Borderline personality disorder (BPD) is one of the best-known, and sometimes most disconcerting, mental conditions. Many people wonder if they, or someone they know, suffers from BPD. Traditionally, this disorder has been identified through a fairly straightforward set of symptoms, involving problems with emotional regulation and sometimes lashing out at others.
However, many people haven’t heard of one specific subtype of BPD, called quiet borderline personality disorder, or quiet BPD. This condition may also be referred to as discouraged BPD, or high-functioning BPD.
Psychologist Theodore Million originally proposed the idea of quiet BPD, along with three other subtypes of borderline personality disorder. He suggests that people may be suffering from the same internal symptoms or feelings, but that these experiences may manifest in different ways for different people. In quiet BPD, the symptoms present more inwardly rather than outwardly.[1]
Diagnosing Quiet BPD
Quiet BPD is not a condition that can receive a formal diagnoses, as it has not been officially recognized under the DSM-5 as of yet. Rather, it is considered as one of the ways the condition manifests. Traditionally, BPD is diagnosed if five or more of the following symptoms are identified:[2]
- Frantic effort to avoid abandonment, or perceived abandonment, by others
- A pattern of intense and changing relationships, altering between extremes of “loving” or “hating” certain individuals
- Struggling with an individual self-identity (Who am I?, What’s important to me?)
- Impulsive and self-sabotaging behaviors in at least two areas of life (such as reckless spending, sex, or driving)
- Recurring suicidal urges, threats, and/or episodes of self-harm
- Frequent or sudden but temporary changes in mood, such as sadness, anxiety, or irritability
- Feelings of emptiness or hopelessness
- Problems regulating anger, including physical or emotional outbursts toward others
- Dissociative episodes (feeling apart from reality), and/or paranoid worries brought on by stress and triggers
Rather than lashing out or blaming others when there are triggers, individuals with quiet BPD may turn their anger inwards. Lo identifies the following symptoms that a person with quiet BPD might experience, in addition to, or instead of, symptoms listed in the DSM-5:
- Blaming oneself. Someone with quiet BPD may consciously believe that the way others treat them is their fault. They may blame themselves for any negative feelings that others have.
- Hiding feelings. One might keep a lid on any negative feelings in public, or even have trouble identifying basic feelings.
- Functioning well publicly. Quiet BPD is sometimes called “high-functioning BPD,” because they keep it together on the outside. Inside, things still feel out of control.
- People pleasing. This might involve going out of one’s way to help and keep others happy, at the expense of your own well-being and needs.
Causes of Quiet BPD
Experts believe that BPD develops during childhood, and is a combination of biological and environmental factors. Certain children are born with a higher vulnerability to trauma and neglect. This sensitivity, combined with traumatic experiences, can lead to the development of borderline personality disorder.[3]
Researchers are beginning to understand borderline symptoms as it relates to post-traumatic stress disorder, which may also develop in response to trauma. Traumatic incidents can be very straightforward, such as an episode of physical or sexual abuse. However, children may also be traumatized by episodes of neglect, constant invalidation, or emotional and verbal abuse by parents or others.
In a well-known book about borderline personality disorder, I Hate You–Don’t Leave Me, the authors note the effect a cold or withdrawn parent may have on a child. Even when parents aren’t abusive in a physical way, a lack of emotional support for a child may be one factor that leads to BPD.[4]
Overlapping Diagnoses
It can be difficult to identify the difference between BPD, particularly quiet BPD, and similar conditions. Often, symptoms of other reactions to trauma may overlap, and individuals may have multiple diagnoses.
Episodes of ongoing trauma in childhood are sometimes described as complex trauma, or complex PTSD. This can occur when children have frequent episodes of trauma, which may include neglect.
Pete Walker, psychologist and author of Complex PTSD: From Surviving to Thriving, identified the experience of emotional flashbacks which is one possible response to childhood trauma. He writes, “When fear is the dominant emotion in a flashback, the person feels extremely anxious, panicky, or even suicidal. When despair predominates, a sense of profound numbness, paralysis and desperation to hide may occur.”[5]
These symptoms may seem similar to borderline personality disorder, and specifically to quiet BPD. However, researchers have identified differences between BPD and PTSD. Symptoms of a frantic fear of abandonment and a lack of sense of self are unique to BPD, and are not necessarily present among those with PTSD or complex PTSD.[6]
Why BPD Manifests Differently Between Individuals
Why would BPD symptoms differ from one person to another? It may be that the cause and feelings of the condition are the same, but they are expressed outwardly in different ways.
As children grow up, they develop coping mechanisms to deal with the environment they find themselves in. In some cases, children may have found that it worked better when they hid their feelings. It may have been emotionally unsafe, or simply unproductive, to lash out or calmly discuss their internal experiences. It served them better to seem okay on the outside while suffering internally.
When these children become adults, they may naturally continue the same coping mechanisms. These may or may not continue to work day to day, but never address the underlying feelings of despair or unhappiness.
Those with high-functioning BPD may also be driven by their past experiences. They may want to prove to others that they can be successful, or may simply not want to live the same life that they grew up in. They can appear very competent on the outside, but feel anything but.
Treatment Options for Quiet BPD
If you or someone you know suffers from quiet BPD, there are steps that may help. Some symptoms may actually improve over time, as you gain more positive experiences in relationships. Meanwhile, you can find support to deal with your symptoms and underlying feelings. Some therapy treatment types are more commonly used than others in addressing BPD.
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is one of the most popular approaches to treating BPD. Someone with quiet BPD may feel that they are different from others who participate in this treatment. Indeed, the outward symptoms may differ. However, the skills learned in DBT can still help.
Common elements of DBT include the following:
- Educational groups to learn everyday strategies to manage mood and life complications caused by BPD.
- Individual therapy with a counselor who can help with identifying thought and behavioral patterns that may be making life more difficult.
- Coaching calls to help individuals practice using skills in difficult moments.
Here are a few of the most popular skills taught in DBT:
- TIPP, which stands for temperature, intense exercise, paced breathing, and paired muscle relaxation. This skill involves changing your bodily experience in order to interrupt any emotional symptoms that are overwhelming you. Often, people hold ice cubes or splash their face with cold water. This has a biochemical effect that can change your mood in the moment. Similar options might include taking a cold shower or going for a run.
- PLEASE, which stands for (treating) physical illness, eating a balanced diet, avoiding addictive substances, sleep balance, and exercising.
- HOW/WHAT, which focuses on mindfulness. This includes the following steps one can use in a difficult moment:
- Observe thoughts and feelings
- Label what you feel
- Allow yourself to have the experience or feeling, even if it’s uncomfortable
- Don’t judge your feelings or experience
- Stay in the moment
- Make a choice based on what’s best for you
Through DBT, people learn to better manage and tolerate the strong emotions that come along with quiet and other types of BPD.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is another type of therapy that can be helpful for those with quiet BPD. CBT is technically a part of DBT, however traditional CBT is structured differently. A cognitive therapist can help you identify thoughts that may be inaccurate but contribute to your feelings of self-blame and emptiness. The experience of having a therapist who is consistent and supportive can also be a way to heal your feelings of neglect as a child.
Bottom Line
Because of the related stigma, many people fear a diagnosis of borderline personality disorder (BPD). Only a qualified mental health professional can make such a diagnosis. Even if you are diagnosed with this disorder, you can still live a happy life. Everyone experiences the world in their own unique way, and you don’t need to compare yourself to others. If you’re already struggling with hidden emotional symptoms, then a diagnosis can be a first step to finding support and beginning to heal your past.
References
- Millon, T., Millon, C. M., Meagher, S. E., Grossman, S. D., & Ramnath, R. (2012). Personality disorders in modern life. John Wiley & Sons.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Cattane, N., Rossi, R., Lanfredi, M., & Cattaneo, A. (2017). Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC psychiatry, 17(1), 221. https://doi.org/10.1186/s12888-017-1383-2
- Kreisman, J. J., & Straus, H. (2010). I Hate You–Don’t Leave Me: Understanding the Borderline Personality. Van Haren Publishing.
- Walker, P. (2013). Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma. An Azure Coyote Book.
- Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European journal of psychotraumatology, 5, 10.3402/ejpt.v5.25097. https://doi.org/10.3402/ejpt.v5.25097
Jennie Lannette is a licensed therapist who specializes in trauma, PTSD, and related issues. She has trained extensively in multiple evidence-based treatments. She has a decade of experience in inpatient, community, and private practice settings.