The Struggles of Quiet BPD

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"Quiet BPD" (Borderline Personality Disorder) is a subtype of BPD that has not been officially included in the DSM.

From the surface, people with Quiet BPD look different from those with classic BPD. Quiet BPD is an internalizing disorder, while BPD is typically an externalizing disorder. Someone with Quiet BPD 'implodes' rather than 'explodes'. You put yourself down when bad things happen, and when you feel rage, you hurt yourself rather than lash out at others.

The emotional pain you suffer is not any less than someone with other forms of BPD, but you do all that you can to hide it. You may appear calm, successful, or even happy, but inside you are plagued with a deep fear of abandonment, toxic shame and severe anxiety of conflicts. Because of how much shame you feel and how much you hide your pain, those around you and even mental health professionals might miss the fact that you are suffering. Quiet BPD often also overlaps with 'high-functioning BPD', where a part of the self is 'split off' to maintain a facade of hyper-competence and independence.

Signs and Symptoms of Quiet BPD

• You look calm on the outside even when you are suffering from extreme pain on the inside.
• You have extreme mood swings that seem to come from nowhere.
• You hide your anger, sometimes to the point you don't know it when you are angry.
• You tend to blame yourself for things even when they are not your fault.
• When relationships end or conflicts arise, you immediately assume you did something wrong.
• You hold up an image that appears 'normal', calm and successful.
• You feel that there is something defective about you.
• You mentally retreat and can become dissociated when stressed.
• Most of the time, you feel empty and numb.
• When someone upsets you, instead of seeking clarification or confronting them, you immediately withdraw and may end the relationship without speaking to the person.
• You feel that you are a burden on others.
• One moment, you idealize other people, but soon you lose trust in them. Generally, you don't feel safe in the world.

There have not been empirical theories that would explain the factors that create this subtype of BPD. Psychoanalytically, it is assumed that people with Quiet BPD turn their anger inward rather than outward because their early experience with the caregivers has taught them that seeking connection from the outside was pointless or even dangerous.

Undercontrol vs. Overcontrol

Dr. Thomas Lynch and colleagues first developed their 'undercontrol/overcontrol' construct when they noticed some people do not respond well to traditional Dialectical Behavioral Therapy—the usual 'gold standard' treatment for BPD. Through research, his team found that some people are 'overcontrolled' rather than 'undercontrolled.' Rather than being dysregulated and impulsive, they have the opposite struggles. They overly tolerate distress to the point where they don't seek help even when needed. They are sensitive to threats and interpersonal cues and easily feel hurt. However, they hide their emotions so much that they appear flat and un-feeling. While most people with BPD are undercontrolled and come across as being overly emotional and erratic, overcontrolled people are quiet, reserved, understated, and seem hard to engage. Because of this, their suffering is missed by most. Usually, undercontrolled personality is associated with Cluster B personality disorders such as Antisocial Personality Disorder or Narcissistic Personality Disorder, while the overcontrolled character is linked to Cluster-C personality disorders such as Avoidant Personality Disorder, Dependent Personality Disorder, or Obsessive-Compulsive Personality Disorder.

According to Dr. Lynch, people who are over-controlled have the following four core deficits:

• Lack of Receptivity and Openness: You tend to be risk-averse and hyper-vigilant. You may avoid new and novel experiences and can be dismissive of other people's input and feedback.
• Lack of Flexible Responding: You may have a compulsive need for structure and order. You plan and rehearse everything. Your life may be governed by rigid rules you impose on yourself. You may also censor yourself and other people's behavior with high moral standards.
• Lack of Emotional Expression and Awareness: You inhibit spontaneous emotional expression. Maybe you have expressions that do not match how you feel inside (e.g. you smile when you are distressed). You also tend to diminish your distress and adopt a stoic facade.
• Lack of Social Connectedness and Intimacy: You may appear distant and aloof and keep people at arm's length. You may also compare yourself with others often and feel envious and bitter.

These biology-based traits are powerful because they are unconscious and affect us without us even realizing it. Because this is an innate predisposition, you cannot will yourself, think yourself, or use more willpower to control or talk your way out of it.

Overcontrol and Attachment Styles

Underlying Quiet BPD can be expressed in anxious or avoidant attachment styles, but on the surface, you appear to be avoidant. This means rather than showing your innermost anxiety and fear of abandonment or trying to seek contact and reassurance, you withdraw to protect yourself. The message you have internalized from a young age is that vulnerability puts you at risk, so it is best that you hide it, suppress it, so that no one can take advantage of you. As a child, you likely exhibit "emotional over-regulation rather than under-regulation" (Martins et al., 2012). Even as an adult, you see yourself as being completely self-reliant. Instead of support from others, self-restraint, discipline, the accumulation of knowledge, resources, and power are what you rely on to feel safe in life.

Treatments for Overcontrol

Traditional Dialectical Behavioral Therapy, as well as many existing psychotherapy methods, are designed to help you raise self-awareness, lower stress, and increase distress tolerance. However, people who suffer from difficulties related to overcontrol, such as chronic depression, anorexia, or obsessive-compulsive personality disorder, usually do not benefit from these methods.

You may benefit from Radically Open Dialectical Behavioural Therapy (RO-DBT), a therapy designed especially for overcontrol. For you, the primary focus of therapy should be to enhance social-connectedness and openness, rather than even higher distress tolerance or behavioral control.

If you already have a therapist, you can also benefit from discussing this trait with your therapist and healing the attachment trauma that has contributed to excessive overcontrol. For example, you can work with your therapist to design behavioral protocols to reduce avoidance. You may also learn from a therapist who will model emotional vulnerability and spontaneity for you. By experiencing safety and trust in your therapeutic relationship, you would heal from the early relational trauma that has taught you to hide. Ultimately, the goal of therapy is to allow you to relax into life and regain the ability to have fun, be spontaneous, and have deep connections with other people.

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Your early experience might have taught you that you must hide your pain to survive, but things are different now. Those who have shamed, humiliated or dismissed you no longer have power over you. And if you are willing to give yourself a chance, there will be therapists and professionals who understand what you have been through and offer the right kind of treatment. It is never too late to move from hurting to healing; and, ultimately, thriving.

To find a therapist near you, visit the Psychology Today Therapy Directory.

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