Published On: January 25, 2018
Reviewed On: November 15, 2021
Updated On: September 12, 2023
While many people have heard of borderline personality disorder (BPD), a lesser-known and more difficult to treat condition is quiet borderline personality disorder (quiet BPD). Though it’s not formally recognized as an actual subtype of BPD, it’s used to describe those who meet the criteria for a BPD diagnosis, but who don’t truly fit the textbook profile.
Quiet borderline personality disorder can be much more difficult than BPD to both diagnose and treat, but as with many mental health conditions, the earlier it’s diagnosed, and intervention is started, the more successful treatment can be.
Learn more about quiet BPD here. We’ll look in-depth at what it is and how it differs from classic BPD. We’ll also explore quiet BPD symptoms, causes, treatments, and more, all here.
Quiet borderline personality disorder is very similar to typical BPD. The main difference is that with quiet BPD, you internalize emotional struggles and episodes. While those with BPD have intense impulsivity, anger outbursts, and episodes of anxiety and depression that are obvious to those around them, turning anger inward is more typical with quiet BPD.
Because struggles and anger outbursts are so often internal, quiet BPD is much more difficult to diagnose. In fact, it often goes undiagnosed or is misdiagnosed for years. Sometimes quiet BPD is also referred to as high-functioning BPD, but this name is largely inaccurate. From an outward perspective, someone with quiet BPD may seem fine and completely able to cope with daily life, but in fact, they’re generally trying to survive an individual, private experience that’s often excruciating and very difficult to manage. Yet another name for quiet BPD is “discouraged” BPD.
Those who have quiet BPD might feel very intense emotions such as:
The National Institute of Mental Health (NIH) describes borderline personality disorder as marked by erratic mood swings, poor self-image, impulsive behavior, extreme “black-and-white” thinking, self-harm, and an inability to maintain stable interpersonal relationships. Episodes of heightened anger, depression, or anxiety are other hallmarks of the disorder. Symptoms of quiet BPD can last for a few hours to a few days.
Quiet BPD isn’t readily distinguished from classic BPD—at least not in an official sense. It doesn’t have a special designation in the Diagnostic and Statistical Manual of Mental Disorders [DSM]. However, therapists and their patients often see a clear distinction between the “quieter” cases and BPD’s more traditional manifestations.
“Quiet BPD is different from classic BPD because Quiet BPD does not display the same outward erratic behavior as classic BPD and its sufferers often are high-functioning and isolate themselves when they experience symptoms. This makes Quiet BPD difficult to diagnose because many of the symptoms look like other disorders such as anxiety disorder and mood disorders. Additionally, many individuals with quiet BPD have experienced trauma in their past, like classic BPD.”
While “classic” BPD is characterized by episodes of obvious, violent outbursts, people with quiet BPD often direct violence inward instead.
“[T]hose with ‘quiet’ borderline personality disorder act in,” says Dr. Gerard Lawson, President of the American Counseling Association. “There is less hostility and fewer aggressive outbursts, but there may still be isolation and self-injurious behaviors or suicide attempts.”
People with quiet BPD still experience the intense emotional roller-coaster that distinguishes the disorder, but they work hard to shut these emotions down or push them aside. Very often, their sense of self is marked by shame or self-hatred.
Quiet BPD has some distinct and common signs and symptoms. While classic BPD symptoms may include outward rage, anger, and other destructive behaviors, quiet BPD can be very different.
What do quiet BPD traits look like?
“Other symptoms include depersonalization and derealization, as well as hiding one’s true feelings. Individuals with quiet BPD are usually high functioning. This can also make it difficult to diagnose the disorder, the person can simply be viewed as a perfectionist or a people pleaser.”
While there’s no known, clear cause for classic or quiet BPD, experts believe a combination of genetics, brain structure and function, and environmental and social issues may come into play. Many therapists point to the fact that for some people there is a history of childhood trauma or abuse as a root cause of the disorder.
Some potential causes of quiet BPD may be the result of:
Possibly the biggest side effect of quiet BPD is the fact that many people stay silent with their struggles, in part due to an incredible fear of putting a significant burden on their loved ones and friends around them. However, when BPD isn’t effectively treated, symptoms can, and often do, worsen drastically over time.
“Some of the complications of quiet BPD is it’s difficult to diagnose because the symptoms are turned inward when most clinicians are used to seeing explosive behavior. Other complications include difficulty maintaining relationships and making meaningful connections with people. Risky and unhealthy behaviors, difficulty setting healthy boundaries (relationships, financial and job related), self-image issues, suiciality and and a high risk of combination diagnosis like anxiety, depression or eating disorders.”
Quiet BPD can increase the risk for other mental health conditions, including:
People with quiet BPD may find it hard to sustain a productive role at school or work. When not treated, quiet BPD can result in impulsively acting out, gambling, substance abuse, uncontrolled spending, and other destructive behaviors that can interfere with daily functioning at school or work.
Unstable interpersonal relationships are a common symptom of quiet BPD. When you have quiet BPD, it can be difficult to emotionally connect to others. You may find that a fear of being hurt causes you to push people in your life away when they try to get close. There’s also commonly the fear of being alone at the same time, which can make things even more unbearable.
Because quiet BPD symptoms are turned inward, they can result in thoughts of self-harm or suicide. If someone you know is having suicidal thoughts, it’s essential to take these feelings or talk seriously. You can help in several ways.
Because people with quiet BPD don’t exhibit the classic, explosive symptoms of BPD, it can take much longer to get a proper diagnosis. This is particularly troubling when symptoms involve self-harm.
Even though there are actually quiet BPD symptoms listed in the DSM, they’re often overlooked. Ultimately, this makes it that much more difficult for people to get a proper diagnosis.
For those who haven’t been properly diagnosed with quiet borderline personality disorder, it’s common to end up feeling invisible and misunderstood. This makes the disorder harder to live with and can lead to more episodes of self-harm and lower self-esteem.
Only a licensed mental health professional is qualified to make a quiet BPD diagnose, which is based on an interview. You may also fill out a survey or questionnaire to help give additional insight. There aren’t any medical tests for quiet BPD, however a medical exam can be beneficial in ruling out other conditions that might be resulting in symptoms.
Of course, you should always make it known if you have a family or personal history of either BPD or any other co-occurring conditions that are common like anxiety, bipolar disorder, depression, or any eating disorders.
Quiet borderline personality disorder can be diagnosed by meeting 5 of the 9 criteria listed in the Diagnostic and Statistical Manual of Mental Disorders [DSM].
Getting a proper diagnosis for quiet BPD is just the beginning. The good news is that treatment options for quiet BPD have increased over the years as the disorder becomes better understood. Once a diagnosis is made, there are several evidence-based treatments available.
Dr. Lawson of the American Counseling Association notes that “Not so long ago (15-20 years) some very skilled clinicians believed there was no help for individuals who have a disorder like BPD,” says Dr. Lawson. “Now, there are actually very good treatment options, and they are improving.”
According to the National Alliance of Mental Health (NAMI), the following psychotherapy (talk therapy) treatment techniques and methodologies are recommended for quiet BPD:
Talkspace, an online therapy platform, makes getting therapy for BPD and other mental health conditions easy, affordable, and convenient. Talkspace utilizes a number of therapy approaches including the ones mentioned above to help people take control of their lives and not let their mental health condition or mood disorder define who they are.
While there isn’t a medication specifically recommended or approved for treating quiet BPD, medication might help you cope with related issues or conditions (like depression or anxiety).
Whatever method you use to treat quiet BPD, it’s important to find a therapist that you feel comfortable with. Quiet BPD is something you may struggle with on and off for the rest of your life. Treatment can lessen the symptoms significantly and decrease the number of episodes you experience overall.
There are several coping strategies that can be beneficial for quiet BPD. Consider any, or all, of the following techniques:
If you have someone in your life who’s living with quiet BPD, you can help support them in the following ways:
“In order to help someone with quiet BPD you must be patient and reassuring, let them know that it is okay to be vulnerable and ask for help. They often feel like a burden or unworthy of love which causes isolation. Help them develop healthy coping strategies and suggest they seek professional help from a therapist.”
If you or someone you know is dealing with quiet BPD, getting connected with a licensed therapist can be a great first start.
Published 2017. Accessed October 24, 2021.
Accessed October 24, 2021
3. Coolidge F, Thede L, Jang K. Heritability of Personality Disorders in Childhood: A Preliminary Investigation. J Pers Disord. 2001;15(1):33-40. doi:10.1521/pedi.220.127.116.1145. https://pubmed.ncbi.nlm.nih.gov/11236813/. Accessed October 24, 2021.
Bornovalova M, Gratz K, Delany-Brumsey A, Paulson A, Lejuez C. Temperamental and Environmental Risk Factors for Borderline Personality Disorder Among Inner-City Substance Users in Residential Treatment. J Pers Disord. 2006;20(3):218-231. doi:10.1521/pedi.2006.20.3.218.
Published 2017. Accessed October 24, 2021.
Dr. Reshawna Chapple, PhD, LCSW is a Therapist and Peer Consultant at Talkspace. She is a California born - Florida based Licensed Clinical Social Worker and an Associate Professor of Social Work at the University of Central Florida. Her areas of research, teaching and practice include the intersection of race, gender and ability, intimate partner violence and trauma recovery, and access to culturally responsive mental health treatment for Black women and Deaf women.