While many people have heard of borderline personality disorder (BPD), a lesser-known and more difficult to treat condition is quiet borderline personality disorder (quiet BPD). Though it’s not formally recognized as an actual subtype of BPD, it’s used to describe those who meet the criteria for a BPD diagnosis, but who don’t truly fit the textbook profile.
Quiet borderline personality disorder can be much more difficult than BPD to both diagnose and treat, but as with many mental health conditions, the earlier it’s diagnosed, and intervention is started, the more successful treatment can be.
Learn more about quiet BPD here. We’ll look in-depth at what it is and how it differs from classic BPD. We’ll also explore typical BPD symptoms, causes, treatments, and more, all here.
What is “Quiet” Border Personality Disorder?
Quiet borderline personality disorder is very similar to typical BPD. The main difference is that with quiet BPD, you internalize emotional struggles and episodes. While those with BPD have intense impulsivity, anger outbursts, and episodes of anxiety and depression that are obvious to those around them, turning anger inward is more typical with quiet BPD.
Because struggles and anger outbursts are so often internal, quiet BPD is much more difficult to diagnose. In fact, it often goes undiagnosed or is misdiagnosed for years. Sometimes quiet BPD is also referred to as high-functioning BPD, but this name is largely inaccurate. From an outward perspective, someone with quiet BPD may seem fine and completely able to cope with daily life, but in fact, they’re generally trying to survive an individual, private experience that’s often excruciating and very difficult to manage. Yet another name for quiet BPD is “discouraged” BPD.
Those who have quiet BPD might feel very intense emotions such as:
- Anger issues
- Fear of abandonment
- Being emotionally attached or obsessive
- Mood swings
- Intense self-doubt
Quiet BPD vs. Normal BPD
The National Institute of Mental Health (NIH) describes borderline personality disorder as marked by erratic mood swings, poor self-image, impulsive behavior, extreme “black-and-white” thinking, self-harm, and an inability to maintain stable interpersonal relationships. Episodes of heightened anger, depression, or anxiety are other hallmarks of the disorder. Symptoms of quiet BPD can last for a few hours to a few days.
Quiet BPD isn’t readily distinguished from classic BPD—at least not in an official sense. It doesn’t have a special designation in the Diagnostic and Statistical Manual of Mental Disorders [DSM]. However, therapists and their patients often see a clear distinction between the “quieter” cases and BPD’s more traditional manifestations.
“Quiet BPD is different from classic BPD because Quiet BPD does not display the same outward erratic behavior as classic BPD and its sufferers often are high-functioning and isolate themselves when they experience symptoms. This makes Quiet BPD difficult to diagnose because many of the symptoms look like other disorders such as anxiety disorder and mood disorders. Additionally, many individuals with quiet BPD have experienced trauma in their past, like classic BPD.”
While “classic” BPD is characterized by episodes of obvious, violent outbursts, people with quiet BPD often direct violence inward instead.
“[T]hose with ‘quiet’ borderline personality disorder act in,” says Dr. Gerard Lawson, President of the American Counseling Association. “There is less hostility and fewer aggressive outbursts, but there may still be isolation and self-injurious behaviors or suicide attempts.”
People with quiet BPD still experience the intense emotional roller-coaster that distinguishes the disorder, but they work hard to shut these emotions down or push them aside. Very often, their sense of self is marked by shame or self-hatred.
Signs & Symptoms of Quiet Borderline Personality Disorder
Quiet BPD has some distinct and common signs and symptoms. While classic BPD presents as outward rage, anger, and other destructive behaviors, quiet BPD can be very different.
What does quiet BPD look like?
Symptoms of quiet BPD:
- Becoming obsessed with somebody and wanting to spend unhealthy amounts of time with them
- Developing unhealthy boundaries
- Hiding self-harm
- Engaging in self-isolation or avoidance
- Giving others the silent treatment
- Directing anger, aggression, or hostility inwardly — having a harsh internal critic
- Feeling hopeless all the time
- Having an intense fear of rejection
- Having a disturbed self-image
- Developing a pattern of first idealizing, then devaluing, others
- Having mood swings that are invisible to others, but that can last for hours to days on end
- Taking things very personally
- Feeling like others are mad at you
- Having distorted and racing thoughts
- Self-sabotaging in a way that holds you back from reaching your goals
- Intense fear of being alone, but simultaneously pushing others away
- Finding it difficult to talk about your feelings
- Being triggered, which leads to internalized emotions that you can’t control
- Feeling empty or numb
- People pleasing, even if it’s detrimental to you
- Derealization — feeling like you’re living in a dream
- Believing that your feelings are wrong, and trying to suppress them
Other symptoms include depersonalization and derealization, as well as hiding one’s true feelings. Individuals with quiet BPD are usually high functioning. This can also make it difficult to diagnose the disorder, the person can simply be viewed as a perfectionist or a people pleaser.”
Causes of Quiet Borderline Personality Disorder
While there’s no known, clear cause for classic or quiet BPD, experts believe a combination of genetics, brain structure and function, and environmental and social issues may come into play. Many therapists point to the fact that for some people there is a history of childhood trauma or abuse as a root cause of the disorder.
Some potential causes of quiet BPD may be the result of:
- Family history of various personality disorders
- History of other mental health conditions (anxiety disorders, bipolar disorder, eating disorders, substance abuse, depression, etc.)
- History of neglect, abuse, trauma, or abandonment in childhood
Common Complications of Having Quiet BPD
Possibly the biggest side effect of quiet BPD is the fact that many people stay silent with their struggles, in part due to an incredible fear of putting a significant burden on their loved ones and friends around them. However, when BPD isn’t effectively treated, symptoms can, and often do, worsen drastically over time.
“Some of the complications of quiet BPD is it’s difficult to diagnose because the symptoms are turned inward when most clinicians are used to seeing explosive behavior. Other complications include difficulty maintaining relationships and making meaningful connections with people. Risky and unhealthy behaviors, difficulty setting healthy boundaries (relationships, financial and job related), self-image issues, suiciality and and a high risk of combination diagnosis like anxiety, depression or eating disorders” – Talkspace therapist Reshawna Chapple, Ph.D., LCSW.
Increased risk of other mental health conditions
Quiet BPD can increase the risk for other mental health conditions, including:
- Bipolar disorder
- Generalized anxiety disorder (GAD)
- Eating disorders
- Substance abuse
- Social anxiety
Difficulty with school or work schedules
People with quiet BPD may find it hard to sustain a productive role at school or work. When not treated, quiet BPD can result in impulsively acting out, gambling, substance abuse, uncontrolled spending, and other destructive behaviors that can interfere with daily functioning at school or work.
Difficulty establishing/maintaining interpersonal relationships
When you have quiet BPD, it can be difficult to emotionally connect to others. You may find that a fear of being hurt causes you to push people in your life away when they try to get close. There’s also commonly the fear of being alone at the same time, which can make things even more unbearable.
Thoughts of self-harm or suicide
Because quiet BPD symptoms are turned inward, they can result in thoughts of self-harm or suicide. If someone you know is having suicidal thoughts, it’s essential to take these feelings or talk seriously. You can help in several ways.
- Call 911
- Stay with them
- Make sure they don’t have access to guns, medications, knives, or anything else they may harm themselves with
How to Get a Diagnosis for Quiet BPD
Because people with quiet BPD don’t exhibit the classic, explosive symptoms of BPD, it can take much longer to get a proper diagnosis. This is particularly troubling when symptoms involve self-harm.
Even though there are actually quiet BPD symptoms listed in the DSM, they’re often overlooked. Ultimately, this makes it that much more difficult for people to get a proper diagnosis.
For those who haven’t been properly diagnosed with quiet borderline personality disorder, it’s common to end up feeling invisible and misunderstood. This makes the disorder harder to live with and can lead to more episodes of self-harm and lower self-esteem.
Licensed mental health professional
Only a licensed mental health professional is qualified to make a quiet BPD diagnose, which is based on an interview. You may also fill out a survey or questionnaire to help give additional insight. There aren’t any medical tests for quiet BPD, however a medical exam can be beneficial in ruling out other conditions that might be resulting in symptoms.
Of course, you should always make it known if you have a family or personal history of either BPD or any other co-occurring conditions that are common like anxiety, bipolar disorder, depression, or any eating disorders.
Quiet borderline personality disorder can be diagnosed by meeting 5 of the 9 criteria listed in the Diagnostic and Statistical Manual of Mental Disorders [DSM].
- Frantically trying to prevent abandonment, whether it’s actual or perceived.
- Having a history of relationships that are unstable and involve idealizing, then devaluing, someone.
- Having an unstable self-identity.
- Engaging in risky or impulsive behavior.
- Self-harm or suicidal ideation.
- Frequent and rapid mood swings.
- Chronic sense of emptiness.
- Having uncontrollable or intense anger.
- Disconnecting from yourself (disassociation).
Treating Quiet Borderline Personality Disorder
Getting a proper diagnosis for quiet BPD is just the beginning. The good news is that treatment options for quiet BPD have increased over the years as the disorder becomes better understood. Once a diagnosis is made, there are several evidence-based treatments available.
Dr. Lawson of the American Counseling Association notes that “Not so long ago (15-20 years) some very skilled clinicians believed there was no help for individuals who have a disorder like BPD,” says Dr. Lawson. “Now, there are actually very good treatment options, and they are improving.”
- Dialectical Behavioral Therapy (DBT) — Specifically developed to treat BPD. It’s an intensive treatment that does more than just treat the symptoms of quiet BPD. It teaches you a new way to interact with the world around you. A comprehensive nature is what makes DBT so successful in treating quiet BPD.
- Cognitive Behavioral Therapy (CBT) — Another form of talk therapy that helps you identify and then change distractive or unhelpful behaviors and thoughts. It can be successful in helping you identify distortions that create black-and-white thinking. Over time, the practice of looking at what you’re thinking about can be helpful. Being mindful about how your thoughts affect you can help control many of quiet BPD’s symptoms.
- Mentalization-Based Therapy (MBT) — Helps you address both yours and others’ emotions, thoughts, and needs. This psychodynamic therapy allows you to better-understand how your internal actions have an impact on your life. MBT can help you see there’s a distinct difference between your perception of situations versus actual reality.
While there isn’t a medication specifically recommended or approved for treating quiet BPD, medication might help you cope with related issues or conditions (like depression or anxiety).
Whatever method you use to treat quiet BPD, it’s important to find a therapist that you feel comfortable with. Quiet BPD is something you may struggle with on and off for the rest of your life. Treatment can lessen the symptoms significantly and decrease the number of episodes you experience overall.
Tips For Coping With Quiet BPD
There are several coping strategies that can be beneficial for quiet BPD. Consider any, or all, of the following techniques:
- Reaching out to a professional
- Confiding in someone you really trust
- Being mindful of emotions
- Eating a healthy diet
- Using positive coping statements or mantras
- Increasing your tolerance for uncertainty
- Identifying additional self-soothing practices
How to Help Someone With Quiet BPD
If you have someone in your life who’s living with quiet BPD, you can help support them in the following ways:
- Ask questions and really listen to their answers
- Be sympathetic
- Try to validate their feelings
- Encourage them to use self-soothing strategies
- Discuss family therapy or group therapy appointments
- Set healthy boundaries in relationships
- Celebrate their wins
- Encourage mindfulness techniques
- Take care of yourself and manage your own stress so you can be there for them
“In order to help someone with quiet BPD you must be patient and reassuring, let them know that it is okay to be vulnerable and ask for help. They often feel like a burden or unworthy of love which causes isolation. Help them develop healthy coping strategies and suggest they seek professional help from a therapist.”
If you or someone you know is dealing with quiet BPD, getting connected with a licensed therapist can be a great first start.