Quiet BPD: Symptoms, Diagnosis and Treatment

By Danielle Boland

Borderline personality disorder (BPD) is a widely known diagnosis in the field of mental health. However, many people do not know that BPD may not always present the same way in those who have it. Although BPD is characterized by extreme outward mood swings and inconsistent behaviors, a person may channel these things inward instead of outward. This is known as quiet borderline personality disorder. Someone with quiet BPD can experience all of the same symptoms as someone with typical BPD, but they are very hard to identify. Sometimes, a person might not even know they are suffering from BPD at all. Learning about quiet BPD and understanding how it differs from typical BPD can help you identify whether you or a loved one may have this condition. 

What Is Quiet Borderline Personality Disorder (BPD)?

Quiet borderline personality disorder (BPD) is a term referring to people who meet the criteria for a formal diagnosis of BPD but don’t fit the typical profile that is normally seen when someone has BPD. Although the term is commonly used to describe this type of person with BPD, quiet BPD is not an officially recognized subtype of BPD.

Someone who has BPD may have frequent and intense outward emotional outbursts, while someone who has quiet BPD may not seem to have these emotions to someone on the outside. Someone with quiet BPD still experiences these feelings and turmoil, but they often suffer in silence or internalize many of the intense emotions they feel. 

Typical BPD behavior can make interpersonal relationships and things like school and work very difficult due to an instability of emotions. Someone with quiet BPD may have difficulty in these areas as well, but it is not as easily recognized. 

Quiet BPD Symptoms

Quiet BPD shares many of the same symptoms as BPD. However, it can be harder to identify and diagnose due to a person pushing their emotions and feelings internally instead of externally. Symptoms of quiet BPD can include:

• Self-isolation
• Avoidance of issues
• Self-harm that is not easily seen or detected
• Mood swings that are not seen by others
• Feeling hopeless
• Obsessing over a person and not having healthy boundaries 
• Fear of rejection
• Self-hatred
• Inability to read others and their boundaries
• Self-sabotage 
• Chronic people-pleasing
• Feelings of guilt and shame for your emotions
• Inappropriate reactions to situations (big or small)

Quiet BPD In Relationships

Someone who has BPD may have difficulty in relationships due to their extreme emotional instability. This can be hard on a romantic partner because the relationship may be very volatile. With quiet BPD, someone still experiences all of the same feelings and emotions as regular BPD, but it may not be obvious to a partner.

Someone with quiet BPD may have a fear of abandonment related to their BPD symptoms but be too ashamed or afraid to discuss it with their partner. This can cause a lot of mixed signals and confusion for someone in a relationship with them. 

Quiet BPD and Friendships

Symptoms of BPD can make it difficult to maintain friendships. Often, someone with BPD can be an inconsistent friend due to their symptoms. Quiet BPD can be confusing to someone who does not understand what their friend is going through, as they are unaware that their friend is suffering from BPD. Quiet BPD may also prevent someone from forming and committing to friendships because they do not have the emotional capacity to have healthy boundaries or navigate friendships. 

What Causes Quiet BPD?

Quiet BPD and typical BPD have many of the same causes. Some of the reasons why someone may develop quiet BPD include:

• A family history of personality disorder or BPD
• Childhood abuse, neglect or trauma
• Presence of another mental health disorder, such as anxiety, depression, OCD, bipolar or PTSD

There is no official diagnosis for quiet BPD, and there are no reasons why someone may develop quiet BPD instead of typical BPD. However, a person’s temperament or upbringing may contribute to how they express themselves and emotions versus someone else. 

How Is Quiet BPD Diagnosed?

To be diagnosed with borderline personality disorder, someone must meet five out of the nine criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria include:

1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance (markedly and persistently unstable self-image or sense of self)
4. Impulsivity in at least two areas that are potentially self-damaging 
5. Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood 
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger 
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Treatment for Quiet BPD

BPD can be a difficult personality disorder to treat due to its many complexities and the different ways it can present. However, there are proven treatment methods that have shown success in treating BPD. Quiet BPD would also benefit from these treatment options, as the treatment does not differ from typical BPD. 

Dialectical Behavioral Therapy 

Dialectical behavioral therapy (DBT) is a type of behavioral therapy that helps people reframe thoughts and emotions to accept a situation and change maladaptive behaviors. Someone who is diagnosed with quiet BPD can have unstable moods and behavior that make it difficult to function in their daily lives. DBT can help people with BPD change unhealthy behaviors, develop healthy coping skills and work toward emotion regulation, distress tolerance and interpersonal effectiveness. 

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a behavioral therapy that works to identify problematic thought patterns and the behaviors that result from them. Quiet BPD and other personality disorders cause a pattern of cognitive impairment, which can lead to issues with emotions, interpersonal relationships and impulse control.

CBT can help someone with quiet BPD identify thoughts and feelings that are not based in truth and are a result of their BPD symptoms. It can help them change behaviors that are a result of their inaccurate thoughts and feelings, and it allows them to develop healthier coping skills for their emotions. 

Mentalization-Based Therapy (MBT)

Patients with quiet BPD show a lower capacity to mentalize, which can cause issues regulating emotions and managing impulsive behavior, especially in relationships. Mentalization-based treatment (MBT) is a short-term treatment approach that promotes the development of mentalizing. Mentalizing is how we make sense of ourselves and others. It plays a large part in how people interact socially, which is why those with BPD have a hard time in interpersonal relationships. 

Medication

Currently, there are no medications that are specifically marketed for treating quiet BPD. However, some medications for other mental disorders have been shown to help manage various symptoms of BPD. There is some evidence that mood stabilizers and antipsychotic medications can successfully help manage quiet BPD symptoms. If you think you may need medication to treat BPD, speak to your doctor for more information. 

Complications of Untreated Borderline Personality Disorder

Borderline personality disorder can be difficult to diagnose, as personality disorders can present in many different ways. Quiet BPD can be even more difficult to identify and treat because a person can become very good at hiding their symptoms, or they may not even realize they have BPD.

Increased Risk of Additional Mental Health Conditions

Leaving BPD untreated can cause other mental health conditions to develop. Someone with quiet BPD may experience anxiety and depression as well as other distressing symptoms. Left untreated, these can develop into their own diagnoses and further complicate the treatment of BPD. 

Difficulties With School/Work

Someone with quiet BPD may have issues with perfectionism and thoughts of self-hatred. This can lead to problems with school or work because they feel a high level of pressure to perform a certain way. If quiet BPD symptoms are out of control, someone may be unable to function in these types of roles and will struggle to keep their emotions and behavior stable enough to succeed. 

Difficulty With Interpersonal Relationships

People with quiet BPD experience the symptoms of a personality disorder, which includes difficulty maintaining interpersonal relationships. If quiet BPD is not treated, it can make a person unable to have a romantic relationship or friendships due to BPD symptoms like lack of trust/boundaries, emotional instability and unpredictable behavior. 

Increased Risk of Substance Abuse

Suffering from quiet BPD can become very isolating and overwhelming to someone who does not know why they act and feel a certain way. They can become embarrassed or ashamed of their emotions and behavior and turn to substances to help cope and numb these feelings. Those with quiet BPD are at a higher risk for substance abuse than those who do not have the disorder.

Suicidal Thoughts and Attempts

People diagnosed with BPD also have a higher rate of suicide attempts. According to research, up to 70% of those diagnosed with BPD will attempt suicide in their lifetime. Quiet BPD is alarming because its symptoms are harder to identify, causing people to remain undiagnosed. As a result, people with quiet BPD may have even less of a support system. 

Quiet BPD Prognosis

It is very important for people who are suffering from quiet BPD to seek out treatment. Unfortunately, this can be difficult because the condition is harder to identify than typical BPD. Medical professionals should take great care in learning to identify the symptoms of quiet BPD so that people are given the proper treatment.

If left untreated, quiet BPD can lead to other mental health disorders, increase the risk of suicide and cause dysfunction in many other areas of life. Fortunately, with the right treatment and support, people with quiet BPD can live happy and healthy lives. If you think you or a loved one may be suffering from quiet BPD, help is available. 

The Nobu app is a free and easy-to-use tool that can help someone address their BPD symptoms. The app has mindfulness tools, mental health lessons, journaling prompts and many other helpful resources. For an additional fee, you can even speak with a licensed mental health professional to receive treatment for quiet BPD. Sign up for Nobu and download the app today, available for free on Apple and Android devices.