High-Functioning BPD: Definition, Symptoms, & Treatments

What Is High-Functioning Borderline Personality Disorder (BPD)?

The non-official subtype of “high-functioning BPD” describes someone whose symptoms of BPD are typically well-managed. Borderline personality disorder (BPD) involves a pervasive pattern of impulsivity and instability of interpersonal relationships, self-image, and affect. However, these symptoms are typically less observable in those with high-functioning BPD.^1,2 These individuals are more likely to internalize their distress than they are to present extreme outbursts of anger, observable mood swings, and suicide attempts, which are more characteristic of low-functioning BPD.

In this case, high-functioning refers both to one’s ability to navigate their life fairly effectively (for example, without constantly losing jobs and burning bridges), as well as to their quieter symptom expression. “Quieter” doesn’t necessarily mean the person isn’t suffering or in pain; rather, this refers to a tendency to direct emotions and behaviors inward, such as through self-criticism or rumination. A person with high-functioning BPD may be perceived by others as emotionally stable, which may or may not be the case.³ Compared with those with low-functioning BPD who tend to be under-controlled and dysregulated, those with high-functioning BPD are more likely to exhibit overcontrolled tendencies.

High-Functioning BPD Symptoms

Those experiencing high-functioning BPD often alternate between pushing people away and pulling them in closer, and may similarly fall into patterns of idealizing and then devaluing others. They tend to exhibit quick switches in emotions, such as going from very happy to very irritated. What others see may not accurately reflect what a person is truly feeling. While someone with high-functioning BPD may feel intense anger suddenly, their frustration may display as one appearing tired and in need of some time alone.

High-functioning BPD tends to leave a person feeling chronic emptiness, uncertainty about their identity, insecurity, and dissatisfaction with themself. Someone experiencing the disorder may ruminate, fear rejection, or perseverate on things they wish they never said (or should have said).

In relationships, the extreme emotions and unstable moods characteristic of high-functioning BPD may lead partners to feel confused. It can seem as though nothing they do or say is enough, or like they are being depended on for too much. Partners may at first tolerate the hot-and-cold nature of someone with BPD but ultimately decide that this behavior is not conducive to a healthy, nurturing relationship. At school and work, those with high-functioning BPD may set high expectations of themselves. When these expectations are inevitably not met or one receives constructive criticism, one may experience helplessness and self-criticism.

High-functioning BPD symptoms may include:

• Depression
• Feelings of emptiness
• Difficulty setting and observing healthy boundaries
• Unstable sense of self
• Fear of rejection
• Self-harm and suicidality
• Dependency in relationships
• Isolation and social withdrawal
• Self-destructive tendencies
• Internalized intense emotions such as anger, loneliness, anxiety, guilt, and shame
• Rumination

Treatment for High-Functioning BPD

Dialectical behavior therapy (DBT) is the treatment of choice for individuals diagnosed with BPD. DBT for BPD is a multi-dimensional treatment approach that involves individual and group therapy, phone coaching in-between sessions, and groups that focus on building skills. These groups focus on improving one’s mindfulness, distress tolerance, emotion regulation, and interpersonal challenges. Mindfulness for BPD is particularly helpful in this case, as it increases one’s awareness of the present moment. This allows someone to identify, label, and separate from their thoughts or emotions, rather than attaching to and building them up internally.

While medications to treat BPD don’t exist, several options can be used to treat its symptoms (such as anxiety and depression) that are often recommended to be used in tandem with psychotherapy.⁴

Whether you’re searching for a therapist for yourself or a loved one, it’s important to find one who has training and experience working with those diagnosed with BPD. A great way to find the right therapist is by searching an online therapist directory, where you can sort by a therapist’s specialty.

Final Thoughts

High-functioning Borderline Personality Disorder can be challenging to deal with, both for the person experiencing it and for their loved ones. That being said, there are ways to cope and options for treatment that can increase your quality of life and help manage your symptoms and suffering.