While quiet borderline personality disorder (BPD) is not a recognized subtype of this condition, more research pinpoints the idea that some people with BPD are quieter than others.

BPD is defined by ongoing patterns of mood changes, self-image, and behavioral complexes. ¹ These symptoms will lead to impulsive actions that can cause daily problems, such as with relationships.

Quiet BPD Defined

Since the DSM-V (Diagnostic and Statistical Manual of Mental Health) doesn’t recognize quiet BPD, it’s not as clearly defined as other conditions.

BPD involves continuous patterns of mood swings, difficulties with self-image, and behavioral complications. In turn, these will result in BPD episodes – intense experiences of anger, anxiety, and depression which can last for a few hours.

With traditional BPD, these episodes will appear outwardly. For example, a person may exhibit angry outbursts or obvious self-destructive tendencies. However, with quiet BPD, these emotional episodes will be internalized (such as inward anger).

Since these feelings can become so internalized, many go undiagnosed (or misdiagnosed), or their illness is referred to as “high-functioning” BPD. While people with quiet BPD appear to cope with their symptoms, they actually struggle just as much as those whose BPD symptoms appear outwardly.

Symptoms

Quiet BPD is more difficult to identify than typical BPD since the signs aren’t as obvious. For this reason, it can help to be aware of the signs and symptoms of someone who struggles with BPD. These include:

• Becoming obsessive with a specific person
• Distorted, racing thoughts
• Fear of rejection or being alone
• Feeling hopeless
• Hostile or angry with others
• Idealizing then devaluing other people
• Mood swings
• Numb or empty feelings
• Passive aggressiveness
• Poor (or changing) self-image
• Problematic people pleasing
• Self-harm
• Self-isolation or avoiding people
• Unable to pick up social cues
• Uncontrollable internalized emotions (i.e. shame, guilt)
• Unhealthy boundaries

Again, not all these emotions will be outwardly present in a person who struggles with quiet BPD. For example, instead of showing rage in an outward manner, a person with quiet BPD may place that rage inward and take part in self-destructive behavior.

Furthermore, people with BPD are likely to become moody or withdrawn, especially during an episode. For this reason, if you have a loved one who you believe struggles with BPD, it can help to reach out and check in on them.

Causes

The causes of BPD remain unclear among researchers as we don’t have enough research to completely understand what causes quiet BPD. Still, some potential causes research has found include:

• Genetics – If you have a family history of others with BPD, you’re more likely to struggle with the condition. ²

• Other Illnesses – If you struggle with another mental health condition (such as anxiety, bipolar disorder, an eating disorder, depression, or a substance use disorder), you’re more likely to develop BPD.

• Trauma – Those who have been through abandonment, abuse, neglect, or other types of trauma during childhood are more likely to develop BPD. ³

There is no specific cause that characterizes quiet BPD vs. typical BPD. Normally, this is due to personality complexes and how temperament is influenced.

10 Hidden Signs of Quiet BPD

Since it may be difficult to pick up on symptoms of this condition, you’ll want to keep an eye out for these hidden signs of quiet BPD:

1.) Self-Blame

People with BPD naturally feel emotions stronger than others, whether positive or negative. One of the most common negative emotions they feel is guilt.

Even when there’s no connection to the person with BPD, they may automatically engage in self-blame. For this reason, it’s important to reassure people with quiet BPD when something is not their fault.

2.) Beating Themselves Up

With self-blame often comes negative self-talk. In other words, a person with quiet BPD may think negatively of themselves and “beat themselves up” for every minor action they’ve participated in.

This characteristic of BPD is best left to a therapist. They can find the trigger of these intrusive thoughts and develop coping mechanisms to overcome them.

3.) Retreating Mentally

If a BPD episode is triggered, someone with this condition normally reacts outwardly. However, people with quiet BPD are more likely to retreat inwardly.

This can be one of the most difficult signs to pick up as there are no clear indications of what goes on in someone’s head. However, such inward thinking may result in anxiety and depression. These two conditions can present more obvious signs.

4.) Always People Pleasing

Since most people with BPD have a history of trauma, it’s common for them to react to this trauma by people-pleasing (or “fawning”).

BPD can cause someone to become attached to another person and they’ll spend a large chunk of time trying to ensure this person likes them. It can feel extremely disheartening if this person gets even a little mad at them. ⁴

To avoid such circumstances, a person with quiet BPD will likely do anything they can to ensure the other person is pleased.

5.) Difficulty with Emotional Intimacy

Along with people-pleasing, a common trait with quiet BPD is the fear of abandonment. While some may react to this trait by being “clingy,” others will retreat from relationships entirely. This is to ensure the other person doesn’t have the opportunity to.

Naturally, this can lead to self-isolation and no support from loved ones. If a person with quiet BPD is undergoing therapy, their therapist likely goes over this issue. However, if they aren’t in therapy, they may be left alone in their struggles. This could lead to depression and in extreme cases, suicidal thoughts.

6.) Suicidal Ideation or Self-Harm

When it comes to people with quiet BPD, there’s always the risk they’ll engage in self-harm or develop suicidal thoughts. This is usually caused by inward anger and blaming everything on themselves. Acts of self-harm (i.e. cutting) can be a way to release these emotions.

Since suicide remains a risk among people with quiet BPD, it’s important to understand the warning signs: ⁵

• Discussing the desire to die or kill oneself
• Extreme mood swings
• Feelings of hopelessness, being trapped, or being a burden
• Increased use of drugs or alcohol
• Seeking out ways to kill oneself
• Sleeping too much or too little
• Withdrawing from social activities

If you or a loved one feels suicidal, help is available. In extreme cases, go to your nearest emergency room or call 911. In other cases, you can reach out to the 988 Suicide & Crisis Lifeline.

7.) Internal Rage

One of the most common symptoms of BPD is uncontrollable anger. As mentioned, people with quiet BPD are likely to internalize this emotion rather than outwardly projecting it.

Sometimes, this emotion can be so intense that the anger is difficult to control. This leaves people feeling “trembly” or with a racing mind.

In other circumstances, the internal rage can build up to a point where it’s eventually released outwardly. This can lead to impulsive thinking and behaviors that could make someone’s life much more difficult than it was previously. ⁶

8.) Dissociation

Since people with quiet BPD have likely lived through a traumatic event, it’s also common for them to develop dissociation.

Simply put, dissociation is when someone disconnects from their current circumstances, identity, memories, and thoughts. In turn, this can result in rapid mood swings, trouble remembering details, panic attacks, and impulsive behaviors. ⁷

9.) Self-Sabotage

It’s common for people with BPD to deliberately interfere with their own goals or personal growth (self-sabotage). Most notably, through self-harm tendencies.

This partly feeds in from the self-blame or guilt aspects of BPD. Most people under these circumstances don’t believe they have the right to grow or reach life goals.

10.) Shutting Down

Since people with quiet BPD internalize emotions, they may eventually “shut down” as a result of the pain. While this may appear in ways such as self-isolation, it could also display itself as someone simply not wanting to talk. Shutting down is very much a quiet BPD meltdown.

Treatment

Since quiet BPD can’t be diagnosed, there are no standard treatments for this form of the condition. Furthermore, the Food & Drug Administration (FDA) has yet to approve any medication for the treatment of BPD.

With that said, most people find relief from BPD through various psychotherapies:

• Cognitive Behavioral Therapy (CBT) – A form of talk therapy that identifies thought and behavior patterns and helps you develop coping mechanisms to overcome those patterns. ⁸

• Dialectical Behavior Therapy (DBT) – Developed specifically for BPD, this therapy teaches mindfulness in the management of emotions and stress. ⁹

• Schema Therapy – A combination of varying therapeutic approaches that emphasize relationships (may be used for quiet BPD and romantic relationships). ¹⁰

Even though there are no FDA-approved medications for BPD, you may receive a prescription if you struggle with another mental illness. Furthermore, you may find relief from vitamins and supplements for BPD.

Final Word

While it’s impossible to diagnose quiet BPD, there’s no denying its existence. The internalization of emotions can be a major setback for those who struggle with the condition, and many times it goes unnoticed.

If you believe someone you love struggles, we recommend learning how to help someone with BPD. While this can be a challenge, people with BPD need a support system. And your support may be all someone needs to overcome their illness.

References

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² Amad A, Ramoz N, Thomas P, Jardri R, Gorwood P. Genetics of borderline personality disorder: systematic review and proposal of an integrative model. Neurosci Biobehav Rev. 2014 Mar;40:6-19. doi: 10.1016/j.neubiorev.2014.01.003. Epub 2014 Jan 20. PMID: 24456942.

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⁴ Stepp SD, Smith TD, Morse JQ, Hallquist MN, Pilkonis PA. Prospective associations among borderline personality disorder symptoms, interpersonal problems, and aggressive behaviors. J Interpers Violence. 2012 Jan;27(1):103-24. doi: 10.1177/0886260511416468. Epub 2011 Aug 22. PMID: 21859760; PMCID: PMC3575083.

⁵ Tsai M, Klonsky ED. Warning signs for suicide attempts in psychiatric inpatients: Patient and informant perspectives. Gen Hosp Psychiatry. 2023 Nov-Dec;85:207-212. doi: 10.1016/j.genhosppsych.2023.11.005. Epub 2023 Nov 10. PMID: 37979471.

⁶ Kim J, Deater-Deckard K. Dynamic changes in anger, externalizing and internalizing problems: attention and regulation. J Child Psychol Psychiatry. 2011 Feb;52(2):156-66. doi: 10.1111/j.1469-7610.2010.02301.x. Epub 2010 Sep 1. PMID: 20825522; PMCID: PMC3006010.

⁷ Lanius RA. Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research. Eur J Psychotraumatol. 2015 May 19;6:27905. doi: 10.3402/ejpt.v6.27905. PMID: 25994026; PMCID: PMC4439425.

⁸ Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am. 2010 Sep;33(3):657-85. doi: 10.1016/j.psc.2010.04.007. PMID: 20599139; PMCID: PMC3138327.

⁹ Chapman AL. Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont). 2006 Sep;3(9):62-8. PMID: 20975829; PMCID: PMC2963469.

¹⁰ Tan YM, Lee CW, Averbeck LE, Brand-de Wilde O, Farrell J, Fassbinder E, Jacob GA, Martius D, Wastiaux S, Zarbock G, Arntz A. Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PLoS One. 2018 Nov 21;13(11):e0206039. doi: 10.1371/journal.pone.0206039. PMID: 30462650; PMCID: PMC6248917.