You have probably already heard of Borderline Personality Disorder, but a new subtype of BPD has been proposed (though not yet clinically proven) called “Quiet BPD”. Whether or not you have heard the term before, if you’re curious and want to learn more you’re in the right place.

Here, we are diving deep into all things Quiet BPD; what it is, its symptoms, who coined the term, how it can be diagnosed, how it can be treated, and more.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about Borderline Personality Disorder or any of its subtypes, we’re here to help.

What is BPD?

Borderline Personality Disorder (BPD) impacts the way an individual thinks, feels, sees the world around them, and relates to other people, in comparison to an individual without BPD.

According to the World Health Organization, an estimated 6.1% of people suffer from some sort of personality disorder, and whilst antisocial personality disorders are more likely to occur in men, BPD is more likely to occur in women.

It is thought that the cause of BPD is most often related to childhood trauma such as physical or sexual abuse, or neglect, and this has been found to be the case in up to 70% of people with BPD. Other factors that are thought to be possible causes are maternal separation, lack of maternal attachment, inappropriate family boundaries, substance abuse by a parent, and more.

“The worst part is the insecure relationships. When I'm attached, they're my whole world – it's crippling. I care so deeply about how long they take to reply or their tone, because I'm so afraid of losing them.” - Anonymous, via Mind.org.uk

What is Quiet BPD?

Quiet BPD is also known as Discouraged BPD, but to date it has not been listed as a legitimate clinical condition. However it has been proposed as a subtype of BPD by psychologist Theodore Millon, along with 3 other possible subtypes; Self-destructive BPD, Impulsive BPD, and Petulant BPD.

“Quiet BPD is not recognised at present in the ICD-11. However, understanding patients and their own narrative is really important so as a clinician although you wouldn't diagnose someone with this, you will be aware how they present their symptoms may be slightly different from the common presentation of BPD.” - Dr Sandhya Eappen, Consultant Psychiatrist

Quiet BPD is much the same as general BPD, with similar causes. The difference is that while those with BPD often struggle visibly, an individual with Quiet BPD may struggle with similar feelings and emotions on the inside rather than the outside, keeping their feelings to themselves so those around them do not notice. It is also sometimes referred to as ‘high-functioning’ BPD due to the fact that people with Quiet BPD may maintain a life that seems fairly regular from the outside. At present, a person can only be diagnosed with borderline personality disorder, not any of the proposed subtypes of BPD.

Research into the subtypes of BPD is limited, and more needs to be done to determine the differences and how best to treat them.

What are the main symptoms of Quiet BPD?

The name ‘borderline’ comes from the characteristic that BPD tends to border other mental health conditions, as it is often diagnosed alongside comorbid conditions like depression, anxiety, eating disorders, post-traumatic stress disorder (PTSD), substance misuse disorders and bipolar disorder.

Borderline personality disorder symptoms might include things like:

• Hypersensitivity to rejection
• Instability in relationships with family, friends and/or romantic partners
• Uncertainty in their behaviours and a distorted sense of self-image
• Intense mood swings
• Rapid changes in interests or feelings for others (from love to dislike and vice versa)
• Black and white thinking, such as viewing people as all good or all bad
• Impulsivity or recklessness
• Taking steps to avoid any sort of abandonment (for example, ending a relationship before someone else does)
• Self-harming behaviours and/or suicidal thoughts/behaviours
• Feelings of emptiness and/or dissociation
• Intense feelings of anger or problems controlling anger

Not all of these symptoms will be present in every person with borderline personality disorder, and the severity and frequency of symptoms will often vary from person to person.

How is BPD diagnosed?

Like other mental health conditions, diagnosing borderline personality disorder must be done by an experienced professional like a psychiatrist or psychologist, and this will happen following an in-depth evaluation of an individual’s symptoms and experiences, as well as any family history of similar conditions.

Some symptoms may point towards other conditions, so these must be ruled out first. BPD is typically diagnosed in late teens/early 20s, though it can affect those younger and older too.

What do I do if I think I might have Quiet BPD?

It is important to remember that, with treatment, people with BPD can start to experience less severe symptoms over time, which can help them lead a better quality of life. People with BPD or Quiet BPD will usually meet at least 5 of the following DSM-5 criteria to be diagnosed:

• Engaging in frantic efforts to prevent actual or perceived abandonment
• A history of unstable relationships that involve idealising and then devaluing a person (called “splitting” or black and white thinking)
• Having an unstable identity or image of yourself
• Problems with impulsive or risky behaviour
• Frequent self harm or suicidal ideation
• Rapid/frequent mood swings and the experience of intense emotions
• A chronic feeling of being empty
• Feelings of intense or uncontrollable anger
• Dissociation (disconnecting from yourself, having an “out of body” experience)

You will not be given a diagnosis of Quiet BPD as this is not currently an officially recognised condition, but an experienced professional may look further into the possibility of a more general BPD diagnosis.

How is Quiet BPD treated?

If you are diagnosed with BPD, the recommended treatments may include a combination of medication and therapy, such as:

• Cognitive-behavioural therapy (CBT): This is a type of talking therapy that can help to change unhelpful thoughts and behaviours. This can help you identify and start to change things like “black and white thinking” or “emotional reasoning” by replacing them with more constructive ways to cope.
• Dialectical Behaviour Therapy (DBT): This treatment was designed specifically for those with BPD, and it teaches strategies to manage stress and heightened emotions, so you can start to relate to others.
• Schema Therapy: This therapy combines different therapeutic approaches with an emphasis on relationships, and helps change the filter you see others through.
• Psychiatric Medication: BPD cannot be cured with medication, but you may be prescribed medications to help manage some of the related symptoms, such as anxiety or depression.
• Mentalisation-Based Therapy (MBT): This type of therapy focuses on how your internal feelings impact what you do on the outside, and how your thoughts, emotions, and needs affect yourself and those around you.
• Transference-Focused Therapy (TFP): This type of therapy focuses on how you relate to a therapist in conjunction with how you relate to others in your life, and discovering patterns there.

If you are interested in learning more about what type of therapy might be best for you, or just want to learn more about other personality disorders like first rank schizophrenia, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments to helping you find a therapist near you for support on your journey.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.