Borderline personality disorder (BPD) can manifest in young adults in many ways. One of these ways is known as quiet BPD. One of the four types of this personality disorder, it is also referred to as high functioning BPD. It has similar symptoms to other types of BPD; however, they present very differently.
Signs and Symptoms of Quiet BPD
Borderline personality disorder typically presents as angry outbursts and self-destructive tendencies. However, people with quiet BPD turn their anger inward and do not exhibit symptoms in the same way. Alternately, quiet BPD may be called discouraged BPD, as the person always blames themselves for their feelings rather than others.
Quiet BPD can be much more complex to diagnose than typical BPD as the signs may not exhibit outwardly. Symptoms to be aware of include:
- Experiencing extreme mood swings they try to hide
- Self-harming and trying to hide it from others
- Having a very harsh internal critic
- Blaming themselves when things go wrong or for other people’s emotions
- Isolating themselves when they feel upset or angry
- Feeling as though the emotions they have are wrong and they should not be having them
- Taking small things very personally
These symptoms are very similar to BPD, with the difference that individuals try to hide their symptoms from their loved ones. They may experience intense shame if they have an outburst in front of people and will withdraw from their loved ones to avoid showing others their symptoms.
Interpersonal relationships can suffer because of quiet BPD, especially when undiagnosed. People can pull their loved ones closer for a while before pushing them away suddenly. This can be because of a deep fear of rejection, abandonment, and criticism, which people with BPD are highly sensitive to.
Diagnosing Quiet BPD
There are nine criteria that are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
- Having an unstable identity or self-image
- Feelings of intense anger
- Feeling empty
- Rapid and frequent mood swings
- A history of turbulent relationships, including black and white thinking
- Doing anything to avoid abandonment
- Impulsive or risky behaviour
- Self-harm and suicidal ideation
Those seeking a diagnosis for quiet BPD must meet five of the criteria above. However, there is a risk of misdiagnosis with quiet BPD as it does not display in the same way that BPD does. It may instead be diagnosed as depression, social anxiety, or autism.
If you feel that you or your child has received a wrong diagnosis, it is crucial to seek a second opinion. Getting the proper treatment for BPD is vital for successful treatment, and receiving the wrong treatment can do much more harm over time.
Treating Quiet BPD
Quiet BPD can be treated in the same way as other types of BPD, with a combination of therapy and medication. This can include:
- Dialectical-behavioural therapy (DBT) – DBT gives people the tools to manage overwhelming emotions, improving emotional regulation, mindfulness, and distress tolerance. It is often used in BPD treatment.
- Medication – no one medication treats BPD, but medications can be used to target specific symptoms. These can include antidepressants, anti-anxiety medications, and mood stabilisers. Medication is most effective when paired with therapy.
- Family therapy – this type of therapy can be highly beneficial for those with BPD and their families. It can help manage BPD symptoms and improve the function of the family system.
Holistic therapies are also beneficial when treating quiet BPD. Activities such as mindful movement, journaling and reflective writing, and team sports can give young adults an outlet to process their emotions and give them more resources to manage their emotions in daily life.
Managing Quiet BPD
There are many ways for young adults to manage quiet BPD:
- Talk to someone – it is important to talk to others about your experience with quiet BPD. Talk to a trusted friend or adult about your feelings and share any potential triggers you would like people to avoid.
- Check-in with your emotions – take a moment every few hours to check in with your emotions and how you are feeling. Keep a journal and write down your feelings throughout the day and how you coped with them. This can be useful to reflect on later to see which coping methods you could include day-to-day.
- Find soothing activities – as quiet BPD is characterised by intense and often painful emotions, learning how to self-soothe when they arise can help you calm down and take a step back. Try an activity such as meditation, crochet, or yoga.
- Look after yourself – eat a healthy balanced diet, try and get some exercise a few times per week and get plenty of sleep. These simple changes can make a significant difference to your mood!
Parents can support young adults with quiet BPD as well. By setting healthy boundaries, encouraging healthy self-soothing strategies, and understanding their emotions and symptoms, parents can support their children and manage their stress at the same time.
However, it may be impossible for young adults to manage quiet BPD alone. They may feel that they do not deserve to look after themselves or have anyone else look after them because of their poor self-image, so professional support is advisable. Do not hesitate to reach out to The Wave if you would like more information about treatment for BPD.
Quiet BPD is a type of BPD that presents differently from other types. Instead of symptoms presenting outwardly, people with quiet BPD focus them internally, causing extreme emotional distress. It can be a challenging form of BPD to diagnose, as people withdraw from their loved ones and hide their symptoms and emotions.
Young adults can struggle to manage BPD alone, and this is where The Wave steps in. We help young adults manage BPD in a residential setting with various treatments available. Each programme is tailored to every young adult who comes to us, and we take a whole-body approach to healing, combining psychotherapy and holistic therapy. Contact us today to find out more.
Fiona Yassin is the International Clinical Director of The Wave Clinic. Fiona is a UK Registered Adolescent and Family Psychotherapist and Clinical Supervisor (Licence number #361609 NCP/ICP), further trained in the specialty of Eating Disorders and Borderline Personality Disorder Treatment. Fiona is trained in FBT (Family Based Therapy), CBTE for eating disorders, FREED (King’s College, London), EMDR for eating disorders (EMDRIA) and has a Post-Graduate Diploma in Neuroscience and Trauma from the University of Tennessee, Knoxville.
Fiona works with international families and family offices from the UK, Dubai, Kuwait, Singapore and Malaysia. Fiona can be contacted by email on [email protected].