A relatively unknown subtype of Borderline Personality Disorder (BPD), Quiet BPD, sometimes called discouraged BPD, has come to the fore in recent years. In this Insight I explain what it is, how it differs from BPD, and treatment options.
What Is Quiet BPD?
When we think of BPD we think of someone who has intense fears of abandonment and rejection, and a high level of emotional dysregulation, often explosively “externalizing” their feelings.
In 2004, psychologist Theodore Millon, an expert on personality disorders, proposed four possible subtypes of BPD, which include [1]:
- Discouraged
- Irritable
- Petulant
- Self-destructive
Of these four, the discouraged subtype most closely resembles what some refer to as Quiet BPD—those who “internalize” their feelings by managing their symptoms inwardly.
Sometimes this is also called “high functioning BPD” because part of the self is ‘split off’ to maintain a facade of hyper-competence and independence, even if on the inside they experience extreme pain. On the surface, they may appear invisible to those around them and be able to very adequately carry out personal and work responsibilities.
Quiet BPD in young adults often presents as hidden emotional turmoil, self-blame, and withdrawal. This makes important life transitions and relationships challenging, sometimes without ever drawing attention or support from others.
How Quiet BPD Differs from Other Forms of BPD
BPD is characterized by rapid mood swings, unstable relationships and self-image, impulsive and self-destructive behaviors with difficulty managing anger, and chronic feelings of emptiness. Young adults with BPD engage in self-harming behavior and have repeated suicidal thoughts, gestures, or attempts.
Quiet BPD has been described as part of a dynamic of ‘undercontrol/overcontrol’ as put forward by Professor Thomas Lynch. Rather than the undercontrol of BPD, with its dysregulation and impulsivity, those with Quiet BPD are overcontrolled.
They are highly sensitive to perceived threats from others and easily feel hurt. But they hide their emotions and appear quiet, reserved, and hard to connect with. As a result, most others do not pick up on their internal distress [2] [3].
Symptoms of Quiet BPD in Young Adults
Due to the subtle nature of Quiet BPD symptoms, it can be challenging for friends and family members to recognise when a loved one might be struggling with the disorder.
Quiet BPD is not an officially recognized diagnosis according to the DSM-5, the manual psychiatrists use to diagnose mental health conditions. However, increasingly the term is used to describe the following symptoms, which young adults may have [4] [5]:
- Internalized Emotional Struggles: Significant inner turmoil. Intense shame, sadness, anger, and anxiety directed at the self rather than others. They may mask this with outward calmness.
- Self-blame and self-criticism: Blame selves for conflicts or problems.
- Social withdrawal and isolation: Due to a fear of rejection or abandonment, young adults may withdraw from social situations, isolate themselves when in distress, and struggle to form or maintain relationships.
- Conflict avoidant: Avoid conflict at all costs, leading to people-pleasing and suppression of personal needs.
- Anger suppression: Instead of showing anger outwardly, they suppress or deny it. May result in self-harm or self-sabotage.
- Low self-esteem: Common and persistent feelings of inadequacy, worthlessness, and detachment from others.
- Dissociation: Under stress, they feel disconnected from themselves or their surroundings.
- High-functioning facade: Young adults may maintain high grades or achievements and outward stability. This makes it difficult for others to understand the degree of their struggles.
- Chronic emptiness: Despise achievements and social activity, feel a deep sense of loneliness and emptiness.
Challenges Young Adults Face with Quiet BPD
Developing their identities, building independence, and forming social connections are all key tasks of young adulthood. But Quiet BPD can make these challenges for growth much harder in these ways:
- Impairs social and academic functioning: Friendships, dating, and participation in activities can all be hindered by social withdrawal and fear of rejection.
- Promotes self-sabotage: Education, work, and personal growth can be disrupted by impulsive self-directed behaviors with destructive choices such as self-harm.
- Strains family dynamics: Relationships with family members, friends, and partners can be strained by difficulty expressing emotions and fear of abandonment.
- Invisible suffering: Given a high-functioning appearance, distress often goes unnoticed by peers, parents, and teachers which can delay appropriate support and intervention.
- Risk of co-occurring conditions: Young adults with Quiet BPD often experience anxiety, depression, eating disorders, and substance use challenges more frequently than peers.
Can Quiet BPD Be Cured? Treatment Options for Quiet BPD
Treatments that can help someone with Quiet BPD include:.
- Standard Dialectical Behavioral Therapy (DBT): Originally developed specifically to treat BPD, it can help raise self-awareness, lower stress, and increase distress tolerance. However, those who suffer from challenges related to overcontrol usually don’t benefit from DBT or most other forms of talk therapy.
- Radically Open Dialectical Behavioral Therapy (RO-DBT): This was developed by Dr. Thomas Lynch especially to treat those with overcontrol. The term “radical openness” means there are three important aspects of emotional well-being: openness, flexibility, and social connectedness.
RO-DBT targets indirect, hidden, and constrained social signaling as the main source of emotional loneliness, isolation, and misery, over problematic internal experiences. Treatment strategies are designed to enhance social connectedness, including new skills to activate areas of the brain associated with the social-safety system and signal cooperation [6].
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Sources
[1] Millon, T. et al. 2012. Personality Disorders in Modern Life.
[2] Ma, I. 2021. The Struggles of Quiet BPD. Psychology Today.
[3] Youtube. Introduction to Overcontrol & Radical Openness by Professor Thomas Lynch.
[4] Norman S. 2023. What Is “Quiet BPD” And How Can You Spot It?
[5] Stewart, H. 2023. Understanding “Quiet” Borderline Personality Disorder.