BORDERLINE PERSONALITY DISORDER: CLASSIC OR QUIET?


WHAT IS THE DIFFERENCE BETWEEN ‘CLASSIC’ & ‘QUIET’ BORDERLINE PERSONALITY DISORDER?


Borderline Personality Disorder (BPD) is a very complex mental health condition, which is often very misunderstood & stigmatised. There is also a common misconception that everyone with BPD behaves in the same way, which is far from the truth. Before we look at different ways it can manifest, let's revisit what BPD is...



What is BPD?


The criteria used to diagnose BPD using The Diagnostic & Statistical Manual of Mental Disorders (DSM-5)’ is shown left.

To receive a diagnosis of BPD, an individual must have five or more of these symptoms, which must have a significantly detrimental and longstanding impact on their daily life.

The symptoms that people with BPD experience can vary considerably from person to person:

Many people with BPD meet all nine criteria, but some may meet as few as five. For example one person may meet criteria 1-5 and another may meet criteria 5-9, meaning that they would only cross over on one of them, despite having the same diagnosis.

There are 256 possible combinations!

It is important to note that even if two people meet all the same criteria, the impact and manifestation of their symptoms can still vary considerably.

This is due to factors such as:

- Individual Personality

- Upbringing

- Comorbid Diagnoses

One resulting (and significant) variation is between those who externalise their emotions (Classic BPD) and those who internalise their emotions (Quiet BPD).

‘Classic’ and ‘Quiet’ BPD are broad terms - it is certainly not a clear-cut thing, however it can be helpful to consider which ‘category’ you or the person you are supporting mainly tends to fall into.

In this article we are focussing more on the lesser known ‘Quiet BPD’ but we will also cover a little on ‘Classic’ BPD.


Intense Emotions & Heightened Sensitivity

Before delving into that, it’s really important to touch on why the behaviour of those of us with BPD may seem over-dramatic and irrational.

Our seemingly ‘over the top’ response can actually be logically understandable in relation to the fact that abnormalities in our brain cause us to experience:

- Intense experience of the emotion

- Heightened emotional sensitivity

The impact of this on us is immense. Marsha Linehan (Creator of Dialectical Behavior Therapy, Psychologist and Author) sums it up well, stating that:

People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”

It requires much more than a paragraph in an article to explore this, but that will have to be saved for another day! The main thing to take away from this though is that it’s not our choice to be sensitive or feel so deeply - our brain is literally wired differently and causes this to happen...so try to remember this if it seems we are reacting unproportionally to the situation!

For more information about this, head to: The National Institute of Mental Health (NIMH) where some of this information was taken from.




Classic BPD (Externalising Emotions)

An expressive individual with BPD who has been brought up in an environment where anger is openly expressed may become outwardly emotional and appear ‘over-dramatic’ in proportion to the situation (for reasons explained above). For example, in a situation where they feel they have been wronged, due to struggling with intense and overwhelmingly unbearable feelings they might :


- Shout

- Cry a lot - Get into fights

- Be promiscuous


Individuals with BPD who usually respond in this way are sometimes referred to as having ‘Classic BPD’.


This is often how people assume or expect everyone with BPD will behave.

As difficult as it may be to do in the heat of the moment, it is important to try to understand and validate the feelings (even if they seem out of proportion with the situation) which have caused the ‘outburst’, rather than using invalidating phrases e.g.


‘You’re being ridiculous’

‘Why are you being like this, it’s only a...’

‘Just calm down will you’

Phrases that can be much more helpful include things like:


‘Can you explain to me how you are feeling - I want to understand and try to help?’

‘It must be horrid having such intense feelings right now - I am here if and when you want to talk about it’

‘I’m here for you - I’m not going anywhere’

Obviously, different phrases will work for different people and in different situations - it can be useful to chat with the individual when they are calm to ask what they might be helpful for them when their emotions are heightened. Overall though, the key is to focus on validating the feelings rather than focussing on the behaviour.

That is NOT to say that you validate or encourage negative behaviour or allow yourself to be harmed in any way. Again, a few short paragraphs is not enough to explore this, but that is for another time...!

N.B Some of the suggestions we make for those with ‘Quiet’ BPD may be helpful for those with ‘Classic’ BPD too.


Quiet BPD (Internalising Emotions)

An introverted and quiet/private individual with BPD who was brought up in an environment where:


- Emotional outbursts were forbidden/discouraged

- Conflict was usually avoided

...is more likely to internalise emotions in an attempt to avoid feelings and/or hide them from others. Those of us with BPD who respond in this way are sometimes referred to as having ‘Quiet BPD’.

Internalising emotions (e.g. in response to struggling with intense and overwhelmingly unbearable emotions in response to feeling wronged by someone) can manifest in many ways, but could include:

Masking: - Laughing/smiling when feeling hurt/angry etc

- Acting fine

Shutting Down: - Going very quiet - People-pleasing - Appearing high-functioning despite struggling - Not opening up

Both ‘masking’ and ‘shutting down’ can result in us being walked all over’, taken advantage of or not taken seriously when asking for help, which heightens our experience of invalidation.


Though internalisers’ responses may be less obvious, our emotions are just as intense as externalisers’ emotions and can be just as problematic.


Behind closed doors, hiding away in our beds, the pain/struggle is very much there, and is even more lonely when others assume you're actually doing fine. We may avoid going out when we're unable to put on a happy face. Shutting down/ masking/avoidance can also cause emotions to build up and lead to (often secret) self-destructive behaviour to try to manage/block the pain.

As we briefly did for individuals with ‘Classic BPD’, we will now consider what might be helpful to support those of us with ‘Quiet’ BPD. The same goes that it is important to try to understand and validate the feelings, but also to encourage and reassure us that you are there for us and want to listen to us, and that our feelings are important.

Try not to downplay our emotions or assume we are fine by saying well meaning things like:


‘Don’t worry - everyone feels like that’

‘You look well’

‘You’re doing well’ .


Instead, ASK US, for example;


‘How are you doing? I know you can often appear fine when deep down you are struggling’

‘Is there anything you’d like to talk about? Nothing is too trivial’

‘That situation would be hard for anyone, but I can’t imagine how it would feel with having BPD making it 100 times more intense! Is there anything I can do to help?’

Wait til you have understood and validated the emotions before jumping in with situations on how to distract or squash the feelings or fix the situation. We’re already very good at doing those things, and that is what causes us to remain stuck! THEN, it may be time to look at solutions!

N.B Suggestions we made for those with ‘Classic’ BPD may be helpful for those with ‘Quiet’ BPD too.




Conclusion

The ultimate thing to remember for those of us with ‘Classic’ or ‘Quiet’ BPD is that our feelings matter and are important! Yes they can be intensely painful and and difficult to manage, but when we are able to express them healthily and interpersonally effectively, they can be validated by safe others and ultimately we can learn to validate them ourselves...it’s flippin’ hard work and can take years, but it is so worth it as it enables us to truly move forwards in our recovery!



This article has been compiled from a tiny part of what we cover in our Borderline Arts’ Educational Workshops. If you would like to learn more or for more information about these workshops, please contact workshops@borderlinearts.org (Please note that due to COVID-19, we are not currently running them, however we can register your interest for future workshops).

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