What Is Quiet Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental health condition in which a person experiences an ongoing pattern of disordered and sometimes extreme moods, self-image, and behavior. People with BPD may be impulsive and have difficulty in relationships. They may also experience intense episodes of anger, depression, and anxiety lasting from a few hours to several days.

Quiet BPD, sometimes referred to as high-functioning BPD, is not an official diagnosis. It's used to describe people who meet the criteria for BPD but whose symptoms don't manifest in the typical, overt way associated with BPD.

While people with BPD tend to "act out"—such as having angry outbursts—people with quiet BPD "act in," directing their symptoms and emotions at themselves. "Quiet" and "high-functioning" are deceptive descriptors. While people with quiet BPD often seem fine outwardly, they are struggling inside with feelings of intense loneliness, shame, or self-criticism.

BPD is estimated to affect about 1.6% of the population at any one time. However, some estimates put the percentage closer to 6%. And nearly 6% of people will experience it sometime during their lifetime.

Read on to learn more about the characteristics, causes, and treatment of quiet BPD.

Symptoms of Quiet BPD

People with quiet BPD meet the criteria for a BPD diagnosis, but their symptoms are directed inwardly, directing the anger and blame towards themselves instead of others. People with quiet BPD work hard to hide their struggles from others, not showing their symptoms on the outside.

People with quiet BPD may:

• Generally feel unsafe in the world
• Feel empty and numb most of the time
• Feel frequent shame and guilt
• Project an image that appears "normal," calm, and successful
• Believe that there is something defective about them
• Have a great need for control
• At times feel "surreal," as though in a movie or a dream
• Look calm on the outside even when they're struggling intensely on the inside
• Have extreme mood swings that are sudden and unexpected
• Hide their anger, sometimes to the point they don't recognize when they're angry
• Blame themselves for things even when they're not at fault
  
• Immediately assume they did something wrong when relationships end or when conflicts arise
• Dissociate and mentally retreat when stressed
• Withdraw and possibly end a relationship when someone upsets them instead of discussing the situation
• Feel that they are a burden on others
• "People please," even when it's detrimental to themselves
• Fear being alone but push people away
• Idealize other people at first, but quickly lose trust in them
• Experience "splitting" behavior" (black-and-white thinking or swinging from one extreme to another, with little provocation)

People with quiet BPD may experience a few of these symptoms or many of them. The frequency, severity, and duration of the symptoms can vary from one person to another.

Causes of Quiet BPD

An exact cause of BPD is not yet clear. Research suggests that several factors may play a role in the development of BPD:

• Family history/genetics: Having a close family member (such as a parent or sibling) with BPD may increase a person's risk of developing BPD themselves. According to the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), BPD is five times more common in people whose first-degree relatives have BPD.
• Brain factors: Some studies indicate that people with BPD can have structural and functional changes in the brain, particularly in the areas associated with impulse control and emotional regulation. It's not known whether these changes are risk factors for the disorder or a result of having the disorder.
• Environmental factors: Traumatic life events, such as abuse or abandonment, hostile conflicts, instability, and other disruptions to a healthy childhood environment, may increase the risk for someone developing BPD.

How Quiet BPD Is Diagnosed

Quiet BPD is diagnosed by a licensed mental health professional, such as a psychiatrist, psychologist, or clinical social worker. To determine a diagnosis, they typically:

• Conduct a thorough interview in which symptoms are discussed at length
• Take a personal and family medical history, including mental health conditions
• Perform a medical exam (a physical exam and possibly other tests) to look for/rule out any potential medical contributions to the symptoms

How Quiet BPD Is Treated

Psychotherapy (talk therapy) is typically the preferred treatment for people with BPD. Treatment sessions can take place individually or in a group setting. Group sessions guided by a therapist provide an opportunity for people with BPD to improve their ability to interact with others and to practice expressing themselves effectively.

Some forms of psychotherapy used to treat BPD include:

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy was developed to treat individuals with BPD. It's the go-to treatment for BPD. DBT is an intensive program of group skills training, supplemented by psychotherapy and phone coaching. It focuses on:

• Mindfulness
• Distress tolerance
• Interpersonal effectiveness
• Emotion regulation

The skills taught through DBT can help:

• Control intense emotions
• Reduce self-destructive behaviors
• Improve relationships

Cognitive Behavioral Therapy (CBT)

CBT involves identifying a problematic thought process and then working to change core beliefs and behaviors that foster inaccurate self-perceptions and difficulties interacting with others.

Radically Open Dialectical Behavioral Therapy (RO-DBT)

This program was designed especially for overcontrol. It is common in quiet BPD. Meanwhile, under control (such as impulsivity) is more common in typical BPD. For people with quiet BPD, therapy should focus on enhancing social-connectedness and openness rather than the behavioral control used in therapies such as DBT and CBT.

Other therapies used to treat BPD include:

• Mentalization-based therapy
• Transference-focused therapy
• Schema-focused therapy

Medications

Medications are not typically used as the main treatment for BPD. However, they may be prescribed to treat conditions such as:

• Mood swings
• Depression
• Other co-occurring mental disorders

Medication isn't right for everyone and can have side effects. Follow your healthcare provider's guidance on whether medication may be beneficial to you.

Prognosis for Quiet BPD

Without treatment, people with BPD may be:

• More likely to develop other chronic medical or mental illnesses
• Less likely to make healthy lifestyle choices

BPD is also associated with significantly higher rates of self-harm and suicidal behavior than the general population.

It is important for people with any form of BPD to seek out and commit to treatment. With professional help, symptoms can improve and people with BPD can lead fulfilling lives.

Coping With Quiet BPD

Quiet BPD should be treated under the guidance of a mental health professional. Other strategies may also help:

• Eat a healthy diet, exercise, get quality sleep, and don't don't drink or smoke
• Use positive coping statements, known as mantras
• Join a support group or speak with a supportive person you trust
• Practice mindfulness and relaxation techniques
• Play music that draws you out of the negative emotion you're feeling
  

Summary

People with quiet BPD meet the criteria for a BPD diagnosis, but instead of acting out as in typical BPD, their symptoms are directed inwardly. People with quiet BPD become adept at not showing their symptoms on the outside.

Psychotherapy is the standard treatment for BPD. Radically open dialectical behavioral therapy may be especially helpful for quiet BPD. Medication may also be prescribed. BPD is associated with increased rates of self-harm and suicidal behavior. If you're considering hurting yourself, seek help immediately. With treatment, the symptoms of BPD can improve.

A Word From Verywell

While quiet BPD may make it difficult to open up and express how you're feeling, working with a therapist who has experience treating quiet BPD can improve your symptoms and help you lead a more fulfilling life. If you're experiencing signs of quiet BPD, see your healthcare provider. They can recommend a treatment that suits you to a T.