Types of Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition (personality disorder) that affects roughly 1.6% of the population. Symptoms can result in distress due to an inability to effectively regulate emotions, conflict within interpersonal relationships, a low sense of self-worth, and an enhanced tendency for impulsivity. Further, BPD is linked to self-harm and higher rates of suicide. According to research, this complex condition is often associated with major depressive disorder and dysthymia (high-functioning depression). 

People who experience BPD often face difficult relationship issues and have severely skewed views of themself and the world around them. BPD can be difficult to diagnose because not all symptoms appear with every diagnosis. Adding to the challenge, there are several subcategories of BPD, and some BPD symptoms can overlap with each other and with other mental health conditions (like bipolar disorder, depression, and certain eating disorders).

The research of noted psychologist and author Theodore Millon helped classify four distinct BPD types. The different types of BPD have specific characteristics in common, but each also has its own symptoms, challenges, and optimal treatment techniques.

What are the Different Types of BPD?

While continued research indicates the likelihood of even more subcategories for the various BPD types, here we’re focusing on the 4 borderline personality disorder types characterized by Millon’s research.

• Discouraged borderline personality disorder (quiet BPD)
• Impulsive borderline personality disorder
• Petulant borderline personality disorder
• Self-destructive borderline personality disorder

1. Discouraged borderline personality disorder

Millon described discouraged borderline personality disorder (also known as quiet BPD) as being marked by frequent feelings of shame, guilt, emotional attachments, social anxiety, feelings of inadequacy, and obsessions.

Symptoms of discouraged borderline personality disorder

• Marked interpersonal difficulties
• Fear of abandonment
• Unstable self-image
• Self-blame
• Rage
• Feelings of emptiness
• Being emotionally attached
• Helplessness
• Paranoid ideation
• Obsessive-compulsive tendencies
• Social retreat
• Perfectionism
• Anxiety

2. Impulsive borderline personality disorder

Impulsivity is a common trait in BPD in general, but it’s prevalent enough in some people to be considered one of the 4 types of BPD addressed by Millon. Those with impulsive borderline personality disorder have an intense need for immediate gratification and often discount delayed rewards. They tend to experience intense emotions of rejection and anger.

Symptoms of impulsive borderline personality disorder

• Preference for immediate gratification
• Discounting long-term results
• Feelings of rejection
• Feelings of anger

3. Petulant borderline personality disorder

People with petulant BPD can display outbursts of anger that aren’t appropriate for a given situation. They might have an unstable self-image accompanied by feelings of being unloved. They feel a strong urge to manipulate or control others and tend to become possessive, resulting in difficulty maintaining interpersonal relationships. Overall, they’re likely to lack emotional stability.

Symptoms of petulant borderline personality disorder

• Inability to enjoy harmonious relationships
• Difficult to satisfy
• Feelings of extreme anger and frustration 
• Frequent irrational, emotional outbursts
• Impatience with others in normal social situations
• Seldom can admit they are wrong
• Often behave in a passive-aggressive manner

4. Self-destructive borderline personality disorder

These BPD types can be their own worst enemies. People with self-destructive borderline personality disorder frequently self-sabotage relationships with family members and friends. They might engage in dangerous or risky behaviors, and generally have little regard for the consequences of their actions.

Symptoms of self-destructive borderline personality disorder

• Substance abuse
• Self-hatred
• Self-harming behavior 
• Frequent depression
• Feelings of bitterness
• Suicidal thoughts 
• Emotional bitterness

How to Treat the 4 Types of BPD

The different types of BPD use slightly different treatment modalities, which can include a combination of medications for specific BPD symptoms combined with various modalities of talk therapy. 

Research suggests that each of the 4 types of borderline personality disorder seems to reflect biologically determined temperaments that could be linked to neuro-biologically based predispositions and vulnerabilities. While we don’t fully understand what causes borderline personality disorder, we are learning more every day about how to treat borderline personality disorder. Some people want to know how to treat BPD naturally,so treatment can vary not only depending on the type of BPD someone has, but also on their personal treatment plan. 

Borderline personality disorder is not necessarily treatable with medication. That is, no medication has been discovered that can cure the mental health condition itself. However, people diagnosed with the various types of BPD can be prescribed medication to help them manage symptoms, like anxiety and mood swings, that stem from BPD. BPD medication can also be effective in decreasing the likelihood of self-harm and may help prevent suicide.

Treatment for discouraged BPD 

Psychotherapy is the predominant treatment modality for treating discouraged BPD types. Dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), and mentalization-based therapy have all been found effective therapy. Therapeutic interventions like antidepressant medications might be recommended if comorbidity with depression presents.

Treatment for impulsive BPD 

Impulsive BPD types can be effectively treated with cognitive behavioral therapy and dialectical behavioral therapy (DBT). 

Treatment for petulant BPD

Therapy is also recommended to treat petulant BPD. Dialectical behavior therapy is the most recommended form of BPD therapy and can teach things like emotion regulation and distress tolerance. It can also help with interpersonal skills. Other forms of therapy that are known to be effective include cognitive behavioral therapy (CBT), mentalization-based therapy, and psychodynamic therapy. 

Treatment for self-destructive BPD

Dialectical behavioral therapy and another form of therapy that uses elements of CBT, known as schema-focused therapy, have been found effective in treating self-destructive BPD. Therapy can help identify triggers, which makes a huge difference in learning to manage any type of mental health condition, including self-destructive BPD. Medication is also commonly recommended. 

Which Type of BPD Do I Have?

Self-diagnosis is never recommended to diagnose any of the borderline personality disorder types. Unfortunately, there isn’t any one single test that can accurately determine if someone has BPD, let alone which type they may have. Thorough testing by a qualified mental health professional is the only reliable method of diagnosis. As noted, making a BPD diagnosis can be difficult given the possibly overlapping nature of symptoms. If you want to learn more about your symptoms you can even take a BPD test as a first step. However, be sure to seek in-person or online therapy to get a proper diagnosis. 

Identifying types of BPD can involve using a variety of testing and assessment measures, including the Personality Assessment Inventory (PAI) and the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 offers a detailed list of criteria used to identify traits and symptoms that must be present in order to make an accurate diagnosis. Also included in the diagnostic process can be health assessments and interviews. 

While there’s no clinical recognition in terms of diagnosing each type of BPD, narrowing them down can help a mental health provider decide on the most effective treatment plan, which can be essential is overall BPD treatment success. Zeroing in on the precise types of BPD that need attention is the best way to gauge the most effective treatment modalities.

Using Millon’s BPD subtype concepts has the potential to help people living with borderline personality disorder figure out the most important areas of concern. Then, they can quickly focus on the most needed, most effective type of treatment. New investigations into the subtypes of BPD, as outlined by Millon, continue with the goal of finding better BPD treatment solutions for optimal care and possibly, one day, a cure. 

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