Quiet Borderline Personality Disorder (sometimes called Q BPD, discouraged borderline, and high-functioning borderline) is an unofficial type of BPD that involves someone turning their volatility inward. In general, BPD is characterized by fear of abandonment, impulsivity, and instability in relationships, low self-esteem and unpredictable changing moods. Like all forms of BPD, quiet borderline personality disorder is a challenging condition, but symptoms can be improved and effectively managed with treatment.
What Is BPD?
Borderline personality disorder (BPD) is a serious mental health disorder that usually causes emotional instability and difficulties with overall functioning. Some common signs and symptoms of BPD include intense and unpredictable emotions, impulsivity, urges to self-harm or suicidal ideation/attempts, and unstable self-identity. However, not everyone with BPD will experience the same or all the associated symptoms and behaviors.1
BPD Subtypes
Not all people with BPD will present in similar ways, so some find it helpful to separate the condition into specific subtypes in an attempt to help explain and clarify the different presentations.
Some sources note five types of borderline personality disorder that include:2
- Affective type: marked by intense mood changes that occur intensely and frequently
- Impulsive type: behaving and acting in ways that show little forethought or planning
- Aggressive type: becoming angry often, sometimes referred to as borderline rage
- Dependent type: struggling to be alone and preferring to be in relationships
- Empty type: Evidenced by issues with identity for trust for self or others
Other sources of information claim that there are only four types of BPD:3
- Discouraged borderline personality disorder (quiet BPD)
- Self-destructive borderline personality disorder
- Impulsive borderline personality disorder
- Petulant borderline personality disorder
In this framework, discouraged borderline, quiet borderline, and “high-functioning” BPD refer to the same subtype, none of which are used in professional settings or among leading experts in the field of borderline personality disorder. This lack of attention could simply mean that quiet borderline personality disorder is just a mild variation from the general condition. It could also indicate that separating BPD types is overly complicated or unnecessary.
What Is Quiet BPD?
Quiet BPD is one type of borderline personality disorder that involves someone turning many of the strong emotions associated with general BPD in towards themselves vs. out towards others. These may include feelings of anxiety, sadness, emptiness, intense anger (known as borderline rage), paranoia, or thoughts of self-harm among others.1
Evelyn P. Meier, PhD, Licensed Clinical Psychologist and Director of the Dialectical Behavior Therapy (DBT) Program at Genesee Valley Psychology says, “While Quiet BPD is not an official, diagnosable disorder, it is certainly the case that many folks don’t fit the prototypical BPD mold, yet their suffering is very real. In my experience, these individuals are less likely to meet criteria for uncontrolled anger and aggression. In fact these folks may be overly passive and people-pleasing, fearful of becoming a burden or taking up too much space.”7
Although quiet borderline personality disorder is not a recognized mental health diagnosis, it can be a helpful way for professionals or people with the condition to quickly explain and understand their cluster of symptoms.
Imi Lo
, Psychotherapist and Consultant, Eggshell Therapy and Coaching, explains, “People with quiet BPD have an ‘internalized disorder’ rather than the typical ‘externalizing’ tendency of BPD. They may feel intensely lonely, socially isolate themselves, be plagued with self-blame and shame, and dissociate from their feelings. Rather than lashing out, they usually turn anger inward. They may also be socially anxious, assume everything is their fault and feel like they are a burden to others. Just like people with ‘classic’ BPD, they also suffer from fear of abandonment, black-or-white thinking, mood swings and urges to self-harm.”8
Characteristics of Quiet BPD
How a person expresses their borderline features will be a unique and individualistic experience. Quiet BPD is typically characterized by subtle differences in the expression of BPD symptoms, reflecting the inward expression of emotions onto one’s self.
While quiet BPD can be more difficult to identify, characteristics include:4
- Becoming suddenly quiet and withdrawn
- Failing to return phone calls and texts or to follow through on plans
- Saying that “everything is fine” even when stress is high
- Feeling that any strong emotional expression is wrong and should cause shame and guilt
- Extreme people-pleasing
- Saying that nothing matters, their feelings don’t matter, and life is meaningless
- Engaging in a string of intense and unhealthy relationships that start positively before going poorly
- Constantly feeling that they are not good enough for another person, even when the person is not very desirable
Meier states, “They may be more prone to dissociation or derealization, basically shutting down when emotions become too intense – which makes sense if you believe that you could be harmed or rejected for expressing emotions or needs. They may experience intense fear of abandonment in relationships, but rather than pleading, lashing out, or making threats, their responses will be more internal: they may isolate, try to convince themselves not to care about the relationship, or bend over backwards to appease the other at the expense of their own needs.”
What Are the Symptoms of Quiet BPD?
The symptoms of quiet borderline personality disorder overlap greatly with other signs and symptoms of BPD. The major difference between the two is how the symptoms are expressed. In typical BPD, the person may show their condition in outwardly powerful ways, while the person with quiet borderline personality disorder may turn their responses inward.
Kaz J. Nelson, MD, Associate Professor, Department of Psychiatry & Behavioral Sciences at the University of Minnesota Medical School notes, “A person with a ‘quieter’ form of BPD may be experiencing symptoms that seriously interfere with functioning, but might not be as visible to others.”9
Quiet BPD symptoms may include:1,4
- Ending relationships quickly: People with BPD tend to fear abandonment, but those with quiet borderline personality disorder may choose to preemptively terminate the relationship before there is an opportunity to be hurt.
- Fragile self-esteem: Because people with quiet BPD turn their feelings inward, their self-worth could quickly tumble based on the actions of others.
- Feeling numb, cold, empty, or hollow: Intense feelings may seem unmanageable, so the person may try to reduce or restrict their feelings. This pattern could result in numbness or reduced emotional responses.
- Limited interpersonal trust: With the pain of disappointment being so great, people with quiet BPD could have little interest or faith in new relationships.
Nelson adds, “On the surface, these symptoms may look like major depressive disorder, or generalized anxiety disorder, when the reality is that these symptoms are much more complex to understand and treat. This may lead to undertreatment or ongoing invalidation from others, including care providers, which can worsen feelings of isolation.”
Causes & Risk Factors of Quiet BPD
For any type of borderline personality disorder, it seems that a combination of factors could cause the condition. Is BPD genetic? Yes, there is a genetic element as the people with a family history of BPD are more likely to acquire it themselves. Additionally, biological brain differences could cause BPD, so differences in the way the brain is structured and functions may trigger the condition.4
In certain situations, a life experience could present as a risk factor that increases the odds of BPD developing.
Some additional risk factors of quiet BPD include:4
- Childhood trauma like abuse, neglect, abandonment, or other difficult events
- Unstable or inconsistent parental relationships
- Volatility and frequent conflicts
- Feeling invalidated in childhood relationships
With the combination of causes and risk factors, a person with a close family member with BPD who has also experienced childhood trauma and frequent conflicts would have an increased chance of developing the disorder. Risk factors will increase the chances of BPD emerging, but even a person with all the risk factors is not guaranteed to have the condition.
Complications Related to Quiet BPD
Personality disorders are so detrimental and complicated because they do not only affect one part of life. Rather, they negatively influence every facet of a person’s health and well-being.
The most common complications related to quiet BPD are:1,4
- Unhappy or inconsistent relationships
- Issues forming loving, trusting relationships with others
- Increased use of alcohol and other drugs to cope with powerful feelings turned inward
- Higher risk of co-occurring mental health conditions like depression, anxiety, and eating disorders
- Struggling to cope with minor setbacks and barriers
- Suicidal ideation and attempts
Lo adds, “The biggest challenge someone with quiet BPD faces is intense loneliness. They may feel trapped in their predicament. They may feel that something is wrong and long deeply for connection, but feel tied up in their fear of losing control. They may be high-functioning on the surface but feel lost and depressed on the inside.”
Meier also mentions, “In my experience, folks with a more internalized BPD symptom presentation will often appear calm, pleasant, and agreeable. This can mask the emotional storm raging inside and result in invalidation from the environment. They may feel bound to maintaining this veneer of composure or risk rejection and abandonment.
At the same time, they may feel terribly misunderstood and fraudulent, like no one knows the “real” them – so even positive interactions and relationships can feel suspect and unreliable.”
8 Ways to Cope With Quiet BPD
Personality disorders are pervasive conditions, but when people put effort and energy into treating their symptoms, situations can improve.
Here are eight ways to cope with quiet BPD:
1. Be Honest About Your Symptoms & Experience
Dealing with quiet BPD starts with you being insightful and clear about your life, relationships, and feelings. Knowing that the issues stem from quiet BPD will help the next steps fall into place.
2. Find Support From Someone You Trust
Although sharing personal struggles may feel uncomfortable if you have quiet BPD, it can be beneficial particularly when self-harming is your way to cope. Consider reaching out to caring and reliable loved ones who are willing to provide moral support when you’re feeling internally overwhelmed. Discuss how to contact them so you can connect when you’re going through a rough patch. This emotional buffer can be instrumental in stabilizing you mentally and keeping you safe through a crisis.
3. Focus on Physical Health
Physical health and mental wellness are intricately related. Poor health can lead to psychological issues, and vice versa. Thus, having good physical health is vital, particularly for people who internalize their stress and frustrations like in cases of quiet BPD. For this reason, it’s important to focus on appropriate forms of self-care like eating nutritiously, engaging in regular physical movement, getting plenty of sleep, keeping up with doctor’s appointments, and managing stress properly. Nurturing your physical wellness can keep you balanced and preserve your overall well-being.
4. Take a Relationship Break
Many people with BPD move quickly between relationships as they hope the next repairs the damage of the last, but this pattern only perpetuates the problems. If relationships have been chaotic, take a break to make yourself the priority.
5. Practice Mindfulness
Mindfulness is a practice often employed in different forms of therapies because of its efficacy in calming the mind, regulating emotions, and enhancing overall wellness.
Incorporating mindfulness practices can be particularly beneficial in reducing symptoms for those living with BPD. Engaging in mindfulness activities allows the BPD sufferer to be fully present in joyful moments, as well as bringing mental clarity, emotional stability, and adaptive responses during stressful situations.
6. Check Your Coping Skills
Intense and uncomfortable conditions like Q BPD can make people seek out unhealthy methods of self-medication. Using drugs, drinking alcohol, overspending money, and casual sex will only provide temporary comfort for a long-term problem.
7. Practice Your Communication
Quiet BPD encourages you to keep feelings inside, so starting to slowly but consistently share your thoughts and feelings can result in wonderful results. Journaling is a safe and subtle way to start the process.
8. Talk To Professionals
Any personality disorder is too much for anyone to manage alone. Call in the professionals to get a therapist and psychiatrist with experience on your team to lead the way.
The ways to cope with quiet BPD are endless, so follow the individualized recommendations and suggestions of your professional treatment team for the best results possible.
How Is Quiet BPD Diagnosed?
Since the quiet BPD diagnosis doesn’t currently exist in professional literature, mental health professionals will focus on the standard borderline symptoms to assess the presence of the condition. There’s no formal test or quiz to measure or identify BPD, so clinicians and other professionals will conduct an interview that focuses on the person’s experience and point of view. If family members are present, their opinions will be considered.
Meier mentions that BPD with “quieter” presentation can be easily confused for something else: “Mental health providers are more familiar with a version of BPD characterized by intense displays of emotional lability, angry lashing out, and behavioral dyscontrol that is harder to miss.
Since “quiet BPD” is not an official, diagnosable disorder and there has been little to no research on it to date, many clinicians are less attuned to the more internalized symptom presentation. Though speculative, it’s likely that these individuals wind up misdiagnosed with depression and anxiety, which may also be present, but is not the full picture.”
Lo also notes, “It is difficult to identify and diagnose quiet BPD because people with quiet BPD go at length to hide their pain. They tend to have an ‘over-control’ tendency, rather than an ‘under-control’ tendency, which means they tend to suppress their emotions and needs, diminish their distress, and appear ‘stoic’ about things. They usually come across as quiet and reserved, rarely get excited and are typically polite, in control, and calm. Even when they are highly anxious, they tend not to let others see it on the outside.”
Treatment Options For Quiet BPD
The borderline personality disorder treatments are improving all the time as experts constantly study, research, and implement new strategies. Though several psychotherapy choices exist, DBT for borderline personality disorder is the leader in talk therapy. Medications may not address BPD symptoms directly, but they can help to better manage some of the mood changes connected to the diagnosis.5,6
Forms of treatment for BPD include:
- Dialectical behavioral therapy (DBT)
- Cognitive behavioral therapy (CBT)
- Schema therapy
- Mentalization based therapy (MBT)
Many people with BPD are well-managed with only individual therapy, while others will greatly benefit from a combination of individual therapy, group therapy, and medication management. Be sure to ask about available support provided in between sessions to understand the therapists’ approach and plan.6
How to Find a Therapist
There are many ways to find the right therapist for borderline personality disorder, not of which should not be overly challenging as many clinicians have experience treating the condition. That said, people suffering from BPD should inquire about the specific services and interventions used. Start your search now in an online therapist directory.
Final Thoughts on Quiet BPD
Having quiet BPD can make you feel an internal turmoil that may seem too hard to overcome. But you can still manage this type of BPD by implementing self-help tools, sharing your emotions with people you trust, and seeking professional help. Remember, you do not need to struggle quietly and alone.
Quiet BPD Infographics
