Comorbidity Hierarchy: primary and secondary or dominant vs. recessive diagnoses in comorbidities.
Secondary disorders are traits and behaviors and amount to subclinical style. They are triggered by environmental stressors and are self-states.
Secondary disorders may be a form of functional overlay (additional symptoms triggered by psychological dynamics) or may even be triggered by the primary disorder (example: ASD and NPD). Similarly, the primary disorder may be a defense against the secondary disorder.
In NPD-BPD comorbidity, NPD is the dominant, primary disorder and is a defense against BPD, the secondary disorder. Only during decompensation does the secondary disorder emerge (affective dysregulation and suicidal ideation).
Covert states are comorbidities: narcissism plus passive-aggression (negativism)=covert narcissist
Find and Buy MOST of my BOOKS and eBOOKS in my Amazon Author Page: https://www.amazon.com/stores/Sam-Vaknin/author/B000APLOFK/allbooks