What Is Quiet BPD and How Is It Treated?

When the symptoms of certain mental health conditions remain hidden, they can sometimes live beneath a veneer of normalcy, barely veiling an inner pain that is very real and desolating.  

Consider Borderline Personality Disorder (abbreviated BPD). It’s often associated with an inability to regulate one’s emotions after being triggered, which can manifest outwardly through intense mood swings, grandiose behaviors leading to interpersonal turmoil, and a difficulty finding one’s way back to a stable place of center. 

Now look at the concealed, almost deeply buried signs of quiet BPD. Unlike the outward, overt expressions conventional to typical BPD, quiet BPD symptoms exhibit themselves as self-directed anger, a deep sensitivity to rejection, and a tendency to internalize negative emotions.  

Since these feelings are often so well-hidden, quiet borderline personality disorder, or quiet BPD — sometimes called high-functioning BPD — may often go unnoticed or even wrongly diagnosed, leading many people to struggle in silence and preventing loved ones from recognizing the severity of their condition.   

Is quiet BPD real, and how does it fit within the BPD paradigm? This lesser-known subtype is sometimes misunderstood (and even misdiagnosed), so let’s examine the complexities of quiet BPD and what quiet BPD treatment looks like. 

What Is Borderline Personality Disorder (BPD)? 

BPD is a complex personality disorder characterized by what’s called emotional dysregulation, or a limited ability to manage one’s emotions when faced with challenging situations. The intensity and length which they feel and process their emotions can make it difficult to return to normalcy after being triggered. 

“People with BPD experience wide mood swings and can feel a great sense of instability and insecurity,” notes the National Alliance on Mental Illness (NAMI). These feelings symptomatic to BPD can result in: 

• Longstanding feelings of emptiness 

• Emotional intensity 

• Unstable, intense and unpredictable relationships  

• Distorted self-image 

• Fear of abandonment 

• Impulsive, erratic or risk-taking behaviors 

• Self-harm (Statistics show that 70% of people will attempt suicide, and between 8% to 10% will succeed) 

• Rageful anger and difficulty controlling it 

• Feeling disconnected from the rest of your body  

BPD goes on to affect about 1.4% of the entire U.S. adult population, and nearly 75% of them are women. Studies show that BPD also impacts up to 20% of mental health facility inpatients and 10% of outpatients. 

Subtypes of BPD  

Under the umbrella of BPD, there are four “subtypes” that the clinical community uses to make diagnoses and differentiate how various symptoms manifest themselves. These four different types were developed by Dr. Theodore Millon, a psychologist who was an expert on personality disorders. 

Discouraged or Quiet BPD 

In some cases, BPD doesn’t always mean intense outbursts or overt self-harm that you’d imagine. A subtype called discouraged BPD, also known as quiet BPD, is marked by internalized anger, deep-seated self-criticism and a tendency to hide emotional pain.   

Those with discouraged BPD often base their identities around their romantic relationships. They may exhibit an overbearing dependence and neediness on others, and a great fear of abandonment, that one’s world becomes destabilized when a relationship ends. These unhealthy dependences are tied to feelings of powerlessness in people with discouraged BPD.  

Impulsive BPD 

People with impulsive BPD tend to engage in risky behaviors, such as reckless spending or gambling, compulsive shopping substance abuse, binge eating or unsafe sex. They often act before thinking, driven by boredom, an urgent need for attention from others and instant gratification, excitement or distraction from emotional pain. If you have impulsive BPD, you might find yourself making sudden decisions without fully considering the consequences, which can further destabilize your relationships (abrupt relationship breakups are also common in impulsive BPD). 

Aggressive anger is a symptom that runs through many forms of BPD, and impulsive BPD is no exception. In this subtype, sufferers may display explosive anger, shouting, breaking or throwing objects and acts of physical violence.  

Self-Destructive BPD 

Unlike a subtype like discouraging BPD, where someone may turn their pain inwards, people who suffer from self-destructive BPD are more inclined to harm themselves physically. When negative thoughts or harsh criticism arise, the person with self-destructive BPD is prone to self-harm, suicidal ideation or putting themselves in dangerous, risky situations. 

These types of self-harming behaviors can stem from depression or feelings of deep bitterness and resentment — often a sign of acting out as a cry for help. Like other forms of BPD, self-destructive BPD can inhibit a person’s ability to form and maintain healthy relationships. 

Petulant BPD 

Moodiness, a pervasive sense of resentment and rapidly shifting negative emotions form the foundation of petulant BPD. Here, you might experience frequent mood swings, harboring a general sense of dissatisfaction with your interactions, feeling that the world is indifferent or even hostile toward you.  

People who show signs of petulant BPD may react to this by lashing out through intense, unpredictable emotional outbursts, impatience in regular interactions and passive-aggressive behavior. You may also feel a strong sense to control others through possessive behaviors.  

What Is Quiet BPD? 

Unlike the more overt, outwardly volatile behaviors of BPD, one of the main signs of quiet BPD is a tendency to turn their fluctuating moodiness and temperamental behaviors inward. Instead of lashing out, people with quiet BPD “lash in,” suppressing and hiding away their emotions — however intense — while often appearing calm or even detached. 

This can make diagnosis of BPD difficult if it’s expressed in a discouraged BPD fashion, since many people with quiet BPD are highly adept at masking their struggles. They may appear composed in social situations but experience intense inner turmoil, self-doubt and chronic feelings of emptiness. 

How Is Quiet BPD Different from BPD?  

The main difference between quiet BPD vs BPD lies in emotional expression. In classic cases of BPD, emotional pain is externalized and projected onto others. With quiet BPD, even if you feel just as intensely, your distress remains hidden, masked and internalized.  

This internalization doesn’t make quiet BPD any less than regular BPD — in fact, it may resonate even more loudly because while you may not show any visible external signs, you engage in a battle within yourself. This disparity can complicate diagnosis and true understanding from others, as friends and family may underestimate the severity of your inner pain. 

It’s currently unclear how prevalent quiet BPD is or how if differs by gender — however, given differences between men and women with other mental health or substance use disorders, we can speculate that quiet BPD in men may lead to repressed anger and self-isolation (akin to Armed Forces veterans who struggle with PTSD), and quiet BPD in women can manifest as extreme people-pleasing and internalized self-criticism.  

What Are the Signs and Symptoms of Quiet BPD?   

Quiet borderline symptoms commonly cross over with those found in a BPD diagnosis, but there are some differences, since the signs are more subtle. These can include: 

• A chronic sense of emptiness and worthlessness 

• Intense self-criticism, shame, guilt and internalized anger 

• Overwhelming feelings of anxiety and depression that are hidden beneath a calm exterior 

• A tendency to withdraw from conflict instead of communicating, which can adversely affect quiet BPD and relationships 

• A persistent fear of abandonment, even if you don’t express it outwardly 

• Repeated thoughts of self-harm or suicide 

• Black-and-white thinking or “splitting,” e.g. vacillating from one extreme emotion to another without reason 

Reframing Negative Thoughts 

All forms of BPD have one important thing in common: symptoms are rooted in repetitive negative thinking, which can adversely influence how you feel and act. A 2023 study from the Journal of Affective Disorders Reports (JAD) elaborates on the types of damaging thought patterns a person with BPD may experience, such as:  

• Brooding 

• Catastrophizing  

• Emotional cascading 

• Rumination, which takes many forms, from angry, anxious, depressive, interpersonal, sadness and stress-reaction 

• Worry 

Learning to adopt a new perspective is just one part of managing BPD. Cognitive-behavioral techniques that focus on reframing your thought patterns can help break the cycle so you can learn to replace harsh internal narratives with a more compassionate and realistic self-view.  

“This is done through various skills taught, some of which include teaching individuals how to reframe thinking,” notes the JAD report. We’ll explore more about these skills below. 

What Causes Quiet BPD? 

The exact causes of quiet BPD are generally the same as the development of BPD:  

• Childhood Trauma: Neglect, abuse or invalidation in early life can negatively shape your emotional regulation. 

• Genetics: A family history of BPD or other mood disorders increases risk of subtypes like quiet BPD. 

• Neurobiology: Differences in your brain structure and function can adversely affect one’s impulse control and emotional regulation. 

• Destructive behaviors: Studies have shown that abuse of certain addictive drugs and substances may contribute to the exacerbation of BPD. 

How Is Borderline Personality Disorder Diagnosed?    

Because quiet BPD often hides behind a façade of calm, it can often be mistaken for other conditions, like depression or anxiety. According to NAMI, some studies have suggested that men be as equally affected by BPD by women, but they are often underdiagnosed or misdiagnosed with either depression or Post Traumatic Stress Disorder (PTSD) — in fact, studies show that up to 40% of people with BPD face higher chances of a misdiagnosis.  

Consulting with a certified, licensed psychotherapist is the only way to receive an accurate BPD diagnosis. Never try to self-diagnose yourself or a loved one. A clinician will look for a constellation of symptoms like the ones listed in the “What Is Borderline Personality Disorder (BPD)?” section above, such as mood instability, fear of abandonment, and difficulty maintaining stable relationships, to determine if your experiences align with a BPD diagnosis. 

This appointment with a therapist is a precursor to receiving treatment, so open and honest communication during your evaluation goes a long way to allowing your therapist to guide them to a proper diagnosis and set you up for success. 

How Is Borderline Personality Disorder Treated?    

If you’ve received a diagnosis, that means you’ve taken a brave first step to addressing BPD, whether it’s discouraged BPD or another variation. The most effective quiet BPD treatment integrates a few different types of therapies and approaches: 

Psychotherapy for BPD 

Psychotherapy is a “first-line treatment” for BPD, according to a study titled “Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos and Awe.” There are generally five different therapies for quiet BPD treatment: 

• Dialectical behavioral therapy (DBT): This type of talk therapy focuses on cultivating mindfulness to help regulate your emotions and develop better, more healthier coping skills in the face of triggers. 

• Cognitive behavioral therapy (CBT): By acknowledging how your thoughts influence your feelings and actions, CBT aims to reframe your negative narrative, replacing destructive thoughts with newer, more self-affirming ones.

• Mentalization-based therapy (MBT): Similar to CBT, this therapy assists you in thinking before acting, helping you arrest negative thoughts before reacting harshly to your feelings or the perceived feelings of other people.  

• Transference-focused therapy (TFP): Also known as psychodynamic psychotherapy, TFP, according to the Mayo Clinic, “aims to help you learn about your emotions and issues relating to others by creating a relationship between you and your therapist. You then apply what you learn to other situations.” 

• Schema-focused therapy: Schemas are maladaptive thoughts and behaviors linked to BPD also thought to manifest during childhood. Schema therapy is meant to “help the individual recognize their behavior, understand the underlying cause(s) and change their thoughts and behaviors so that they’re better able to cope with relationship challenges or emotions in healthy, productive ways,” notes Psychology Today. 

Holistic Therapy for BPD 

Holistic therapies are meant to treat your whole self — mind, body and spirit, with the understanding that they contribute to your overall mental, physical and emotional wellness by addressing not just the psychological aspects of BPD but also the physical manifestations of stress that emotional dysregulation often brings. 

Complementary to talk therapy, you might try yoga or tai chi to encourage better mindfulness and emotional grounding through meditation and gentle movement; music therapy to express yourself through sound and lyrics (and recognize new talents along the way) or equine therapy to care for and build a bond with a therapy horse. 

Medication for BPD  

There is currently no single medication for treating BPD, but certain prescriptions are proven effective in managing your symptoms. Mood stabilizers, antidepressants and antipsychotics may be helpful in calming emotional volatility, create emotional regulation and lessen co-occurring depression and anxiety that often accompanies BPD. 

Finding Help for Borderline Personality Disorder 

Quiet BPD doesn’t mean it’s a lesser version of borderline personality disorder; far from it. The intense internalization associated with the subtype of BPD raises the risk of it going unnoticed by people who want to help. Don’t ignore the signs if you observe them in yourself or someone you care for. Use your intuition and consider how some of the solutions we’ve talked about in this article can help.  

We urge you to keep browsing our site to see how Royal Life Centers can help. We offer a comprehensive range of therapy and support for various mental health conditions, and our therapists and support staff are experienced in helping people just like you overcome BPD and the effects they have on your life. From evidence-based therapy to connecting you with mental health resources, we can help — but the first step begins with you. 

If you have questions about treatment for quiet BPD or other mental health or substance abuse issues, don’t hesitate to call us today.