Quiet BPD: Symptoms, Causes, Diagnosis & Treatment - Healthline

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HealthlineSubscribeAll About Quiet BPD (Borderline Personality Disorder)

Medically reviewed by Yalda Safai, MD, MPH — Written by Kristeen Cherney — Updated on July 13, 2022

Definition
Symptoms
Causes
Complications
Diagnosis
Risk factors
Treatment
How to help
Takeaway

Borderline personality disorder (BPD) is a mental health condition that causes intense emotions and impulsive behavior. When these symptoms are directed inwards, not outwards, some people call this “quiet BPD.”

Borderline personality disorder (BPD) is a mental health condition that’s known for fluctuations in mood and behaviors. People with BPD may also struggle with relationships as well as their own self-image.

It’s been suggested that there are “subtypes” of BPD, but this theory is unproven. One such subtype is known as “quiet” BPD, which means that you direct your struggles more inward so others don’t notice.

However, quiet BPD is not a recognized diagnosis. A person can only be diagnosed with BPD, not quiet BPD.

BPD can be difficult to diagnose and treat, but the earlier you seek help, the better the outcome. Here’s what you need to know.

What is quiet BPD?

Experts don’t agree on what quiet BPD is or whether it is different from BPD in general. You can’t be diagnosed with “quiet BPD” specifically. You can only be diagnosed with BPD.

To be diagnosed with BPD, a person must have:

an ongoing pattern of unstable interpersonal relationships
unstable self-image and emotions
impulsive behavior that typically appears by early adulthood, and happens across a range of contexts

Clinicians also look at more specific symptoms and behavior patterns before making a diagnosis. You must have multiple signs and symptoms of BPD in order to be diagnosed with the condition.

In general, the experience of living with BPD can be different from person to person. This means that people diagnosed with BPD may not have many symptoms in common with each other.

So what do people mean when they refer to quiet BPD? The term can be traced back to psychologist Theodore Millon, who proposed four subtypes of BPD:

discouraged (quiet) borderline
self-destructive borderline
impulsive borderline
petulant borderline

In the past, some clinicians used the term “quiet” to describe people with BPD who direct many of their mood swings and behaviors inward, rather than directing them toward others.

In other words, quiet BPD was thought to be about “acting in,” rather than “acting out.” This label has also been used to describe people with BPD who avoid communicating their emotions and getting close to other people.

People with BPD tend to experience intense emotions. In theory, “quiet BPD” describes when these significant feelings are directed toward yourself without letting others see them.

Some of the emotions associated with BPD include:

anger or rage
anxiety
irritability
emptiness
cycles of idealizing certain people and relationships, then rejecting them
fear of abandonment or rejection
mood swings
feeling disconnected or paranoid

Quiet BPD has sometimes been called “high-functioning” BPD. This reflects the idea that some people with BPD may not “show” their symptoms and are still able to cope in everyday situations, such as work and school.

However, these are only theories. Because there’s no real way to diagnose BPD subtypes, there is limited research on quiet BPD.

A better understanding of BPD subtypes could eventually lead to improved treatments, according to studies from 2017 and 2018.

But overall, there’s not enough evidence to say whether subtypes like quiet BPD really exist.

What are the symptoms of quiet BPD?

Different symptoms don’t actually represent specific types of BPD. But, historically, the theory of “quiet BPD” referred to symptoms such as:

intense mood swings that you manage to hide from others
suppressing feelings of anger or denying that you feel angry
withdrawing when you’re upset
avoiding talking to others who have upset you and cutting them off instead
blaming yourself whenever there’s a conflict
persistent feelings of guilt and shame
having a “thin skin” and taking things personally
feeling like you’re a burden to others
people-pleasing, even at a cost to yourself
social anxiety and self-isolation
fear of being alone, yet pushing people away at the same time

Even though people have used the term “quiet BPD” for these symptoms, it is not a separate diagnosis from BPD in general.

BPD can look quite different from person to person. BPD symptoms can include:

intense mood swings that can last for as little as a few hours, or up to a few days
thinking in extremes, such as seeing things only as completely good or completely bad
a pattern of quickly changing your interests and values
fears about abandonment
starting and ending relationships quickly and impulsively
a pattern of unstable, intense relationships with family or others you’re close to
emotional distress
feelings of emptiness
problems with anger
dissociation, or feeling disconnected from your body or real life
unstable self-image
dangerous or self-destructive behaviours
self-harm

What are the causes of quiet BPD?

The causes of what’s called “quiet BPD” are the same as the causes of BPD in general.

Like certain other mental health conditions, an increased risk of BPD is thought to be passed down in families (inherited). Studies have found that BPD may have genetic links, but more evidence is needed to understand the connection.

Genetics probably aren’t the only cause of BPD. Several studies have found that emotional and physical abuse, as well as childhood neglect can increase an individual’s risk. Exposure to — or a personal history of — unstable relationships may also contribute.

Physical changes to the brain and alterations in the neurotransmitter serotonin may be associated with BPD. However, it’s not clear whether brain changes lead to BPD or if they occur after the fact.

What are the possible side effects or complications of quiet BPD?

There are no specific side effects or complications associated with BPD types. The possible side effects are linked to the actual BPD diagnosis, not a subtype theory.

It can sometimes be difficult to start the process of seeking a diagnosis and treatment for mental health symptoms. Without help, though, the symptoms may worsen over time.

Increased risk of other mental health conditions

Some other mental health conditions may be more likely to occur alongside BPD. These include:

bipolar disorder
depression
eating disorders
anxiety disorders
ADHD
substance use disorders

Hard to establish and sustain relationships

It can be difficult to establish and sustain relationships when you have BPD, and some of the related symptoms can cause even more difficulties in this area.

You might find it hard to connect emotionally with others because of the constant push and pull where you’re afraid of getting hurt but are also afraid of being alone.

Difficult to maintain work or school schedule

You might also find it increasingly challenging to maintain your role at work or in school.

Untreated BPD may increase your risk for acting out impulsively, and engaging in uncontrolled spending, gambling, drinking, and other dangerous behaviors.

Self-harm and suicidal thoughts may occur

Thoughts of suicide and self-harm are possible with BPD. Always take any talk or feelings of suicide seriously.

Suicide prevention

If you or someone you know is considering suicide, you’re not alone. Help is available right now:

Get help from a crisis or suicide prevention hotline. Try the 988 Suicide & Crisis Lifeline at 800-273-8255. Or text HOME to the Crisis Textline at 741741.
Dial 911 or your local emergency number if you think there’s an immediate danger or you can’t reach someone you trust. Trusted options might include a member of your health care team or your local emergency room.
If you decide to call an emergency number like 911, consider asking the operator to send someone trained in mental health, like Crisis Intervention Training (CIT) officers.
If you’re helping someone else, stay with them until help arrives.
Remove any guns, knives, medications, or other things that may cause harm.
Listen, but don’t judge, argue, threaten, or yell.

How is BPD diagnosed?

Due to misconceptions and the inward nature of this condition, it’s possible for quiet BPD to be misdiagnosed as another condition, such as depression or social anxiety disorder.

While such conditions may occur together, BPD is a separate diagnosis that only a mental health professional can make.

Licensed mental health professionals, such as psychiatrists and psychologists, can diagnose BPD based on an interview with you.

They may also have you fill out surveys based on your symptoms to gain some insight.

There’s no medical test for BPD per se, but undergoing a medical exam may help rule out other conditions that may be contributing to your symptoms.

It’s also important to let your clinician know if you have any personal or family history of BPD or other common co-occurring conditions such as anxiety, depression, or eating disorders.

An at-home BPD online survey may also help guide your way to obtaining a diagnosis.

Keep in mind that such online screenings are not official tests, and they are not the same thing as speaking with a licensed mental health professional. Self-diagnosing a mental health condition can be problematic.

Who’s at risk for quiet BPD?

There are no specific risk factors for quiet BPD, because it is not an accepted diagnosis. The risk factors apply to BPD in general.

Certain risk factors have been shown to influence the development of BPD. These may include:

family history of BPD
previous traumatic experiences
experiences of childhood neglect or maltreatment

BPD sometimes happens alongside other mental health conditions such as:

depression
anxiety
eating disorders
substance use disorders

However, having another mental health condition does not necessarily lead to BPD.

How is quiet BPD treated?

Because you can’t be diagnosed with quiet BPD, the treatment options are the same as for BPD in general.

Working with a psychologist, psychiatrist, or licensed therapist can help people with BPD manage their symptoms. Therapy provides a “safe space” to unlearn old habits, and develop healthy strategies.

It can be tough to acknowledge when it’s time to talk to someone about your struggles, but you’ll likely find a sense of freedom and validation once you do so.

Schema therapy

Schema therapy has been shown to be effective for treating BPD. Typically, this type of therapy:

targets schemas, which are rigid, hard-to-change beliefs about yourself and the world
includes role-play and other experience-based therapies
teaches you healthy ways to meet your emotional needs

Mentalization based therapy (MBT)

MBT is another treatment option that’s shown promising results in research. During MBT, your therapist guides you to think through your emotions and reactions. This therapy focuses on improving your ability to:

reflect on your actions, thoughts, and emotions in your daily life
understand other people’s feelings and intentions
maintain a strong sense of self

Dialectical behavior therapy (DBT)

DBT is another type of therapy to consider for BPD. DBT may be helpful because it teaches:

mindfulness, or staying in the moment
regulating your emotions
coping with distress
managing interpersonal relationships

With practice, this can help reduce self-destructive thoughts and actions.

Medications

If a psychiatrist recommends it, certain mental health medications may help ease some of your symptoms.

However, you shouldn’t rely on medications alone, as they don’t necessarily address the underlying causes of your BPD. Such medications often work best in conjunction with psychotherapy.

Living with BPD

Keeping up with your treatment plan is your best route to living well with BPD.

Mental health treatment isn’t always easy. You might feel like you aren’t ready to get started with therapy. Or, you might find it hard to stick with therapy over time.

But remember that you deserve to feel better. Getting help can lead you toward healthier habits, and stronger relationships with yourself and others.

How to help

You may be wondering how to help a loved one cope with BPD.

Here are some tips for supporting someone during a mental health struggle:

Try not to judge or shame, even if you don’t understand your loved one’s behavior.
Ask your loved one to share contact information for their mental health care team and other supports, in case you need to contact care providers during an emergency.
Know your own limits and boundaries, but do your best to be reliable in a crisis.
Make sure you have your own support network, which may include a therapist.

Your loved one may experience anger or thoughts of self-harm

BPD has the potential to cause episodes of anger or suicidal ideation. It’s important to talk with your loved one about how to handle these episodes, before they happen.

Find out what kinds of emergency mental health resources are available in your area, such as a local crisis team or inpatient program. Talk with your loved one about options for crisis intervention and emergency treatment. Learn what their preferences are, so that you can advocate for them if an emergency happens.

All in all, it’s not always easy to support a loved one through a health struggle. It’s completely normal to feel lots of different emotions along the way. Remember to prioritize caring for yourself, so that you can continue to be there for your loved one.

Key takeaways

Not everyone with BPD has exactly the same set of symptoms. Some people’s symptoms may be more outwardly noticeable, and others’ less so. Even so, “quiet BPD” is only a theory, not an actual diagnosis.

BPD can take time to identify, but the sooner you understand your symptoms, the sooner you can take action.

It’s important to recognize that your feelings do matter, and that it’s perfectly acceptable to share them with others.

While you might quietly struggle with persistent guilt and poor self-worth, the truth is you deserve a happy and fulfilling life.

See a licensed mental health professional to get started.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Medically reviewed by Yalda Safai, MD, MPH — Written by Kristeen Cherney — Updated on July 13, 2022

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