Quiet borderline personality disorder (BPD) is not a recognized subtype for diagnosis. Instead, it’s a term for people who meet the criteria for borderline personality disorder but don’t fit the typical profile.
The National Institute of Mental Health (NIMH) says, “Borderline personality disorder is a mental illness that is marked by a pattern of constantly changing moods, self-image, and behavior.” These symptoms often lead to acting on impulse and having problems with other people. People with borderline personality disorder may have intense bouts of anger, depression, and anxiety that can last from a few hours to a few days.
Unlike most people with BPD, who have angry outbursts and act self-destructively, people with quiet BPD have emotional episodes that they keep to themselves (they turn their anger inward).
Because of this, quiet BPD is often missed or given the wrong diagnosis. This illness is also called “high-functioning BPD” at times.
What is Quiet BPD?
Borderline personality disorder, or BPD, is a mental health condition that is often marked by mood swings and trouble controlling emotions. People with this condition can have big changes in their moods that can last for a long time. The National Alliance on Mental Illness says that BPD affects about 1.4% of U.S. adults and that about 75% of those who have it are women.
There is some disagreement about whether BPD is more common in women or men, especially when it comes to the idea that some behaviors may show up differently because of “traditional” gender roles. For example, men are often thought to be more aggressive than women, so their behavior may get a pass in some places.
Ernesto Lira de la Rosa, Ph.D., is a psychologist in New York City and the media advisor for the Hope for Depression Research Foundation. He says that “quiet BPD” is not a real diagnosis. Instead, the term refers to one of four subtypes of BPD that were first identified by psychologist Theodore Millon. However, he says there isn’t a complete agreement on these subtypes.
This subtype of BPD, which is also called the “discouraged” subtype, has the same “sense of instability in interpersonal relationships, self-image, affect, and impulsivity.” However, Dr. Lira de la Rosa says that people with this subtype may internalize their behavior instead of acting out.
Quiet BPD is also characterized by a strong bond with one or two important people and a constant feeling of being in danger.
Symptoms of BPD
In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a borderline personality disorder is defined by nine criteria:
- Avoiding being left alone, whether it’s real or not
- Relationships that are close and unstable
- A problem with identity leads to an unstable sense of self or self-image.
- At least two self-harming impulses, such as spending money, having sex, using drugs, driving too much, or binge eating disorder.
- Repeated acts or threats of suicide or self-harm
- Mood swings or moods that change quickly
- Feeling empty all the time
- Anger that is out of place, very strong, or hard to control
- Stress-related paranoid thoughts or severe, temporary dissociative symptoms
Even though these are common symptoms of BPD, quiet BPD looks different. If you have quiet BPD, you might try to hide these symptoms from other people, which can make you feel very angry, guilty, or ashamed of yourself. You might try to hide your moods or hide things you do on the spot. You could also pull away from people or isolate yourself.
When you try to hide the signs of quiet BPD, it can hurt your relationships with other people. Extreme emotions and moods and behaviors that change often can also make it hard to keep relationships going. You might worry that people will reject you or become very sensitive to what you think are their criticisms. You might be afraid that everyone will leave you, which can make you feel bad about yourself.
In relationships with other people, you can sometimes push people away or pull them closer. Most of the time, BPD is diagnosed in adults, but sometimes it can be found in people younger than 18. In these situations, you can’t be diagnosed until you’ve had symptoms for at least a year.
What are the Causes of Quiet BPD?
The same things that lead to BPD in general also lead to “quiet BPD.” Like some other mental health problems, there seems to be a higher risk of BPD in families (inherited). Studies Trusted Sources have found that BPD may be linked to genes, but they need more proof to fully understand the link.
BPD is probably caused by more than just genes. Several studies have found that emotional and physical abuse, as well as not being cared for as a child, can make a person more likely to get cancer. Exposure to unstable relationships or a history of them may also play a role.
There may be physical changes in the brain and changes in the neurotransmitter serotonin in people with BPD. But it’s not clear if changes in the brain cause BPD or if they happen after the fact.
Complications Related to Quiet BPD
Personality disorders are so bad and hard to deal with because they affect more than one part of a person’s life. Instead, they hurt the health and well-being of a person in every way.
Some of the most common problems with quiet BPD include:
- Relationships that are unhappy or discordant
- Problems developing loving, trustworthy relationships with people
- Increased usage of alcohol and other drugs to cope with intense emotions that turned inward
- Co-occurring mental health problems such as depression and anxiety are more likely.
- Struggling to overcome minor setbacks and obstacles
- Suicidal ideas and attempts
Lo says, “The hardest thing for someone with Quiet BPD is being very alone.” They might feel stuck in their situation. They may feel like something is wrong and want to connect deeply, but their fear of losing control keeps them from doing so. They may seem to be doing well on the outside, but on the inside, they may feel lost and sad.
Meier also says, “From what I’ve seen, people with BPD symptoms that are more internalized tend to seem calm, nice, and agreeable. This can hide the emotional storm going on inside and make others think less of you. They may feel like they have to keep up this front of calmness or risk being rejected and left alone. At the same time, they may feel very misunderstood and fake, like no one knows the “real” them, so even positive interactions and relationships can feel sketchy and unreliable.
How is Quiet BPD Diagnosed?
Five out of the nine criteria in the Diagnostic and Statistical Manual of Mental Disorders must be met for someone to be given a diagnosis of borderline personality disorder (DSM-5). Among the criteria are:
- Trying hard to avoid being left alone, whether it’s real or imagined.
- A pattern of unstable and intense relationships in which people go back and forth between idealizing and devaluing each other.
- Disruption of identity (markedly and persistently unstable self-image or sense of self)
- Impulsiveness in at least two ways could hurt themselves.
- Repeated suicidal thoughts, actions, threats, or actions that hurt oneself
- Affective instability is caused by moods that change quickly and often
- Feelings of emptiness all the time.
- Anger that is out of place, very strong, or hard to control
- Stress-related paranoid thoughts that go away quickly or severe dissociative symptoms.
Quiet Borderline Personality Disorder Treatment
Since there is no way to diagnose quiet BPD, there are no standard ways to treat it. Also, the Food and Drug Administration (FDA) hasn’t approved any drugs to treat BPD yet.
So, most people who have BPD get better through different psychotherapies:
Cognitive Behavioral Therapy (CBT) – A type of talk therapy that looks for patterns in your thoughts and actions and helps you come up with ways to deal with them.
Dialectical Behavior Therapy (DBT) – This therapy was made for people with BPD and teaches them how to use mindfulness to deal with their emotions and stress.
Schema Therapy – A mix of different kinds of therapy with an emphasis on relationships (i.e. may be used for quiet BPD and romantic relationships).
Medication – There is no one drug that works for BPD, but some medications may help with some of the symptoms. For example, some medicines can help keep your mood stable. Talk to a doctor about your symptoms if you think that medicine might help.
Even though there is no FDA-approved medicine for BPD, if you have another mental illness, you may be given a prescription. Also, vitamins and supplements for BPD may help you feel better.
What Therapy May Work Better for Quiet BPD?
If you have quiet BPD, you might find that some of the things in traditional Dialectical Behavioral Therapy (DBT) don’t apply to you or even bother you. DBT is made for people with BPD, so it focuses on making people more tolerant of distress and reducing conflicts. However, these are not what you need.
If you have quiet BPD or tendencies to be too controlled. You may benefit from Radically-Open DBT instead of traditional DBT.
You might also find it helpful to work with an attachment-based therapist on your relationships. By going through an emotionally corrective experience, you can see for yourself how safe it is to express yourself without being shamed, punished, or made to feel stupid. You get to try out expressing your anger with confidence and being spontaneous and fun. Then, you can take what you’ve learned about emotional openness and vulnerability and use it in other parts of your life. You can start to relax, be kind to yourself, and connect deeply with other people.
You have kept your pain hidden for a long time. But you can heal and even thrive if you are willing to take the first step. Let people who understand your unique personality get to know you.
What Can Trigger a Quiet BPD Episode?
Dr. Lira de la Rosa says that it can be hard to find the exact causes and warning signs of a BPD episode because the condition is complicated and not everyone is affected by the same things. But there are some things that can make symptoms worse, such as:
Relationship Issues: Relationships with other people can have a big effect on people with BPD. BPD episodes can happen when the person feels rejected, criticized, or left alone.
Loss or Rejection: Some people with BPD may also have an episode when they lose something or feel rejected, like when a relationship ends or they lose their job.
Intrusive Thoughts: BPD may worsen when upsetting thoughts or images come to mind out of the blue, especially if they bring up painful memories. To figure out what sets off your BPD, it might help to think about past episodes and the things that happened before them. These events can help you figure out what starts an episode. People who live with a family member or friend who has BPD may find it helpful to work with a mental health professional to learn more about what makes their family member or friend act out.
Quiet BPD Vs Normal BPD
The National Institute of Mental Health (NIH) says that people with borderline personality disorder have mood swings, low self-esteem, impulsive behavior, extreme “black-and-white” thinking, self-harm, and can’t keep stable relationships with other people. The disorder is also characterized by times of extreme anger, sadness, or worry. Quiet BPD symptoms can last anywhere from a few hours to a few days.
Quiet BPD is hard to tell apart from classic BPD, at least from an official point of view. The Diagnostic and Statistical Manual of Mental Disorders (DSM) doesn’t call it anything special. But therapists and their patients often see a clear difference between the “quieter” cases of BPD and its more common signs.
“Quiet BPD is different from classic BPD because people with Quiet BPD don’t show the same erratic behavior to the outside world as people with classic BPD, and people with Quiet BPD are often high-functioning and isolate themselves when they have symptoms. This makes it hard to tell if someone has Quiet BPD because a lot of the symptoms look like those of other disorders, like anxiety disorders and mood disorders. Also, like people with classic BPD, many people with quiet BPD have been through trauma in the past. People with “classic” BPD have clear, violent episodes, but people with “quiet” BPD often turn their violence inward instead.
People with quiet BPD still go through the intense emotional ups and downs that are a sign of the disorder, but they try hard to shut down or ignore these feelings. A lot of the time, they feel ashamed or hate themselves.
Risk Factors of Quiet BPD
Researchers aren’t sure what causes borderline personality disorder, but studies suggest that genetic, environmental, and social factors may make it more likely to happen. Some of these things could be:
People may be more likely to get borderline personality disorder if a close family member, like a parent or sibling, already has it.
Brain Structure and Function
Researchers have found that people with borderline personality disorder may have changes in the way their brains are built and how they work, especially in the parts of the brain that control impulses and emotions. But the studies don’t show if these changes made people more likely to get sick or if these changes were caused by the disorder.
Environmental, Cultural, and Social Factors
Many people with borderline personality disorder say they went through traumatic things in their lives, like being abused, being left alone, or having a hard childhood. Others may have been in relationships or conflicts that were unstable or hurtful.
Even though these things may make a person more likely to get borderline personality disorder, it doesn’t mean that they will definitely get it. People who don’t have these risk factors may still get the disorder at some point in their lives.
How to Help Someone With Quiet BPD
If you know someone who has quiet BPD, you can help them in the following ways:
- Ask them questions and pay close attention to what they say
- Try to understand.
- Try to make them feel better.
- Encourage them to use ways to calm themselves
- Talk about making appointments for family or group therapy
- Make sure your relationships have healthy limits.
- Honor their wins.
- Encourage mindfulness techniques
- Take care of yourself and deal with your own stress so you can be there for them.
Even though it’s impossible to tell if someone has quiet BPD, there’s no doubt that it exists. People with this condition can have a lot of trouble. When they keep their feelings to themselves, which often go unnoticed.
If you think that someone you care about is having trouble, you should learn how to help someone with BPD. Even though this can be very hard, people with BPD, especially those with quiet BPD, need help. And your help could be the only thing someone needs to get better.
Frequently Asked Questions (FAQs) about Quiet BPD
Who can diagnose borderline personality disorder?
Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center. He is an Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. He says that BPD is usually diagnosed by a mental health professional like a psychologist, psychiatrist, or social worker.
What Causes Quiet Borderline Personality Disorder?
Just like many other personality disorders, quiet borderline personality disorder can be caused by abuse, trauma, genes, and the environment. You may want to figure out what caused your disorder, but if you don’t get treatment, it may be impossible.
Are Women More Likely to Have BPD?
Studies from the past showed that women were more likely to have BPD than men. Research shows that BPD is more common in men than was thought before. Women are more likely to get help, though.
Which Psychotherapy is Best for Quiet BPD?
DBT is the first treatment for BPD, but it usually only helps with the symptoms of typical BPD. Radically open DBT may be a better fit because quiet BPD involves too much control and is not under control. Talk to the person who takes care of your mental health about which method would work best for you.
How is borderline personality disorder (BPD) diagnosed?
Borderline personality disorder can’t be found out for sure with a single test (BPD). Simon A. Rego, PsyD, chief psychologist at Montefiore Medical Center. He is an Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City. He says that it is diagnosed through a clinical interview with a licensed mental health professional.
What does having a quiet BPD feel like?
If you have quiet BPD, you might not like yourself very much and feel angry, sad, or anxious a lot. You may also have hurt yourself or thought about killing yourself in the past. You might also feel guilty or ashamed if you have quiet BPD.
Is Quiet BPD worse than BPD?
A quiet borderline personality disorder is much harder to diagnose and treat than BPD. However, as with many mental health problems. The earlier it is diagnosed and the treatment begins. The more likely it is that it will be cured.
Can a quiet person have BPD?
Having a quiet borderline personality deficit disorder can make life very hard and tire. It can make it hard for someone to enjoy their everyday life. They have to work hard to deal with their strong thoughts and feelings.
How common is quiet BPD?
People with quiet BPD may seem fine on the outside. But they are often struggling on the inside with strong feelings of loneliness, shame, or self-criticism. About 1.6% of the population is thought to have BPD at any given time. But some estimates say that the number is closer to 6%.
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