren't just for narcissists, but a lot of people... So across the board, each one, you know, has a different percentage, but there are studies that show that narcissistic personality disorder is like 77 to 80% heritable.

Robert (21:43.49)
Right.

Peter Salerno (22:01.198)
Mm-hmm.

And this is going off of, like, again, empirical data. So it's going off brain scans. It's going off where you see deficiencies or deficits in certain areas of the brain that make traits.

Robert (22:17.169)
So you're saying if a husband and wife, one of them, let's say is a narcissist, diagnosed, they have a child, that child has a 77% chance? No?

Peter Salerno (22:22.243)
Mm-hmm.

Mm-hmm.

Peter Salerno (22:32.242)
No, that's a great question. So heritability, or I should say genetics, don't necessarily mean 100% guaranteed biological transmission. You can have two parents who don't meet the criteria for a personality disorder, and they can have one child out of four that meets the criteria for a personality disorder. It's not like a, you're doomed because it's genetic, it's like a death sentence and there's no cure.

Robert (22:52.1)
Thank you.

Peter Salerno (23:00.534)
but it's definitely more genetic than it is environmental.

Robert (23:06.905)
Okay, so like we were, you know, we were kind of briefly talking too. I mean, if you had, if going back to that same example, if there's a husband and wife and both of them are diagnosed with personality disorder, there is a higher chance then, I mean, when you say there's a higher chance then, especially say a sibling is diagnosed, there would be a higher chance then that fourth or other child, if there's two children, that other child,

Peter Salerno (23:08.6)
Ahem.

Robert (23:34.241)
I guess there would be a higher chance of them having some sort of personality disorder, correct?

Peter Salerno (23:39.17)
Possibly, but when we talk about, so like when we talk about like development, there are things that are outside of our control that you know that just develop, you know, for example, there's other neurodevelopmental disorders nobody questions their genetic because People are born that way. I think one of the things that causes people to have difficulty with this is For almost a hundred years they were told that it was a nurturing issue

Robert (23:48.325)
Right.

Right.

Peter Salerno (24:08.75)
It was an environmental issue. And so it's really hard to wrap your head around the possibility that people might be born with this tendency.

Robert (24:18.257)
So somebody is born with it. When can they effectively be diagnosed or when can you start to see that? Is it 12, is it 18 and are there things? Well, go ahead and answer that and then I have a question to follow up.

Peter Salerno (24:28.074)
Mm-hmm.

Yeah. So because we've always were taught that it was an environmental, we actually weren't allowed to diagnose a personality disorder until someone's 18 because the theory was, well, they're still developing, so we can't really, you know, put that label on them until they're 18. Even then, that's just legal adult age, that's not full brain development age. So there was a lot of controversy there. But when you see the clinical research that these signs are visible like...

in like three-year-olds, that these kids are just different, you know, it's not... Then you can start... they call them different things, like we have conduct disorder, oppositional defiant disorder, and then those things like conduct disorder, for example, goes into an adulthood like antisocial personality disorder. So they call it something different as it's like in the interim of development.

Robert (25:06.809)
Yeah.

Peter Salerno (25:30.262)
But now with the clinical research, these things are visible and diagnosable very, very early on in life.

Robert (25:38.637)
Okay. So a mom sitting there, she has two kids and one of them is, let's say it's a single mom, two children, one's perfect kid. No issues. The other one is exhibiting traits of the X and she starts freaking out. Oh no. Oh crap. What do I do? My, you know, baby number two or child number two is a narcissist. What can she do? Is there anything she can do?

Peter Salerno (25:49.475)
Mm-hmm.

Peter Salerno (25:56.13)
Mm-hmm.

Peter Salerno (26:08.586)
Absolutely. So there is that percentage that is environmental or in social forces, right? So there's this there's If you take like a Psychopath for example, which so many people defines psychopathy differently but a psychopath is Somebody who completely lacks a conscience so they don't have any guilt shame or remorse. Okay

There's some theory that if you put that person, if that person has good, responsible parents who nurture them in a way or teach them in a way, where they cannot, they are more likely to not act out these impulses or urges. They might become a CEO of a big company as opposed to becoming, you know, a serial killer. So...

Robert (27:07.15)
Right, right.

Peter Salerno (27:08.782)
There's that percentage of how much can we influence the behavior, but those traits are still inborn, they're still innate. So to answer your question, let's say, and by the way, there's a great book on borderline personality in children called Stop Walking on Eggshells for Parents. Yes. Because it has vignettes and information about how these traits are...

Robert (27:15.045)
Gotcha.

Robert (27:25.849)
Yep, yep. Oh, for parents.

Peter Salerno (27:36.894)
obvious like early on in childhood. So I would say...

Robert (27:39.909)
Great, I'm listening to you.

Robert (27:44.469)
Is it written? Here we go. This is not for the parents, but this is. So yep, Randy Craig and Paul Mason.

Peter Salerno (27:49.706)
Yeah, I think that... is Randy, is Randy Kroeger on that? Yeah. Yeah, so the stop walking on eggshells for parents was written because there are some parents that, like you said, they have this one child that seems to be pretty normal functioning and then they have another child that they're at their wits end. They're not responding to any sort of reasonable discipline or, you know, anything like that. And so the parent is getting blamed.

By the school, the parent is getting blamed, you know, by everybody, by therapists, but yet they have this other kid that's just not problematic. So it kind of, you know, supports that nature research. But that doesn't mean that, again, it doesn't mean it's like that they're doomed. I would actually say the sooner you get the kid into therapy with someone who knows how to treat personality disorders, the better the outcome, you know, because the behavior can start to be intervened on.

Robert (28:31.13)
Yeah.

Peter Salerno (28:45.938)
immediately versus it kind of setting in and being a bit more fixed like in someone's 30s or 40s or you know something like that

Robert (28:53.549)
Wow. That's good to know. That's, that's, that's really good to know. So it's not, as you said, it's not, it doesn't mean that, Hey, if my spouse has it, my children will get it, um, from what you said. And then it's not a, Oh, I don't want to say a death sentence, but a doom sentence. Yeah.

Peter Salerno (29:09.946)
No, it's not a death sentence or a doom sentence. Well, if you look at autism spectrum disorder, for example, that's, you know, two parents cannot have that, and then a child can. That's genetic, right? I mean, no one... Some people still have an issue with that, but for the most part, no one's gonna get real rattled if you say that that's genetic, because you've seen two parents not have it, and then a child have it. Um, so that's how you can...

Robert (29:21.549)
Yeah, yeah, there you go.

Robert (29:34.618)
Yeah.

Peter Salerno (29:39.814)
That's, I would say, one of the best explanations for how two parents who don't meet the criteria for a personality disorder could have a child who does meet the criteria. But again, it's not a death sentence or a doom sentence, like you said.

Robert (29:53.989)
Jumping back, we were talking offline. And I want you to go into that about the nature and nurture and other cultures around the world and everything else. Do you mind going into that a little bit more?

Peter Salerno (29:56.694)
Mm-hmm.

Peter Salerno (30:06.645)
Mm-hmm.

Peter Salerno (30:10.602)
Yeah, well the research shows cross-culturally across the globe, these trait deficiency disorders, personality disorders are... They exist. They're present. So that... When you think about how diverse nurturing is in different cultures, right? I mean, something that would be constitute abuse in America, and you'd get child protective services called on you, but you're doing it in a different country.

Robert (30:34.094)
Right.

Peter Salerno (30:35.85)
So there's a lot of cultural definition of what constitutes abuse, what constitutes good parenting, but across the board these disorders are prevalent. I mean, that is because it's more of a genetic thing than it is of a nurturing thing.

Robert (30:50.997)
Yeah. Interesting. So I'm gonna ask you this too. I guess you sort of answered it. But I'll say there were twins born.

Peter Salerno (31:02.102)
Mm-hmm. Well, twin studies are what a lot of this clinical research are, you know, a lot of the findings come from twin studies. So you could take identical twins who were not raised together, you know, for whatever reason, or who were raised together. So biological parents adopted in the foster care system. And across the board, the...

Robert (31:12.017)
Okay.

Robert (31:26.597)
Right.

Peter Salerno (31:34.166)
the research shows that it doesn't matter what the upbringing is or what the situation is. The traits are already there. There's genetic influence over it regardless of the environment, regardless of, you know, the bi—like again, whether the biological parents—the traits are there regardless of blended families. So it's, you know, a lot of times there's this theory that, you know, well—

The divorce and then the step-parent caused the borderline personality. It's an attachment disorder. Not according to the empirical evidence. It's not. It doesn't matter what the location of your upbringing is or the style or type. There's not one single type of parenting style or one single parenting trait, if you will, that will predict the development of a personality disorder.

Robert (32:03.29)
Right.

Peter Salerno (32:28.662)
It's just not in the research. It's in popular prevailing notion and beliefs about the research, but it's not in the actual research.

Robert (32:38.117)
Do you think, I mean, you seem like you're so much on the forefront of this.

Do you think?

Robert (32:49.177)
Do you think that psychology will start stepping up and start to better diagnose, start to better treat, start to better manage, uh, recognize than where they are? Are they just, I know sometimes medicine is a little slow at adapting change, right? It's the way it's been taught and sometimes not.

Peter Salerno (33:09.95)
Yeah, well also, we like research and we like findings that support our beliefs. Nobody wants to believe that this is something that's genetic. It makes more sense emotionally to believe that it was environmental. This is a really great book. I'm not sure if you can see that. So...

Robert (33:31.937)
Yeah, science and pseudoscience and clinical psychology by who's that by?

Peter Salerno (33:36.478)
Yeah. Let's see, we have, um... Well, we got a few people, I'll just keep it up there. Ha ha. Um...

Robert (33:44.213)
Yeah, there we go by Scott Lillianfield, Stephen Lin and Jeffrey Lohr. Okay, perfect.

Peter Salerno (33:52.894)
Mm-hmm. So this whole book is about origin myths of pathology and the evidence that decades ago disproved these theories. But they're not... this research is not popular because it's not dramatic or exciting. It's just the facts, right? So the prevailing notions typically have some sort of a...

Robert (34:13.017)
Gotcha.

Peter Salerno (34:19.502)
kind of an entertainment flair to them, the pop psychology books, you know, movies and stuff about these disorders, you know, those are exciting and fun and, you know, to a certain degree in the entertainment industry, fun to, like, poke fun at or, you know, because it's interesting. But when you really look at this research, this whole aversive childhood theory stuff doesn't add up with the personality disorders.

This book dispels so many myths and explains why they prevail. So that's a really good one to do. To, to, yeah.

Robert (34:53.893)
Hmm. No, that's interesting. That's very interesting. So let me ask you this too. You know, we talked about the medical field. What about the court system? Can you speak on that? Do you know, like, do you think they'll ever, just in your opinion, do you think they'll ever catch up? Because I know a lot of times in the court system, in the family court system, let's use that specifically, it is...

Peter Salerno (35:04.587)
Mm-hmm.

Robert (35:23.199)
in several cases or not in several cases but a lot of times it's ignored. Do you think your feelings do you think that will become

more the norm where they are not the norm, but where they will start to recognize that more and what do they have to do to get to that point.

Peter Salerno (35:43.266)
They have to do a lot of reform like any institution. I've seen kids, personally and professionally, children taken away from parents because a social worker or a therapist or somebody will say, the mom was abused, which means that they're definitely going to abuse their kid. And so you need to, you know, take them out of it. I mean, literally, like literally children taken away from loving parents because...

Robert (36:08.41)
Wow.

Peter Salerno (36:12.15)
They use the history of abuse reasoning. Personality disorders are so misunderstood. Lawyers, defense attorneys give those assessments we were talking about earlier to psychopaths and narcissists so that they can take them ahead of time so they know how to score on them in a way that will benefit them in some way. So the system can easily be messed with. And there's another really good book.

Robert (36:39.377)
Too bad there's not a blood test. You know? I mean, that's just so scary because they can't. Yeah.

Peter Salerno (36:42.086)
Yeah, it is, it's terrifying, it's terrifying, it's disturbing. But people don't know this because oftentimes they don't know what they're dealing with, you know? A really good book to read that's chilling but also very interesting is, it's called Without Conscience by Dr. Robert Hare. He's like the foremost expert on psychopaths and this...

His book has some of the most interesting stories that there's one in there where he talks about a psychopath who wanted to get out of prison, so he faked being schizophrenic, took tests that validated this, he got put into a mental institution, got so bored there because everybody there was crazy, so he then he tested again to get back into the prison system. So these are real stories, these people know how to do all kinds of manipulative things.

Robert (37:30.991)
Yeah.

Peter Salerno (37:41.33)
And it goes by, you know, people in the court system can be deceived, people in obviously domestic life can be deceived, people in therapy who are professionals can be deceived by it.

Robert (37:54.969)
So I want to ask you something. How, I mean, you're such an expert in this. Doctor, how'd you get into this? Like, and you're fascinated with it. I mean, you know, watching you, talking to you through this conversation and earlier and just, you know, online, I mean, you are, you're fascinated with these two. How, where did this, where did this originate with you?

Peter Salerno (38:14.793)
Mm-hmm.

Peter Salerno (38:19.274)
Well, when I started studying psychology, I started to... They tell you not to do this, but we start diagnosing our family members to make sense of our past. So, one thing that always struck me was my maternal grandmother... Yeah. But my maternal grandmother fit the bill for borderline personality, like, across the board. Like, all... like, there's, you know...

Robert (38:29.642)
I was, yeah, okay.

Robert (38:35.025)
It'd be great to have Thanksgiving with you and watch your eyes as you're going around diagnosing everybody.

Peter Salerno (38:48.77)
There's criteria. Some people meet some of it, some people meet all of it. She met all of it. Nobody understood what it was. She was informally always referred to by family members as schizophrenic or paranoid, or paranoid schizophrenic, but nobody really knew. And so the behavior was just so erratic, this constant from kind to cruel, from love to hate, turn on you in an instant, you know?

devalue you, idealize you, this constant back and forth. And so... But my mother and her two siblings, they don't meet any criteria for personality disorder. So it was really interesting to see why that was the case. It always kind of like stumped me as somebody studying this in grad school. What really...

got me super interested in it was two things. One, if you treat people with narcissism or borderline the way you would treat any other client in therapy, they don't get better. They don't collaborate with you in the treatment. They don't problem solve. They don't self-correct and they don't change their behavior. So somebody who's really suffering, they typically want a solution. These people are not looking for solutions.

Period. I mean, so that was one thing. It was frustrating me that they weren't getting, like, helped. And then the main thing, though, was I entered into a personal relationship with somebody that pretty much turned my world upside down, and I was treating them as if they were a trauma survivor, because that's what they kept telling me, why they were doing the things they were doing. And the more you empathized with them, the more...

exceptions you gave them, the more patience you gave them, the worse the abuse got. And I'm just not somebody who's gonna roll over and be like, okay, you know. So I started an investigation and I started stumbling upon research that was saying, we've been saying this for a hundred years, what if these people are doing this on purpose? And I was like, when you—

Robert (40:53.849)
Right.

Peter Salerno (41:08.826)
spend the amount of money I spent on education and you have this confirmation bias and this belief already like embedded in your thinking, it's really hard to see a different perspective. And so I had to force myself to be okay with this other possibility that this was intentional manipulation, it was intentional that it wasn't because somebody was suffering from, you know, a bad childhood. That's really what got me...

Robert (41:11.749)
Right.

Robert (41:17.36)
Right.

Peter Salerno (41:36.39)
fascinated with the research and then I just kind of ever since then I just was like on a quest to find out what was real versus what was you know fiction.

Robert (41:46.909)
Isn't that so common with narcissism where they're the victim? I mean, there are, and isn't that a way they just latch on and dig their claws into somebody of being a victim and talking about their poor upbringing of all the, everything that happened to them, poor them, poor them. And, and then that, um, you know, the recipient of this or their, the person there, um,

Peter Salerno (41:52.744)
Oh, always.

Peter Salerno (41:58.786)
Ahem.

Peter Salerno (42:08.661)
Mm-hmm.

Robert (42:16.717)
trying to attract, has that empathy. And I guess feeding them supply, I guess is that correct and yeah.

Peter Salerno (42:19.348)
Mm-hmm.

Peter Salerno (42:22.746)
Oh, for sure. And when you're a therapist who empathizes with people and you want people, you look for people's best interests, you give them the benefit of the doubt, you take their stories at face value, you're an easy target. I mean, admittedly, that's like, that's easy. Easy prey. And that's the one exception I'll use. I tend to not use absolutes. But when we're talking narcissistic personality, I can say with confidence, they are always.

The victim.

Robert (42:53.197)
Yeah. That's interesting. That's interesting. All right. I want to be respectful of your time. Um, narcissism, uh, narcissism, personality disorder, borderline personality disorder. Is it more prevalent? Each one of them, are they more prevalent in males? Females? Is it? Yeah.

Peter Salerno (42:57.268)
Mm-hmm.

Peter Salerno (43:01.282)
Oh, sure.

Mm-hmm.

Peter Salerno (43:14.09)
Mmm, good question. So I would say, well, and I'm not gonna say this because it's my opinion, but I'm actually literally looking at, I anticipated this question, so I'm looking at the gender prevalence here. Borderline personality disorder, 50% women, 46% men. Narcissistic personality disorder, 50 to 75% men.

Robert (43:37.857)
Interesting. That's very interesting. Okay. All right. Tell me this. Um, biggest misconceptions about each. What would you say there are?

Peter Salerno (43:52.302)
I think the biggest misconception for borderlines... actually I think a lot of people who accuse their partner of being narcissists might actually be referring to borderline But I think the biggest misconception is these trait deficiency disorders would be preventable had the childhood been different. That's the biggest misconception. Be careful of that.

I don't have any financial incentive or advantage by sharing this research. I haven't even written on it yet. But, so, I have no reason to believe this for personal investment or interest. But if you make the exception for people who are abusing others, that they don't know what they're doing because they're hypervigilant, because they have PTSD, or it's because, for whatever other reason, you...

you can find yourself in a lot of trouble. Emotional, definitely, sometimes physical danger as well. So this misconception that this is an unconscious process, they don't know what they're doing, be very careful of believing that, I would say.

Robert (45:07.853)
All right. One other question. Uh, you're in a relationship with someone that has these, you know, that has one of these two disorders or I guess, I guess you can have both. Um, what do you do? What do you, what do you do? They are diagnosed. This is not internet diagnosed. This is, you know, you and your buddy sitting around drinking beer or with your girlfriends and drinking wine and you diagnose your spouse with it.

Peter Salerno (45:12.599)
Mm-hmm.

Peter Salerno (45:28.599)
Mm-hmm.

Robert (45:36.497)
This is they are clinically diagnosed. What do you do? Run? Ha. Yeah.

Peter Salerno (45:40.722)
I would say that all depends on the severity. So some escalate to violence, so I would say like any other practical solution, get yourself into a place where you're safe. That's the first thing. You have to manage your own safety first and foremost. And then you have to kind of decide...

If you have exhausted your resources, if you've done your due diligence and the person is still refusing to cooperate, refusing to collaborate, refusing to problem solve, then you have a decision to make, right? I mean...

Robert (46:17.593)
Yeah, I guess tell me this personal therapist, get a personal therapist. But from what you said earlier, a couples therapist would be useless, correct?

Peter Salerno (46:21.896)
Mm-hmm.

Peter Salerno (46:28.69)
Mm-hmm. It's not actually indicated to do couples therapy if somebody has one of these because it could actually make it worse for the victim. Yeah.

Robert (46:42.834)
All right, with age, what happens with age? Do they just stay? Do they get to a certain point when they're 30, 40, and that's where they are? Does it increase? Does it decrease? What happens?

Peter Salerno (46:55.494)
Yeah, so with personality disorders, unlike other disorders, I want to be clear on that, it's a pervasive enduring pattern across the lifespan. Some people wear themselves out, some people get into enough trouble that they modify their behavior, or everybody just leaves them. They're left with no choice but to start, you know, maybe at least trying to behave a little bit better.

And some people do get better in therapy, but yeah, but as far as the... That's what distinguishes this from like any other disorder, is it's pervasive and enduring across, in all areas of life, across the lifespan. That's why it's a disorder of the person, and it's not a symptomatic condition.

Robert (47:44.749)
Dr. Slerno, what else? What have we missed? I just wanted to, you know, I wanted to have you on. I have a series of this coming up over the next couple months, talking about divorce and co-parenting, and then talking about the effects, if the effects on children, if one parent, you know, if one parent has one of these two disorders, what have we missed? Anything else you wanna add in?

Peter Salerno (47:51.487)
Mm-hmm.

Peter Salerno (48:16.23)
I mean, I hate to say this because it sounds horrible, but I think we've missed that people do things on purpose. I mean, that's really like, just look at the evidence in your own life, I would say to people. Does this seem like somebody is suffering from, you know, the way they were treated 30, 40, 50 years ago, or does it seem like some of this is deliberate?

You know? So I would say don't lose faith in humanity, don't walk around, you know, hypervigilant, watching your back all the time, but definitely factor in the possibility that some people are social and relational predators, and they're doing this on purpose.

Robert (48:55.533)
And so at times there's, they're just being an ass just to be an ass. I mean, is that.

Peter Salerno (48:59.682)
Oh yeah. Oh yeah. Yeah. So I mean, cause...

Robert (49:03.287)
Is it?

Robert (49:06.965)
Is it, is it because they like the chaos? Is it because they get the attention? You get the reaction? Why is that? It's just them. It's just part of it.

Peter Salerno (49:18.226)
It is part of them, but I think what they really want is some sort of an advantage in every situation of life.

Robert (49:28.753)
That's so sad. So sad.

Peter Salerno (49:30.566)
It is sad. And for the record, borderlines, they experience a lot of suffering. They can be vicious, but they can also experience a lot of suffering. Narcissists typically only get distressed when they're not getting what they want. And it's a different type of distress than like somebody feeling horrible about themselves, or somebody feeling sad. It's different than that. It's more like I didn't get my way.

Robert (49:58.745)
Wow. So is it fair to say a borderline, it's more of a, I guess what I'm capturing from you is that a borderline, it's more of a sad life they leave, they live inside. Is that correct?

Peter Salerno (50:10.914)
Very painful. Yeah, so one of the main things, one of the main criteria for borderline is like suicidal gestures, suicidal thoughts and behaviors, and then sometimes actual attempts. And 10% of them are successful in their attempts. So it's a very painful way to go through life.

Robert (50:36.689)
Okay, so while we're on that with suicide, because I had read in the past that narcissists very rarely will commit suicide.

Peter Salerno (50:44.77)
they will commit suicide according to the research and according to clinical practice when they're humiliated or when they have no choice but to come to terms with that emptiness that's behind that portrayed image. They will attempt suicide because there's really not a self to maintain outside of that image. And so, but it's not because they're depressed.

So it's really hard.

Robert (51:15.321)
So it's what, that they've been exposed? Is that what it is?

Peter Salerno (51:18.118)
Yeah.

Robert (51:20.633)
Wow. That's just so sad. So sad. And it's scary. I mean, I'm glad more is, is becoming known. And I'm glad there's people like you that are speaking up about the misconceptions as well as better defining it, uh, out there as well. Look, I so much, again, I want to be, you know, cognizant about your time and I so much appreciate you.

Peter Salerno (51:24.018)
It is sad. It is sad.

Peter Salerno (51:36.776)
Mm-hmm.

Robert (51:46.789)
uh, you know, spending this last hour with us, but, um, look, thank you so much. What tell people how they can find you? Um, you know, you have books, they're on Amazon. Uh, you can search for him. Uh, Peter Salerno it's S A L E R N O. Uh, you can, you can type that into Amazon and look at the numerous books that all of them very well reviewed. Uh, how else can people find you?

Peter Salerno (51:58.902)
Mm-hmm.

Peter Salerno (52:16.582)
Well, obviously like Instagram, you know, I'm on Instagram It's at dr. Peter Salerno. Yeah

Robert (52:21.829)
What is that? What's your address on that, do you know?

Robert (52:27.621)
Okay, and I highly recommend that everybody look them up and very informative. Um, I guess you would say I'm still learning about Instagram, uh, reels and posts on there as well, or do you YouTube or anything?

Peter Salerno (52:45.014)
I do have a YouTube channel I just started, so there's not a lot of content on there, but there will be, and then I'm also in the process of finishing a book about this particular subject we've been discussing, differentiating between trauma-related disorders, PTSD and stuff like that, and personality disorders.

Robert (53:04.869)
When do you think that'll be out?

Peter Salerno (53:07.147)
A couple months.

Robert (53:08.657)
Can we have you back on either right before or right after? I would love to have you back on talking about the book more as well. And look, I so much appreciate you being on. I definitely do. And I'm honored to have you on. When I reached out to you, I'm like, oh, there's no way. He's going to accept. And you're like, yeah, I'd love to. I'm like, oh my gosh, this is wonderful. And so it's like a few days later, here we are. And I just appreciate it so much. And look, everybody again it's Dr. Peter Salerno.

Peter Salerno (53:10.092)
Yeah.

Peter Salerno (53:14.054)
Absolutely. Yeah, I'd be honored.

Peter Salerno (53:30.869)
Yeah.

Robert (53:38.077)
And that's S-A-L-E-R-N-O. Feel free to look him up on Instagram and definitely on Amazon as well. Look at his books. And Dr. Look, thank you so much for being on. I certainly appreciate it. So thank you for spending that time with us. And everybody, thank you for listening to Dad to Dad's podcast. You can find us on Spotify, as well as Apple, and also YouTube. And do not forget to hit that subscribe button so you don't.

Peter Salerno (53:52.066)
Thank you for having me. I'm honored. I'm honored. It was a lot of fun.

Robert (54:07.725)
miss any future episodes and we will see you next time. Thanks so much doctor.

Peter Salerno (54:12.142)
All right, thank you.