What Is Quiet Borderline Personality Disorder?

Quiet borderline personality disorder (BPD) is not an official mental health condition. It describes people who meet the criteria of a BPD diagnosis but who don't meet the typical profile for the condition. Sometimes quiet borderline personality disorder is referred to as high-functioning BPD, as people may seem fine outwardly but are struggling inside with intense feelings.

With BPD, a person experiences an ongoing pattern of disordered and sometimes extreme moods, self-image, and behavior. People with BPD may be impulsive and have difficulty in relationships. They may also experience intense episodes of anger, depression, and anxiety lasting from a few hours to several days.

This article discusses the symptoms, causes, and treatment of quiet BPD, and how traits differ from other BPD types. It explains how treatment and healthy lifestyle choices can help people cope with quiet BPD.

BPD and Quiet BPD

Borderline personality disorder affects up to 2.7% of people worldwide and is present in about 12% of people receiving outpatient therapy for a mental health disorder. It's less clear how often people develop a "quiet" and therefore less visible type of BDP, although many symptoms are shared.

The main difference is that people diagnosed with BPD typically act out (with angry outbursts, for example) while people with quiet BPD direct their distress at themselves. This less-visible form can lead to delays in diagnosis because symptoms can be similar to depression and other disorders.

BPD is a complex disorder, with nine different criteria for a positive diagnosis to be accurate, and five required, based on the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. That allows for 256 possible combinations of traits that can lead to a BPD diagnosis.

Symptoms of Quiet BPD

People with quiet BPD meet the criteria for a BPD diagnosis, but their symptoms are directed inward, internalizing the anger and blame within themselves instead of others. People with quiet BPD work hard to hide their struggles from others, not showing their symptoms on the outside.

People with quiet BPD share many of the same traits that are part of a BPD diagnosis. These include:

• Feeling empty and numb most of the time
• Having emotional instability and extreme mood swings that are sudden and unexpected
• Experiencing disruptions in their relationships, feeling unsafe in the world, and withdrawing from people or pushing them away despite fears of abandonment
• Blaming themselves for events, feeling shame, guilt and other negative emotions
• Hiding their anger when it emerges as intense and hard to control
• Recurring thoughts and behaviors of suicide and self-harm
• Lack of trust in others (including stress-related paranoia)

People with quiet BPD often mask their BPD traits and appear calm, even when they're struggling in their inner lives. They often want to please people at cost to themselves, and may withdraw from others when upset rather than working things out. They may engage in "splitting" behavior" (black-and-white thinking or swinging from one extreme to another, with little provocation).

People with quiet BPD may experience a few of these symptoms or many of them. The frequency, severity, and duration of the symptoms can vary from one person to another.

Causes of Quiet BPD

The exact cause of BPD is not yet clear. Research suggests that several factors may play a role in the development of BPD:

• Family history/genetics: Having a close family member (such as a parent or sibling) with BPD may increase a person's risk of developing BPD themselves.
• Brain factors: Some studies indicate that people with BPD can have structural and functional changes in the brain, particularly in the areas associated with impulse control and emotional regulation. It's not known whether these changes are risk factors for the disorder or a result of having the disorder.
• Environmental factors: Traumatic life events, such as abuse or abandonment, hostile conflicts, instability, and other disruptions to a healthy childhood environment, may increase the risk of someone developing BPD.

Diagnosis of Quiet BPD

Quiet BPD is diagnosed by a licensed mental health professional, such as a psychiatrist, psychologist, or clinical social worker. To determine a diagnosis, they typically:

• Conduct a thorough interview in which symptoms are discussed at length
• Take a personal and family medical history, including mental health conditions
• Perform a medical exam (a physical exam and possibly other tests) to look for/rule out any potential medical reasons for the symptoms

Treatment for Quiet BPD

Psychotherapy (talk therapy) is typically the preferred treatment for people with BPD. Treatment sessions can take place individually or in a group setting. Group sessions guided by a therapist provide an opportunity for people with BPD to improve their ability to interact with others and practice expressing themselves effectively.

Therapies

There are a number of therapies that can be used to treat BPD:

• Dialectical behavior therapy (DBT): DBT was developed specifically to treat individuals with BPD. It is an intensive program that focuses on regulating emotion, building effective relationships, and limiting self-destructive behaviors.
• Cognitive Behavioral Therapy (CBT): CBT involves identifying a problematic thought process and then working to change core beliefs and behaviors that foster inaccurate self-perceptions and difficulties interacting with others.
• Radically Open Dialectical Behavioral Therapy (RO-DBT): This program was designed especially for overcontrol, a common feature of quiet BPD. The therapy focus is on enhancing social connectedness and openness rather than behavioral control.

Other therapies used to treat BPD include mentalization-based therapy, transference-focused therapy, and schema-focused therapy.

Medications

Medications are not typically used as the main treatment for BPD. However, they may be prescribed to treat conditions such as:

• Mood swings
• Depression
• Other co-occurring mental disorders

Medication isn't right for everyone and can have side effects. Follow your healthcare provider's guidance on whether medication may be beneficial for you.

Prognosis for Quiet BPD

Without treatment, people with BPD may be:

• More likely to develop other chronic medical or mental illnesses
• Less likely to make healthy lifestyle choices

BPD is also associated with significantly higher rates of self-harm and suicidal behavior than the general population.

It is important for people with any form of BPD to seek out and commit to treatment. With professional help, symptoms (and quality of life with BPD) can improve.

Coping With Quiet BPD

Quiet BPD should be treated under the guidance of a mental health professional. Other strategies may also help. You can:

• Eat a healthy diet, exercise, get quality sleep, and avoid alcohol or tobacco use.
• Join a support group or speak with a supportive person you trust.
• Practice mindfulness and relaxation techniques, like deep breathing exercises. There's research evidence to support the role of mindfulness practice in mental health treatment.
• Play music that is healing to you. Music therapy is often used in treating personality disorders and other mental health conditions.
  

Summary

People with quiet BPD meet the criteria for a BPD diagnosis, but instead of acting out as in typical BPD, their symptoms are directed inwardly. People with quiet BPD become adept at not showing their symptoms on the outside.

Psychotherapy is the standard treatment for BPD. Radically open dialectical behavioral therapy may be especially helpful for quiet BPD. Medication may also be prescribed. If you're experiencing signs of quiet BPD, see your healthcare provider.

BPD is associated with increased rates of self-harm and suicidal behavior. If you're considering hurting yourself, seek help immediately. With treatment, the symptoms of BPD can improve.