One of the hardest aspects of psychology is trying to accurately diagnose someone with a mental disorder. This is one of the main reasons why it takes years of education and clinical practice and experience to become licensed.
Medical doctors have the benefits of being able to see the symptoms of their patients. Broken bones, high cholesterol, and organ inflammation can all be tangibly measured.
Mental health professionals do not have these luxuries and must rely on the behaviors and words of their patient. In the case of borderline personality disorder, the symptoms are often highly visible such as intense mood swings, rage, and unpredictable behavior. These extreme outbursts can make it easy to diagnose, but what happens if these issues aren’t so obvious?
What Is Quiet Borderline Personality Disorder?
According to The National Institute of Mental Health, borderline personality disorder is marked by unpredictable mood swings, faulty self-imaging, impulsive behavior, extreme “black and white” thinking, self-harming, and a general inability to maintain stable relationships with others.
Additionally, episodes of intensely heightened anger, depression, or anxiety are common with borderline personality disorder, and these episodes may last for a few hours or even a few days. As of now, there remains no clear cause for borderline personality disorder but experts believe a combination of genetics, brain structures, and functions, coupled with environmental and social experiences, are contributing factors.
Therapists often point toward childhood trauma or abuse as being potential root causes for the disorder. In the official sense, “quiet” borderline personality disorder is not distinguished any differently than “regular” borderline personality disorder. Although different, they are still diagnosed the same. In more traditional forms of borderline personality disorder, episodes are characterized by episodes of violent and unpredictable outbursts, but with the quieter versions, these episodes are directed inward. There will traditionally be much less hostility and aggression towards others and fewer outbursts, but instead, there will be increased isolation, self-injurious behaviors, and even suicide attempts.
Some of the more intense emotions that a person will experience include:
- Emotional attachment and unhealthy obsessions
- Fear of being rejected and abandonment issues
- Mood swings
- Self-blame and intense guilt
- Severe self-doubting
This “quieter” version will still result in a person experiencing the intense emotional roller coaster that trademarks the disorder, but they will often work hard to shut these emotions down or push them aside. In most cases, their sense of self is heavily marked with shame and self-hatred. Borderline personality disorder often results in a person feeling that their emotions are “wrong,” and so they spend a lot of time pushing their feelings down or working to justify them. These feelings often lead to either outbursts or withdrawal. As a result of these opposite reactions, it can make it very difficult to accurately diagnose borderline personality disorder.
What Are the Symptoms of Quiet Borderline Personality Disorder?
The symptoms of this disorder are mostly manifested inward, which makes them very difficult to identify or notice to an outsider. Even for someone that suffers from these symptoms, they may feel like it’s completely normal and that everyone else probably experiences them as well. Some of the most common symptoms are:
- Experiencing intense mood swings that can last for hours or even days, but no one else can tell
- Suppressing feelings of anger or outright denying they exist
- Withdrawing from others when feeling upset
- Avoiding talking to others that have upset you and instead cut them off
- Blaming yourself when there’s a conflict
- Persistent feelings of guilt and shame
- Being “thin-skinned” and taking things too personally
- Extremely low self-esteem
- Feelings as though you are a burden to others
- Feelings of being numb or empty
- Feeling detached from the world and sometimes feeling as though you are dreaming
- Trying very hard to please people, even at an unreasonable cost
- Deep-seated fear of being rejected
- Social anxiety and tendency to self-isolate
- Being afraid of being alone while pushing people away at the same time
- An inability to build connections with other people
- Self-harm or thoughts of suicide
How Is Quiet Borderline Personality Disorder Diagnosed?
The symptoms of quiet borderline personality disorder are typically internalized and therefore make it difficult to notice. A person’s intense feelings of rage, sadness, and frustration will be directed inward and they will have a tendency to cut off interactions with the ones that they love. This makes it very hard for other people to notice there may be a problem and that their loved one may need to see a mental health professional.
Since people suffering from this quiet form of borderline personality disorder don’t exhibit the traditional explosive symptoms, it will take much longer to receive an accurate diagnosis, which can be dangerous since self-harm and suicidal thoughts are often involved. Even in the event that a person realizes they have an issue, their symptoms can be so difficult to notice that sometimes they are overlooked when a patient is being evaluated. Patients that are not properly diagnosed can end up feeling worse about their situation, which will make their disorder even harder to live with and can lower their self-esteem even further and increase the episodes of self-harm.
Are There Treatments for Quiet Borderline Personality Disorder?
Once a person is diagnosed with the quiet version of borderline personality disorder, then they can begin the battle to improve their mental health. It can be a huge relief for someone to find out that they do indeed have a specific mental illness since they may have been misdiagnosed in the past.
Over the years, there have been increases seen in the treatment for borderline personality disorder. As more is being learned and understood about the disorder, such as symptoms sometimes being “quiet,” there are several more evidence-based treatments being created. Some of the best treatments include:
Otherwise known as talk therapy, this treatment is a fundamental approach to borderline personality disorder. The goals of psychotherapy are to help the patient:
- Focus on their current ability to function
- Learn how to manage the emotions that make them feel uncomfortable
- Reduce their impulsiveness by helping them observe their feelings rather than acting on them
- Work to improve their relationships by being aware of their feelings and the feelings of others
- Educating them on borderline personality disorder
Some of the various types of psychotherapy that can be effective in treating borderline personality disorder include:
- Dialectical behavioral therapy. This therapy includes group and individual therapy sessions that are designed specifically to treat borderline personality disorder. By using a skills-based approach, dialectical behavior therapy teaches the patient how to better manage their emotions, tolerate distress, and improve their relationships with others.
- Schema-focused therapy. Performed either individually or in a group, schema-focused therapy helps the patient to identify their unmet needs that may have led to their negative life patterns, which at some point may be helpful for survival, but are not hurtful in several areas of their life. By getting these needs met in a healthy manner, the patient will be able to promote more positive life patterns.
- Mentalization-based therapy. A type of talk therapy, mentalization-based therapy helps the patient to identify their own thoughts and feelings at any given moment in order to create an alternate perspective on the situation. The emphasis is placed heavily on thinking before reacting to a situation.
- STEPPS. This acronym is broken down into Systems Training for Emotional Predictability and Problem Solving and is a 20-week treatment program that involves working in groups incorporating the patient’s family members, caregivers, friends, or significant others.
- Transference-focused psychotherapy. Otherwise known as psychodynamic psychotherapy, this treatment aims to help the patient understand their emotions and interpersonal difficulties by developing the relationship between the therapist and the patient. This insight is then applied to their ongoing situations in their lives.
There are currently no drugs specifically approved by the Food and Drug Administration to treat borderline personality disorder, but there are plenty of medications that can help to combat the symptoms. Medications such as antidepressants, antipsychotics, or mood-stabilizing drugs can all be effective to treat various symptoms such as depression, impulsiveness, aggression, or anxiety.
For individuals that need more intense treatments, they may need to spend some time in a psychiatric hospital or clinic. These hospitals can help to keep the patient safe from self-injury and will address suicidal thoughts and behaviors.
It can be very difficult to accurately be diagnosed with borderline personality disorder when the symptoms are “quiet’. Symptoms are internalized and end up not being seen as easily by others. Still, there are ways that it can be seen and many options available to help treat it once diagnosed.
The best way to discover if you may be experiencing a “quiet” version of borderline personality disorder is to talk to a mental health professional. If you routinely experience several of the symptoms listed above then it will be more than worth time and effort to speak with a psychiatrist in order to find out. Anyone experiencing suicidal thoughts of self-harm should seriously consider seeking treatment and counseling or calling the suicide hotline at 800-273-8255.