A Closer Look at Quiet BPD and Its Symptoms

Borderline personality disorder is a mental health condition that can cause extreme emotional swings and unstable self-image. While people with BPD are considered to be impulsive, emotional, and prone to intense anger, BPD traits can show up differently. In some people, BPD symptoms are mostly directed inwards. This is called  “quiet BPD.”  This differs from the display of classic BPD symptoms. 

What is quiet BPD?

In “quiet” borderline personality disorder (BPD), symptoms are directed mostly inwards, rather than directed toward others. This means that instead of expressing intense feelings through outbursts — as is common in classic BPD — people with quiet BPD tend to keep their pain inside. In simple terms, this mental health condition can significantly affect a person’s inner world and daily life, even if those struggles aren’t outwardly visible.

Mental health professionals don’t recognize this or any other type of BPD officially. It also isn’t described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Instead, it can be used to better understand the patterns in this condition and provide the right mental health treatment.

Quiet BPD symptoms and signs

The symptoms are quite similar to a typical BPD, but the way they show up is more hidden or directed inward. Instead of explosive responses, intense emotions are often buried, and it makes the person seem calm, even when they struggle deeply inside. 

According to the DSM-5, there are nine core symptoms of borderline personality disorder. To be diagnosed, a person must show at least five of them. These include:

1. Fear of abandonment
2. Unstable relationships
3. Poor self-image
4. Impulsive and self-destructive behaviors
5. Repeated suicidal thoughts or self-harm
6. Extreme mood swings
7. Chronic feelings of emptiness
8. Explosive anger
9. Feeling suspicious or out of touch with reality under stress

At the same time, those living with quiet BPD might represent specific symptoms. They aren’t scientifically proven, but according to the theory of subtypes, quiet BPD is characterized by specific signs:

• Blaming oneself instead of others
• Withdrawing when you’re upset
• Constant feeling of guilt and shame
• Fear of being a burden
• Overthinking, rumination, and silent self-criticism
• Taking things personally
• Hiding or suppressing intense anger to avoid confrontation
• Trying to hide any manifestations of the borderline personality disorder symptoms

What does a quiet borderline personality disorder (BPD) look like?

It can be more challenging to diagnose BPD in those whose symptoms are mostly quiet because the signs are mainly hidden. Yet, the emotional distress is still there, but mostly bottled up rather than shown openly. 

A person with quiet BPD may appear calm and polite on the outside, while inside they are overwhelmed by fear of rejection and self-doubt. So, instead of showing intense mood swings, they might:

• Overanalyze everything, trying to understand whether they did something wrong
• Push people away just to avoid being potentially abandoned in the future
• Disappear from friends or any other social circles when feeling overwhelming emotions
• Overthink or silently criticize themselves for past mistakes
• Have black and white thinking, especially when considering their own problems

This is how a user with BPD describes their experience: “When you live with quiet borderline personality disorder, you may go to work every day, perform well, and seem like you have everything under control. Still, inside, I feel deeply stressed and experience frequent mood swings. I try to hide my loneliness outwardly but instead turn it on myself through inner criticism or thoughts about self-harm.”

This can make quiet borderline personality disorder isolating. Since people living with this mental health disorder often mask their pain, they may go undiagnosed for years. Also, it’s possible to misdiagnose it with depression or anxiety, as the symptoms (like low self-worth, withdrawal, or emotional numbness) can be pretty similar.

Causes of quiet (high-functioning) BPD

The causes for developing quiet BPD are similar to the ones for developing the typical form of the condition. This is because quiet borderline personality disorder is considered a subtype rather than a separate diagnosis. 

Even more, as this isn’t a subtype officially acknowledged by the mental health community, there are no studies for quiet BPD. So, we’ll provide the information based on what is known about BPD in general, while highlighting how these factors may present differently in the quiet subtype.

1. Childhood trauma and adverse childhood experiences

A study published in Frontiers in Psychology states that emotional neglect and childhood trauma are associated with 30-90% of borderline personality disorder cases. [1] This is because if a child grows up in an environment where their feelings are dismissed, they might not learn how to handle emotions healthily. Instead, they could start reacting in extreme ways (from acting out to shutting down), which may later lead to borderline personality disorder development.

2. Genetics and family history

According to another study, genetic factors also matter as they account for 40-60% of BPD variation. [2] It’s challenging to say why this disorder develops, as there’s no specific gene that causes it. Still, inherited traits — like heightened sensitivity or difficulty managing stress — may increase the risk. If a close family member has borderline personality disorder or another mental health condition, it may raise the chances of developing similar issues.

3. Brain differences

Brain scans show that people with BPD often have changes in certain brain areas. These include smaller sizes in parts that help with emotions, decision-making, and memory (like the frontal lobe, amygdala, and hippocampus). [3] Even more, the amygdala of people with quiet borderline personality disorder reacts too strongly to emotional triggers, while the anterior cingulate cortex may have trouble calming those reactions down. [4]

Risk factors

These were the main causes of quiet BPD. The research published in Diagnostics also highlights the risk factors that can potentially contribute to the disorder’s development (as developmental stressors). Here they are:

• Low socioeconomic status
• Long periods of being separated from the mother during early childhood
• Peer rejection
• Harsh discipline in a family
• Chronic stressors
• Alcohol and drug dependence in adolescence [5]

Some researchers also suggest that a hyperbolic temperament may play a role. This means that people might experience quiet BPD episodes because they naturally feel things more deeply and intensely than others. 

When their environment doesn’t understand this emotional intensity, it can lead to challenges with handling emotions. Over time, this mix of emotional sensitivity and difficult life experiences may contribute to the development of borderline traits. [6]

Triggers of quiet BPD episodes

A study published in the Author manuscript has highlighted the main triggers and 

environmental factors contributing to the inner turmoil of a person with BPD. These can make the symptoms of quiet BPD manifest suddenly or intensify without outward signs:

• Rejection. Feeling like no one needs you can make a person suddenly pull away from everyone, leading to self-isolation.
  
• Abandonment. Panic, acting out, or clingy behavior might stem from the emotional turmoil a person experiences while being left out.
  
• Betrayal. When trust is broken, it can lead to intense emotions like anger or suspicion.
  
• Disappointment in others. When people let someone with BPD symptoms down, it can cause fights or emotional pain.
  
• Being offended. Taking things personally may be another trigger of intense emotional reactions.
  
• Threats to self-image. Anything that shakes the sense of self can lead to difficulties with emotional regulation.
  
• Being alone. Feeling lonely can bring up deep sadness or cause risky behavior and suicidal ideation. [7]

Complications and long-term impacts on mental health and interpersonal relationships

While the symptoms of quiet BPD often stay hidden from others, the inner struggles are very real and can deeply affect a person’s routine. These are the complications they can bring to life over time:

1. Mental well-being issues

Borderline personality disorder (BPD) may lead to daily issues with emotional stability. Quiet BPD can make a person feel overwhelmed by strong emotions, constant self-criticism, and confusion about who they are. 

Over time, this can turn into low self-esteem and feeling emotionally drained. Some people with quiet BPD may also feel numb, like they’ve lost touch with themselves.

2. Interpersonal difficulties

Quiet BPD may bring some challenges in communication with others. This can involve chaotic relationships, clinginess or emotional withdrawal, difficulty setting or respecting personal boundaries, etc. As quiet BPD might be a part of a personal or family history, it can also shape how a person forms attachments, trusts others, or reacts to conflict. This can cause emotional distance in a relationship.

3. Challenges in daily functioning

4. Common co-occurring conditions

As researchers state, people with a BPD diagnosis are likely to have numerous other mental health conditions. [8] Among the most common personality disorders that can co-occur with BPD are:

• depression
• generalized anxiety disorder
• social anxiety disorder
• substance abuse disorder
• eating disorders
• post-traumatic stress disorder (PTSD)
• attention-deficit/hyperactivity disorder (ADHD) [9]

How is quiet BPD diagnosed?

Only a licensed mental health professional can diagnose a mental illness. They use criteria from the DSM-5 to assess patterns of thoughts, emotions, and behaviors. 

Please note that it’s impossible to diagnose a person, particularly with quiet BPD. Mental health professionals can only identify that someone lives with BPD and recognize that their symptoms may appear more internalized or hidden. These are the ways they can get a better understanding of what’s going on with someone’s psychological state [10, 11]:

Structured diagnostic interviews

These are detailed, standardized interviews conducted by trained clinicians to formally diagnose BPD based on DSM-5 criteria. Professionals may interview patients about everyday life, desire for self-harm, emotional experiences, and coping mechanisms to better understand their mental state. 

They can also assess life history, discuss family patterns, and what issues might affect their interpersonal relationships. The Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) is a common example.

All-involving questionnaires

Professionals can turn to the Mental Health Inventory-5 to spot the emotional turmoil and notice quiet BPD symptoms. They might also use other surveys to check mood fluctuations, anxiety, and how a person deals with stress. This way, psychiatrists collect more data on the manifestations and can spot other mental health disorders as well.

Clinician-rated measures

Trained professionals can provide a more comprehensive overview of the symptoms of personality disorders (particularly BPD), their severity, and context. For instance, Borderline Evaluation of Severity Over Time (BEST) might be helpful to track changes in BPD symptoms across time. As the BEST is based on ongoing clinical observation, it helps clinicians detect patterns that may not be immediately evident in a few hours’ one-time interview. 

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Treatment options for individuals with quiet BPD

As clinicians can’t diagnose people, particularly with high-functioning BPD, it’s approached in the same way as a typical BPD. It’s usually cured through talk therapy of various types, where a person can find a safe space to express their emotions and learn to handle them. Here are some types of treatment that might be helpful to overcome the challenges of living with quiet BPD.

1. Cognitive behavioral therapy (CBT)

This is a perfect fit to treat not only borderline personality disorder but also other mental health conditions (like eating disorders or substance abuse) as well. It allows a person to change unhelpful beliefs and behaviors, and fill in skill gaps that keep symptoms going. [12] CBT also relies on a clear, supportive therapist–patient relationship, which helps build motivation and trust. 

If a person lives with quiet BPD, cognitive behavioral therapy might help them learn to free up their emotions and express their needs openly. Individuals with quiet BPD may also learn to develop a more stable sense of self, thus reducing unstable self-esteem.

2. Dialectical behavior therapy (DBT)

This type of therapy is often used for people with mood-related challenges. As the article published in Psychiatry states, the standard DBT treatment package consists of weekly individual therapy sessions, a weekly group skills training session, and a therapist consultation team meeting. [13]

DBT might be focused on being more mindful, coping with stress, and regulating emotions. For people with high-functioning BPD, it may help them manage intense experiences, set healthy boundaries, and reduce self-sabotage.

3. Schema therapy

Schema therapy is another effective treatment for borderline personality disorder. [14] It helps individuals with quiet BPD to understand and change deep negative beliefs they formed in childhood. These beliefs, called schemas, often come from not getting enough love, safety, or support. The therapy looks at how they affect current thoughts and behaviors to let people find better ways to cope with them.

4. Mentalization-based therapy (MBT)

Another study published in Psychology and Psychotherapy has proven that MBT can bring a significant change to people with quiet BPD. [15] It allows you to:

• Understand your feelings better
• Manage intense emotions more effectively
• Reduce impulsive behaviors
• Build stronger and healthier relationships

5. Medication management

When getting professional support, your psychiatrist may also recommend that you take some medications. There are no specifically approved treatments for BPD, and they cannot serve as the main treatment. Yet, they might help handle specific symptoms of high-functioning BPD, like mood swings, anxiety, depression, or impulsivity. 

Coping strategies and self-care to avoid emotional pain

If living with quiet BPD brings some challenges to your life, it should be approached and treated with a mental health professional. Nevertheless, there are some simple self-care things that might help you become more emotionally stable. They aren’t targeted at people with quiet or typical BPD but may be helpful to everyone, as they promote emotional balance, reduce stress, and build resilience against difficult feelings.

How to help someone with quiet BPD

Living or connecting with someone who experiences quiet BPD might be challenging — they can handle inner struggles daily, face immediate danger from their own psycho, or experience the anger focused inward. You need to understand and appreciate these differences to provide the right kind of support. Here are some tips to consider:

• Listen without judgment. What might sound meaningless to you can be super-important and triggering for another person. Let someone with quiet BPD share their feelings without pressure.

• Respect boundaries. Remember that everyone needs space to process emotions, especially people with quiet BPD. Respect it, but let a person understand that you’re always here to help.

• Be patient. Quiet BPD might involve inner battles. Don’t push someone if they’re not ready to share.
  
• Watch for warning signs. Pay attention to whether your loved one shows any signs of suicidal or self-harming thoughts. Encourage them to seek immediate help if needed.
  
• Learn about quiet BPD. Understanding more about the condition and its symptoms will let you respond with empathy rather than confusion.

Conclusion

Working on your thoughts, emotions, and behavioral patterns is a powerful way to deal with unstable self-image and handle the symptoms of quiet BPD. The Breeze app can become your all-in-one toolkit that allows you to notice unhelpful beliefs and challenge them. Try mood tracker and journaling options to notice how quiet BPD might manifest. Then, try customizable routines to take care of yourself, get more grounded, and build emotional resilience.

Sources

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3. Lis E, Greenfield B, Henry M, Guilé JM, Dougherty G. “Neuroimaging and genetics of borderline personality disorder: a review.” J Psychiatry Neurosci. 2007
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7. Miskewicz K, Fleeson W, Arnold EM, Law MK, Mneimne M, Furr RM. “A Contingency-Oriented Approach to Understanding Borderline Personality Disorder: Situational Triggers and Symptoms.” J Pers Disord. 2015
8. Shen CC, Hu LY, Hu YH. “Comorbidity study of borderline personality disorder: applying association rule mining to the Taiwan national health insurance research database.” BMC Med Inform Decis Mak. 2017
9. The British Journal of Psychiatry. “Pharmacological interventions for co-occurring psychopathology in people with borderline personality disorder: secondary analysis of the Cochrane systematic review with meta-analyses.” 2024
10. Tedesco, Vanessa & Day, Nicholas & Lucas, Sophie & Grenyer, Brin. (2023). “Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience.” Personality and Mental Health.
11. Thornton, Owen & Li, Wenjun & Cole, Hunter & Cólon, Isabella. (2023). “Borderline Personality Disorder Diagnosis and Assessment: A Review of Criteria and Tools.”
12. Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. “The effectiveness of cognitive behavioral therapy for personality disorders.” Psychiatr Clin North Am. 2010
13. Chapman AL. “Dialectical behavior therapy: current indications and unique elements.” Psychiatry (Edgmont). 2006
14. 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
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