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Quiet BPD and The Internal Suffering We Don’t See

Quiet Borderline Personality Disorder may sound like a mild or watered-down version of BPD, but nothing could be further from the truth.

The reality is the basic characteristics that create disruption and devastation in the life of a person with BPD are the same for those with quiet BPD. 

If you’re searching for guidance or suspect someone you love may have quiet BPD, you’ll want to know more about it as well as a roadmap for recovery. 

Quiet BPD produces the same unstable relationship patterns, mood swings, and episodes of extreme anger, but it’s all turned inward instead of outwardly expressed.

People with quiet BPD often struggle with intense guilt and shame. But they suffer in silence. The good news is there are treatment options that have shown success.

So how do you know if you have quiet BPD? Let’s dive in!

What Is Quiet Borderline Personality Disorder (BPD)?

Quiet borderline personality disorder (BPD), or ‘high-functioning BPD,’ is a subtype of BPD. It is characterized by the same explosive behaviors, mood swings, and emotional challenges as BPD but expressed inwardly. This means people with quiet BPD can still go through the motions of daily life while keeping their tumultuous emotions to themselves.

Typical BPD can be diagnosed as a mental health issue via the Diagnostic and Statistical Manual of Mental Disorders (known as the DMS-5) as a personality impairment in self-direction, identity, empathy, and intimacy. Quiet BPD, on the other hand, is considered a subtype and not an official diagnosis in the DMS-5. 

Some practitioners do not even recognize it as a distinct subtype, but there are growing calls to classify it as a distinct subtype with specific symptoms and patterns of behavior.

Initially suggested by Theodore Millon as the ‘discouraged subtype’, quiet BPD is characterized by frequent feelings of inadequacy, shame, guilt, social anxiety, emotional attachments, and obsession. 

However, these feelings are turned inwards, and they generally suffer in silence, seemingly able to carry on with life to those around them. 

Sadly, in these cases, people with quiet BPD aren’t actually okay. Although inwardly contained, these highly negative emotions, which often include self-hatred, fear of abandonment, and mood swings, can be debilitating.

A graphic image of a woman in stress sitting on the floor with her knees pulled in. A scribble of white lines form a thought bubble. The title reads What is quiet BPD?
Understanding Quiet BPD

Some of the defining traits of quiet BPD include:

  • Having no boundaries in relationships or having unhealthy boundaries
  • Obsessive relationship with a specific person and going to great lengths to ‘win them over.’
  • Feelings of anxiety and self-loathing that manifest in pre-empting the end of the relationship 
  • Self-isolation in an attempt to get ahead of perceived rejection
  • Inwardly-directed rage, for example, the silent treatment of the cold shoulder
  • Depression, self-harm, suicidal ideation
  • Fluctuation of mood that is bottled up and kept away from others
  • Inability to accurately assess the behavior of others toward you
  • Bottling up emotions while appearing to cope to the outside world

Because some of these characteristics are common to other disorders, quiet BPD is sometimes misdiagnosed as social anxiety or depression.

What Is The Difference Between BPD and Quiet BPD?

Typical BPD and quiet BPD share a lot in common, including:

  • A pattern of unstable emotions
  • Intense relationships
  • A tendency to self-sabotage by allowing their fear of abandonment to run rampant

But there are some differences. Quiet BPD is often described as ‘acting in’ instead of ‘acting out.’

The main difference between quiet and typical BPD is that in the latter case, the intense anger, impulsivity, and wild fluctuation between anxiety and depression are visible to those around them.

This is because those with BPD struggle to regulate their emotions and will often explode outwardly. This looks like bouts of rage, tantrums, risk-taking behavior, hostility, and even self-harm.

Quiet BPD sufferers direct these feelings inward, keeping all these painful and harmful feelings to themselves.

This doesn’t mean they don’t also engage in self-harm, suicide ideation, or even attempt suicide. The damaging effects of the intense emotions aren’t any less simply because they can keep it all bottled up inside. 

Perhaps the most profound difference is that typical BPD shows a lack of emotional control; quiet BPD is marked by having too much control over your emotions.

Quiet BPD Symptoms

Since quiet BPD does not have a separate set of diagnostic criteria from typical BPD, the same basic criteria apply to be diagnosed with BPD. These include:

  • Patterns of unstable interpersonal relationships
  • Relationships characterized by cycles of ideation (BPD love bombing) and rejection
  • Splitting
  • Fluctuating self-image/low self-esteem
  • Frequent and extreme mood swings
  • Extreme anxiety and bouts of paranoia
  • Fear of rejection or abandonment

But, whereas typical BPD adds outward expressions of rage, hostility, risk-taking, antagonism, and outburst of anger, quiet BPD looks like this:

  • Suppressing feelings of anger and withdrawing when upset
  • Cutting those off who have upset you
  • Hiding your changing emotions from others
  • Persistent feelings of guilt and shame – feeling like a burden to those around you
  • Taking the blame for any conflict
  • Social anxiety and isolating yourself
  • Fear of being alone, offset against a deep fear of intimacy – pushing people away.
  • People-pleasing or fawning behavior, especially at the beginning of relationships
  • Dissociation and self-harm

For more on the signs of quiet BPD, this clip has a lot of great insights:

How Do I Know If I Have Quiet BPD?

With so much to describe quiet BPD and a lack of official diagnostic criteria for the subtype, how would you know if you have BPD?

Many of the characteristics and symptoms of quiet BPD are common to those who have past traumas, are living high-stress lives, or have a history of relationship trauma – so how do you know if you have quiet BPD?

Most people at this point in their journey of discovery about quiet BPD are here because they feel something is off – whether it’s for yourself or a loved one, you may feel misunderstood. 

This is especially true for those who have not sought help or chased a diagnosis. If you suspect that quiet BPD may feature in your life, here are some questions to ask yourself (or ask about a loved one):

  • Do you tend to ‘fall in love’ easily and quickly feel intensely about new people you meet? Is there a tendency to idealize this person to the extent that they take up all your time and pervade your thoughts?
  • Do you often suddenly feel that this person doesn’t like you anymore or that you suspect they’re going to cut you off – so you cut them off first or ghost them?
  • If someone upsets you, do you withdraw, isolate yourself, and not talk to anyone? Do you cut people off that upset you rather than trying to clear the air?
  • When you have a conflict with someone, is your first thought that it’s your fault or lamenting that you knew you weren’t worth it all along?
  • Do you often feel like a burden to those around you, that you’re wasting their time, or that they don’t really want to engage with you?
  • Do you feel ‘apart’ or ‘separate’ from every one, with feelings of emptiness and numbness being familiar to you?
  • Do you experience intense mood swings that you keep to yourself while going through the motions?
  • Are guilt and shame things you often feel, even if there’s no logical reason?
  • Do you sometimes feel like you’re watching yourself from outside your body
  • Do you sometimes hurt yourself or think about ending things because you don’t feel you’re worth it?

While answering ‘yes’ to some of these doesn’t diagnose you with quiet BPD outright, it can help you determine whether there are potential red flags that you should address.

It’s a good idea to see a professional to discuss these issues and to determine whether there is a possible diagnosis. Remember that knowing what you’re dealing with is the first step to finding relief.

You don’t have to figure this out on your own.

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What Causes Quiet BPD?

It can be difficult to determine the cause of mental health issues, as certain mental disorders are thought to be triggered by emotional abuse over time, traumatic events, or even as an effect of substance abuse.

BPD has also been associated with certain negative life experiences. While childhood trauma and harmful environmental factors aren’t necessary to cause BPD, there is some correlation.

Research also shows that this factor and psychosocial influences affect brain development. There is also evidence linking increased stress hormone levels, reduced feedback sensitivity, and other neurobiological fluctuations to BPD. It’s also possible that changes to the brain and serotonin levels could be related to BPD.

Many studies suggest that a predisposition for BPD is inherited. Having a parent with BPD, a history of substance abuse, and other severe mental health issues like depression or post-traumatic stress disorder are all risk factors for developing BPD. 

While quiet BPD isn’t triggered by anything per se, the inevitable relationship cycle that is so characteristic of BPD will lead to the flaring up of emotions, which are then suppressed. 

How Quiet BPD Can Impact Your Quality Of Life

Despite being known as the high-functioning version of BPD, quiet BPD can still be disruptive and debilitating. Not knowing whether you or a loved one has BPD means you aren’t equipped to deal with how BPD can affect your life. 

Here are some of the ways quiet BPD can affect your life and the lives of those around you:

  • Struggle to make and maintain relationships; romantic partnerships may end abruptly from your side or the partner, who may not understand your behavior.
  • Engaging in risky behavior to please those around you can have serious consequences. For example, overspending, alcohol misuse, or dangerous impulsive actions.
  • Struggling to express yourself and bottling up all your emotions isn’t healthy for you. It could result in other mental health issues, like generalized anxiety disorders, depression, eating disorders, substance abuse, and even suicidal thoughts.
  • Managing and maintaining a work/school schedule becomes difficult if you’re overcome with negative emotions – and your lack of self-esteem may thwart career aspirations.
  • Confusion about your identity likes and dislikes, and core beliefs feed into negative thoughts about your value.

As scary as these sound, not knowing why you’re going through these challenges will be even more frightening.

Getting a professional opinion and helping to identify mental health disorders means a plan of action can be developed to mitigate such challenges. As the saying goes, knowledge is power, and a BPD diagnosis doesn’t mean the end of the road for you.  

Advances in research and our understanding of how the psyche works mean we have some options that can dramatically improve the lives of those with BPD and help promote much healthier thought patterns and happier relationships resulting from more balanced behaviors. 

Is Quiet BPD Serious?

While quiet BPD is often seen as less serious or less severe than typical BPD due to its inward nature, it is still a condition that can cause immeasurable distress to those who struggle with it and their loved ones. Any condition that leads to self-harm, suicidal thoughts, and self-loathing is serious, and those with BPD are worthy of living a happier, healthier life.

A graphic of two women sitting in a therapy session. The title reads "How To Treat Quiet BPD"
Quiet BPD Treatment Options

Therapeutic Treatment For Quiet BPD

Some of the current treatment options for BPD include therapies such as:

1. Psychotherapy

Psychotherapy is the overarching ‘talk therapy’ that many of these therapeutic interventions mentioned here fall under. The success of psychotherapy hinges on building a trusting relationship between the person and the therapist. Some of the therapies that fall under this that are useful for treating BPD include:

2. Cognitive Behavioral Therapy (CBT)

CBT is a fairly common intervention and a more traditional type of ‘talk therapy’ that strives to change harmful thought patterns and behaviors that tend to worsen your current challenges.

The basic premise is to teach you to examine your thought process, look for negative patterns and distortions, and to teach you to create different thoughts to replace those. 

Once this form of ‘taught thought replacement’ becomes a habit, you will be able to control the obsessive thoughts better, logically examine perceived rejection, and change the way you react in a healthier way. 

3. Dialectical Behavior Therapy (DBT)

Taking some guidance from CBT, dialectical behavior therapy was developed by a psychologist called Marsha Linehan, who suffered her mental health challenges and realized through recovery that achieving a balance between accepting oneself and striving to be the best version of who you are will promote a healthy psyche. 

The main goal of DBT is to activate strategies that allow you to deal with your emotions mindfully so that you can relate better with others without falling back into self-destructive habits.

Feelings are considered very important, so sharing them is encouraged –particularly helpful for those with quiet BPD who tend to hide everything away. 

DBT promotes coping strategies by teaching interpersonal effectiveness, mindfulness, distress tolerance, and regulating emotions. These are believed to help ease the symptoms quiet BPD sufferers experience the most. 

4. Mentalization-Based Therapy (MBT)

As the name implies, mentalization-based therapy emphasizes your ability to examine thoughts and emotions – yours and those of the people you interact with.

The first step in MBT is to educate the person with BPD on how their internal processes affect their life. By drawing attention to how your feelings and behaviors affect others and affect you, you will be more inclined to control emotions that have harmful effects. 

The difference between reality and how you perceive them is critical here since those with BPD tend to see themselves as the cause of all negative situations.

Becoming aware of this helps you to pre-empt negative feelings about yourself. It also promotes empathy, which is essential to help shift the focus from you to those affected by your behavior. 

5. Transference-Focused Therapy (TFT)

Based on the idea that BPD is a disorder of relationships, transference-focused therapy uses the relationship between you and your therapist to identify thought patterns and behaviors common to you in the real world. This allows the therapist to understand how you interact, think, and respond to challenging situations. 

Through the relationship with your therapist, TFT strives to help develop a more well-rounded sense of self that doesn’t struggle against itself so much and can relate to others in a healthier way. 

6. Schema Therapy

Also focusing on relationships, schema therapy sees a coming together of a few different approaches. The word schema describes how you, as a unique person with unique lived experiences, see the world and how this affects your interpersonal relationship. 

Schema therapy can be helpful to those with quiet BPD because the aim is to work on the patterns that lead to negative emotions and harmful behaviors. The objective is to help you find healthier ways to meet your intimacy needs without the risk of perceived abandonment. 

7. Medical Intervention For Quiet BPD

Currently, there aren’t any specific medications for BPD or its subtypes, but various medications – and even herbal remedies – may alleviate some of the symptoms. Speaking to a professional about this is wise, as some medications must be carefully monitored. Options include mood stabilizers, anti-depressants, and anti-anxiety medications.

The benefit of such treatment is that you can think much clearer and engage with therapeutic interventions better when the overarching negative emotions abate somewhat. Medication alone isn’t a solution, but pairing carefully prescribed medications with consistent therapy will see the best possible results. 

Can I Recover From Quiet BPD?

In all cases where mental health issues exist, having a diagnosis is always the best option for potential recovery.

Remaining in the unknown means you have no starting point for treatment and no guidance on how to mitigate symptoms; many BPD cases feature suicide attempts and should serve as a reminder that getting help should be a priority.

Quiet BPD, left untreated, will culminate in many areas of difficulty, not the least of which are in the relationships with those around you.

Getting help and committing to learning healthy coping mechanisms and strategies to maintain relationships will benefit you immensely and put you on the right path to a more fulfilling life. Studies show that symptoms can dissipate over time with the right treatment plan. 

Final Thoughts on Quiet BPD

Quiet BPD may seem like the lesser of two evils alongside typical BPD, but the tumultuous and potentially dangerous emotions the person experiences are equally as intense. It is perhaps even more dangerous for the person with quiet BPD since they tend to keep everything to themselves and may not actively seek help.

If you suspect you or someone you care about has quiet BPD, reach out and get help; you deserve a life with fulfilling, healthy relationships, which is achievable with treatment.

Want to learn more about BPD? Check out these resources:

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What is Quiet BPD? PIN

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