Borderline personality disorder (BPD) is a type of mental health condition that’s known for fluctuations in mood and behaviors. People with BPD may also struggle with relationships as well as their own self-image.

You may be familiar with BPD, but there are also other subtypes of this condition. One such subtype is known as “quiet” BPD, which means that you direct your struggles more inward so others don’t notice.

Quiet BPD is difficult to diagnose and treat, but the earlier you seek help, the better the outcome. Here’s what you need to know.

To date, there are four recognized types of BPD:

  • discouraged (“quiet”) borderline
  • self-destructive borderline
  • impulsive borderline
  • petulant borderline

As with other mental illness terms, “quiet” BPD can be misleading.

Having quiet BPD means that you direct any mood swings and behaviors inward, rather than directing them toward others. In other words, you “act in,” rather than “act out.”

Acting inward can complicate an already invisible mental illness. With quiet BPD, you may direct significant feelings toward yourself without letting others see them. Such intense emotions may include:

  • anger
  • anxiety
  • emotional attachments/obsessions
  • fear of abandonment or rejection
  • mood swings
  • self-blame and guilt
  • severe self-doubt
  • rage

Quiet BPD is also sometimes called “high-functioning” BPD.

This is another potentially misleading term that indicates a person with this type of BPD may not “show” their symptoms and are still able to cope in everyday situations, such as work and school.

Since quiet BPD tends to manifest inward, this form of borderline personality may be difficult to identify at first. Some of the most notable symptoms of quiet BPD include:

  • mood swings that can last for as little as a few hours, or up to a few days, but no one else can see them
  • suppressing feelings of anger or denying that you feel angry
  • withdrawing when you’re upset
  • avoiding talking to others who have upset you and cutting them off instead
  • blaming yourself whenever there’s a conflict
  • persistent feelings of guilt and shame
  • having a “thin skin” and taking things personally
  • extremely poor self-esteem
  • feeling like you’re a burden to others
  • feelings of numbness or emptiness
  • feeling detached from the world and sometimes feeling like you’re in a dream (derealization)
  • people-pleasing, even at a cost to yourself
  • deep-seated fear of rejection
  • social anxiety and self-isolation
  • fear of being alone, yet pushing people away at the same time
  • inability to build connections with others (depersonalization)
  • self-harm or suicidal thoughts

Keep in mind that some people with quiet BPD may experience just a few of these symptoms, while others might experience more.

Many people with quiet BPD struggle in silence out of fear of burdening anyone. Without help, though, the symptoms may worsen over time.

Increased risk of other mental disorders

This type of borderline disorder may increase your risk of other mental health disorders, including:

Hard to establish and sustain relationships

It can be difficult to establish and sustain relationships when you have quiet BPD, and some of the related symptoms can cause even more difficulties in this area.

You might find it hard to connect emotionally with others because of the constant push and pull where you’re afraid of getting hurt but are also afraid of being alone.

Difficult to maintain work or school schedule

You might also find it increasingly challenging to maintain your role at work or in school.

Untreated quiet BPD may increase your risk for acting out impulsively, and engaging in uncontrolled spending, gambling, drinking, and other dangerous behaviors.

Self-harm and suicidal thoughts may occur

Self-harm and suicidal thoughts or actions may also take hold. Always take any talk or feelings of suicide seriously.

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Mental illnesses are often hereditary, and BPD is no exception.

One study found that the development of personality disorders during childhood had significant genetic links. Adults with BPD may also have a family history of the condition.

Genetics aren’t the only causes of the development of BPD during childhood.

Researchers have also noted that emotional and physical abuse, as well as childhood neglect can increase an individual’s risk. Exposure to — or a personal history of — unstable relationships may also contribute.

Alterations in the neurotransmitter serotonin can be associated with BPD. However, it’s not clear whether brain changes lead to BPD or if they occur after the fact.

Certain risk factors have also been shown to influence the development of quiet BPD. These may include a history of:

  • eating disorders
  • substance abuse
  • bipolar disorder
  • anxiety
  • depression
  • abandonment or neglect

Due to misconceptions and the inward nature of this condition, quiet BPD is also sometimes misdiagnosed as another condition, such as depression or social phobia.

While such conditions may occur together, quiet BPD is a separate diagnosis that only a mental health professional can make.

Licensed mental health professionals, such as psychiatrists and psychologists, can diagnose quiet BPD based on an interview with you.

They may also have you fill out a survey based on your symptoms to gain some insight.

There’s no medical test for quiet BPD per se, but undergoing a medical exam may help rule out other conditions that may be contributing to your symptoms.

It’s also important to let your healthcare provider know if you have any personal or family history of BPD or other common co-occurring conditions such as anxiety, depression, bipolar, or eating disorders.

An at-home BPD online survey may also help guide your way to obtaining a diagnosis.

Keep in mind that such online screenings should not replace an official discussion with a mental health professional. Self-diagnosing a mental illness can be problematic.

It can be difficult acknowledging a need to talk to someone about your struggles, but you’ll likely find a sense of freedom and validation once you do so.

Psychodynamic therapy, dialectical behavior therapy (DBT), or psychiatric medications are among the first lines of treatment for quiet BPD.

DBT teaches mindfulness strategies, emotional regulation, distress tolerance, and interpersonal effectiveness.

With practice, this can help reduce self-destructive thoughts and actions. A psychotherapist administers DBT.

If a psychiatrist recommends it, certain mental health medications may help ease some of your symptoms.

However, you shouldn’t rely on medications alone, as they don’t necessarily address the underlying causes of your BPD. Such medications often work bestin conjunction with psychotherapy.

Quiet BPD can take time to identify, but the sooner you understand your symptoms, the sooner you can take action.

It’s important to recognize that your feelings do matter, and that it’s perfectly acceptable to share them with others.

While you might quietly struggle with persistent guilt and poor self-worth, the truth is you deserve a happy and fulfilling life.

See a mental health professional to get started.