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.
Symptoms of Quiet BPD
If 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a person with typical BPD might have crying fits or throw tantrums, while someone with quiet BPD will become moody and withdrawn.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:
Having unhealthy boundaries Becoming obsessed with a specific person and wanting to spend as much time as you can with that person Self isolation or avoidance as a form of self protection when you are feeling overwhelmed Self harm that is hidden from others so that they don’t suspect that something is wrong Being mean to others in a quiet way (e.g., giving the silent treatment) A feeling of hopelessness all the time (e.g., existential angst) Inwardly directed hostility, anger, or aggression (e.g., having a harsh internal critic, self harm) Having a poor self image or rapidly changing self image Intense fear of rejection Mood swings that can last hours to days (but that appear invisible to outsiders) A pattern of idealizing others and then devaluing and discarding them Taking small things personally (e.g., assuming someone is ignoring you) Not being able to read others (e.g., thinking people are mad at you when they are not) Racing or distorted thoughts A fear of being alone or pushing people away Self sabotage that holds you back from reaching goals Experiencing a feeling of being “triggered” that leads to uncontrollable internalized emotions (e.g., shame, guilt) Having a hard time talking about your feelings Feeling numb or empty inside Derealization (feeling as though you are living inside a dream) Problematic people pleasing (that causes problems in the long term) Feeling as though it is wrong to have the emotions that you do (which results in trying to suppress them) Feeling as though you are in a state of hypervigilance
Diagnosis of Quiet BPD
Quiet 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:
Do you have bad mood swings that can last days, but nobody around you really knows how you are feeling?Do you feel guilty or ashamed a lot of the time, even though others might tell you that you have nothing to feel guilty about?If you have a conflict with someone, is your go-to response to blame yourself?In relationships or friendships, do you have a tendency to idealize someone but then eventually decide that you don’t like them anymore (even if you don’t outwardly let them know)?Does it feel as though you are separate from everyone, empty, or numb all the time?Does it sometimes feel as though you are watching yourself go through the motions or like your life is “surreal”?When you get angry, do you have a tendency to push it down or suppress it?Do you feel like a burden to others or that you are just taking up too much space?When people hurt you, do you have a tendency to cut them out of your life rather than try to discuss what happened?If you get upset, is your tendency to go into withdrawal mode and not talk to anyone at all?
Causes of Quiet BPD
Are 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.
A family history of personality disorders (hinting at a genetic susceptibility) Experiencing abuse, neglect, abandonment, or trauma during childhood A history of another mental disorder (e.g., eating disorder, anxiety disorder, depression, bipolar disorder, substance abuse)
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 BPD
Those 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:
You may find that when you are in relationships, the other person tends to end things because they cannot handle the impact of your symptoms You may be at risk for engaging in risky behaviors such as overspending, using substances, or risky sexYou may have trouble building deep connections with other peopleYou may experience other mental health disorders (e.g., generalized anxiety, depression, social anxiety, eating disorders, substance abuse)You may lack friendships or connections with other peopleYou may have trouble expressing yourself in a relationship (e.g., alexithymia, or trouble recognizing or describing your emotions) which can cause feelings to festerYou may experience suicidal thoughtsYou may struggle with perfectionism or the feeling that you need to appear successful and independentYou may struggle to manage hardships like job loss, financial instability, divorce as this can cause your sense of self to crumbleYou may end relationships abruptly and end up hurting the ones you said you lovedYou may feel as though you are afraid to be alone but at the same time you continue to push people awayYou may avoid relationships altogether as it is safer not to even tryYou may have confusion about your identity, beliefs, values, and what you like
Treatment of Quiet BPD
Some 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 Therapy
Schema 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 Medication
Although 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. 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.
Coping With Quiet BPD
Below are some tips to cope if you are living with quiet BPD:
Confide in someone you trust and let them know you sometimes engage in self harm. Tell them what situations trigger you and work together to make a plan to identify these triggers and choose an alternative coping strategy (e.g., writing on your skin instead, snapping an elastic band)Reach out to a professional if you are struggling and have not received professional help.Adopt a healthy diet and regular pattern of sleep. Be mindful of your emotions and check in with yourself every few hours and ask yourself how you have been feeling. Write in a journal every night about the emotions you experienced that day and how you coped with them.Increase your tolerance for uncertainty by writing down possible explanations for uncertain events (e.g., if someone has not responded to your text, you could write down that they might be busy)Use positive coping statements, self talk, or affirmations to manage your emotions. Identify some self soothing activities that you can do to feel better such as practicing mediation, listening to music, or even a hobby that you enjoy.
Helping Someone Cope With Quiet BPD
Perhaps 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:
Listen and be sympathetic. The person with quiet BPD isn’t likely to open up about their emotions, so they need you to ask the right questions and be a good listener.Ask questions. and try to listen and understand the emotions that they are experiencing rather than getting bogged down in the stories about what happened. Again, you need to be a detective and get at the underlying emotions.Validate their feelings. and let them know that they are being heard. A person with quiet BPD is more likely to stuff down their emotions, so it’s even more important to show them that it’s okay to feel what they are feeling.Help them practice self-soothing strategies. by making them a cup of tea, playing calming music, or getting them involved in an enjoyable hobby.Set healthy boundaries. Avoid making threats or ultimatums.Consider making a family therapy appointment. If the person won’t admit that they have a problem, consider making a family therapy appointment and going together.Encourage them to use mindfulness techniques. Suggest meditation and deep breathing.Celebrate smaller wins. Understand that they may take small steps rather than make big progress. Celebrate those wins so that they keep going.Take care of yourself. Manage your own stress and don’t put their needs ahead of yours or you will end up depleted.
A Word From Verywell
While 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. For more mental health resources, see our National Helpline Database. 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.
