Quiet borderline personality disorder (BPD) is not a recognized subtype in terms of diagnosis; rather, it’s a term that refers to people who meet the criteria for diagnosis of borderline personality disorder but who don’t fit the typical profile. Show
According to the National Institute of Mental Health (NIMH), “Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.” Whereas the typical presentation of BPD involves angry outbursts and obvious and outward self destructiveness, those with quiet BPD have internalized emotional episodes (they turn their anger inward). For this reason, quiet BPD tends to go undiagnosed or is misdiagnosed. This illness is also sometimes referred to as “high-functioning” BPD. However, this name is a misnomer. Although these individuals may seem to cope fine with the demands of daily life, they are in fact living a private experience that is anything but functional. Symptoms of Quiet BPDIf you are wondering whether you or someone you know might be struggling with quiet borderline personality disorder, it can be helpful to read over some of the common signs and characteristics. The truth is that quiet BPD can be harder to identify than typical BPD as the signs are often not outwardly obvious. For example, while a person with typical BPD might show outward signs of rage, a person with quiet BPD might turn that rage inward and engage in self destructive behaviors. Similarly, a person with typical BPD might have crying fits or throw tantrums, while someone with quiet BPD will become moody and withdrawn. Listed below are the some of the most common characteristics of quiet BPD:
Diagnosis of Quiet BPDQuiet borderline personality disorder is diagnosed according to a list of symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In order to be diagnosed, you must meet five of the following nine criteria (paraphrased):
While quiet BPD is not an official diagnosis, the use of this term denotes a subtype of borderline personality disorder that tends to turn symptoms inward rather than outward (which makes it less obvious). Because of the hidden nature of quiet BPD, it often is misdiagnosed as something else (e.g., depression, social anxiety, autism) or takes longer to diagnose because of the lack of classic symptoms. Most clinicians think of the borderline personality disorder case as being angry and explosive, but these individuals are instead quiet and hurting. People living with quiet BPD may feel misunderstood and receiving a correct diagnosis can feel as though a weight has been lifted off your shoulders. If you are wondering if you might meet criteria for BPD, you could ask yourself the following questions:
Causes of Quiet BPDAre you wondering what might cause quiet BPD? In fact, the causes are similar to the causes of typical BPD. Below are some potential causes of this type of personality disorder.
While there are no specific causes that would result in quiet BPD vs. typical BPD, it’s likely that one’s personality or temperament influences how the disorder manifests in terms of outward symptoms or inward symptoms. In addition, a child who was berated for talking too much or being a nuisance, might turn inward instead of outward. Complications of Quiet BPDThose who live with quiet BPD will experience secondary effects of having this personality disorder. This might mean having another mental health disorder, experiencing difficulties in relationships, or falling apart when faced with challenging life circumstances. Below are some of the common compilations that can arise if you are living with quiet BPD:
Treatment of Quiet BPDSome people with quiet BPD may feel as though they do not deserve help because their problems are “not that bad.” Perhaps you appear to be functioning in most areas of your life, and to all outward appearances things mostly seem to be fine. However, the truth is that there are multiple effective treatments that can help with the symptoms of quiet BPD. Below are some options to consider. Cognitive-behavioral therapy (CBT)Cognitive behavioral therapy is a form of talk therapy aimed at modifying unhelpful thoughts and behaviors that perpetuate the problems that you are experiencing. Specifically, a CBT therapist will have you keep thought records to examine your thoughts and look for distortions such as “black and white thinking” or “emotional reasoning.” Then, you’ll be asked to generate alternative adaptive thoughts to use instead. Over time, gradual practice of examining your thoughts and being mindful of thinking errors is helpful for getting control of racing thoughts and reacting to your perceptions of situations rather than the situations themselves. Dialectical Behavior Therapy (DBT)Dialectical behavior therapy (DBT) was developed specifically for the treatment of borderline personality disorder. The objective of DBT is to teach you mindfulness strategies to manage stress, emotions, and distress. The goal is to improve your ability to relate to others without engaging in self-destructive patterns. DBT teaches you that your feelings are important and that you should share them (even if that hasn’t been your tendency in the past). You will also learn about the “wise mind” and how it can help you to calm yourself. Schema TherapySchema therapy combines a variety of different therapeutic approaches and has an emphasis on relationships. It was designed specifically for people with personality disorders, making it potentially helpful for those with quiet BPD. A schema refers to a filter through which you view the world or your patterns of relating to other people (that you may have developed in childhood). The goal of schema therapy is to work on these patterns that are causing you emotional distress so that you can find ways to get your needs met in more healthy ways. Psychiatric MedicationAlthough there are no medications specifically approved for BPD, you could be prescribed a medication to cope with a related issue such as anxiety or depression. Mentalization Based Therapy (MBT)Mentalization refers to your ability to think about your thoughts, emotions, and needs as well as those of other people. During mentalization-based therapy, which is a form of psychodynamic therapy, you learn how your internal events can have an impact on what you do. Thus, the goal of therapy is to improve your ability to reflect on your internal experiences and those of others. For example, you might learn to see the difference between how you perceive a situation (that someone is rejecting you) and the actual event (a mild criticism). This process leads to better control over emotions and a better sense of self. Transference-Focused Therapy (TFP)Transference-focused therapy is another form of psychodynamic therapy that uses the relationship between the client and therapist as part of the therapy process. It is thought that how you relate to your therapist will in large part play out the same way as how you relate to other people in your everyday life. And, it’s likely that this way of relating to others developed during childhood with your earliest relationships. The goal of the therapist is to figure out what patterns of interactions that you bring to therapy mirror how you behave out in the world. Once these are determined, then your therapist has a better sense of how you feel, think, and interact with people in your day to day life. The goal of therapy is to develop a more emotionally mature self that experiences less internal volatility. Coping With Quiet BPDBelow are some tips to cope if you are living with quiet BPD:
Helping Someone Cope With Quiet BPDPerhaps you have recognized quiet BPD in someone you love or that person has already been diagnosed. What can you do to help support that person? Below are some supportive strategies to help the person with quiet BPD:
A Word From VerywellWhile it’s true that others won’t necessarily understand the degree to which you are living in despair with quiet BPD, it’s also true that it’s no less painful just because it’s not visible. In fact, one could argue that because of the hidden nature of BPD it’s almost more painful to deal with because you are often dealing with it entirely alone. Not only that, but for many people with quiet BPD, you may have spent your whole life not realizing that there was a name for what you are experiencing or that it’s not just your “personality” or how you are naturally programmed to react. While it’s true that some parts of your experience of BPD are likely influenced by your personality, a personality disorder is not just a “way of being.” Instead, it’s a dysfunctional way of thinking and behaving, and there are solutions if you are willing to put in some time. Finally, be aware that many people in your position are misdiagnosed or not diagnosed at all. Even though this disorder is poorly understood and not often identified, that doesn’t mean that it is not treatable. If you fail to get anywhere with your family doctor, make an appointment with a mental health professional who specializes in borderline personality disorder. Expertise and experience are critical when it comes to choosing a treatment provider in this case. What does a quiet BPD episode look like?“This can look like poor self-image and excessive self-criticism, feelings of emptiness and instability in goals, values and opinions.” Individuals living with quiet BPD may have decreased levels of empathy, high conflict relationships, clinginess and fear of abandonment, adds Dr.
What happens to borderlines as they age?The condition seems to be worse in young adulthood and may gradually get better with age. If you have borderline personality disorder, don't get discouraged. Many people with this disorder get better over time with treatment and can learn to live satisfying lives.
Do I have quiet BPD?If you have Quiet BPD, you "act in." You experience the entire gamut of emotions — fear of rejection, mood swings, rage, obsessive emotional attachment, self-doubt, anxiety, etc. However, you do not show your inner turmoil on the outside. Instead of lashing out, you direct the anger, hate, and blame toward yourself.
What's it like living with quiet BPD?Living with quiet borderline personality disorder can be exhausting and incredibly debilitating. It can stop a person from being able to enjoy their everyday life, as they struggle to cope with the intense thoughts and emotions that they experience.
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