Key Takeaways
- Quiet Borderline Personality Disorder is a form of BPD where people internalise their intense emotions rather than externalising them.
- Symptoms of Quiet BPD include intense episodes of sadness, shame, guilt directed towards self, social withdrawal, fear of rejection, sensitivity to criticism, and distorted self-image.
- The causes of Quiet BPD are not entirely understood, but they may include genetic factors, altered neurotransmitter levels, abuse, dysfunctional family relationships, and trauma.
- Quiet BPD can significantly impact a person’s life, causing uncertainty about their identity, dissatisfaction with oneself, and feelings of emptiness. It can also co-occur with other mental health conditions such as anxiety disorder, depression, eating disorders, bipolar disorders, substance abuse, and post-traumatic stress disorder.
- Leaf Complex Care provides person-centred care to people living with high-functioning BPD and other mental health challenges, offering proper support in their own homes.
What is “Quiet” BPD or High-Functioning BPD?
Borderline personality disorder (BPD) is a mental health challenge affecting around 1.6% of the global population. Also called internalising BPD, it describes when distress is turned inward rather than outward. It is characterised by intense emotions of anxiety, anger, depression, and fear of abandonment, combined with self-destructive behaviours. Due to challenges with emotional regulation, people living with BPD may often affect relationships with their family members, friends, and partners. While mental health experts have a better understanding of this challenge, quiet BPD is still an understudied type.
Quiet borderline personality disorder is a form of BPD where the person directs their painful feelings (such as sadness, anger, and shame) towards themselves. Unlike other forms of borderline personality disorder, people with quiet BPD act inward rather than taking out their emotions on others. The internalisation of intense anger and other strong emotions creates concealed turmoil that can affect a person’s overall perception of the world, which brings emotional instability and chronic feelings of social anxiety, which can lead to deteriorated physical health at one point. On the outside, most people living with quiet BPD can seem emotionally stable and high-functioning. However, on the inside, they experience depression, anxiety, intense mood swings, poor self-image, fear of abandonment, and negative feelings. Therefore, with professional support from a mental health professional, people can learn healthy methods to deal with their condition.
Thereare many research and lived-experience reports that constantly show harmful treatments of borderline personality disorder patients, in hospital settings. Many describe being misunderstood, labelled as “attention-seeking” or “manipulative”, and having their distress dismissed rather than being treated humanely. Studies suggest that standard psychiatric inpatient care, especially when not tailored to BPD, is often unhelpful and can increase the risk of self-harm or suicidal thoughts and behaviour, intense fear, self-blame, uncontrollable anger and overwhelming emotions.
Quiet BPD Symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognises several characteristics of borderline personality disorder, including mood swings, intense anger, an unstable sense of self, and turbulent relationships. However, people living with quiet BPD experience these moments in a unique manner that differs from other forms of borderline personality disorder.
Common characteristics of high-functioning BPD include the following:
- Intense episodes of sadness, shame, and guilt directed towards self
- Repressing and hiding mood changes
- Social withdrawal
- Extreme fear of rejection and sensitivity to criticism
- Distorted self-image and low self-esteem
Quiet BPD Episode
In a quiet BPD episode, a person may experience intense emotional turmoil and inner distress while outwardly appearing composed and calm. During an episode, the person may struggle with overwhelming feelings of fear, anger, or sadness, yet conceal these emotions from others, often with remarkable skill. Internally, they may battle with a relentless storm of self-doubt, anxiety, and emotional pain while externally projecting an image of stability and control. This stark disparity between inner turmoil and outward composure can be profoundly isolating for the person, as their struggles remain hidden from those around them, making it challenging for others to recognise the depth of their emotional turmoil.
People can experience recurring quiet BPD episodes. Developing effective coping mechanisms, practising mindfulness techniques, engaging in regular physical activity, and seeking guidance from therapists specialising in BPD can help in managing the emotional challenges associated with recurring quiet BPD episodes. Additionally, connecting with others who understand the unique challenges of living with BPD can provide invaluable emotional support and practical guidance, contributing to improved management of quiet BPD episodes.
How Long Can Quiet BPD Episodes Last?
Quiet borderline personality disorder (BPD) episodes don’t have a fixed length and are not a permanent state, since they can last from hours or days to weeks or even months, depending on the person and what’s happening in their life. Borderline personality disorder subtypes (quiet BPD, impulsive/externalising BPD, self-destructive BPD) don’t determine whether episodes happen. They influence how distress is processed, and that strongly affects whether episodes are brief and explosive or quiet and long-lasting.
From a clinical and lived-experience perspective, they have a typical duration that still varies widely:
- Short episodes: a few hours to several days (often triggered by a certain event, stress, or rejection).
- Moderate episodes: a few weeks (common when stressors persist).
- Longer phases: several months (usually linked to ongoing trauma, relationship instability, burnout, or lack of support).
What matters most is whether the underlying needs are being met, such as safety, validation, therapy, stable relationships, and coping tools. Without adequate support, quiet BPD patterns can become more chronic, blending into depression or long-term emotional shutdown.
Causes of High-Functioning BPD
Despite mental health professionals acknowledging quiet BPD as one of the most prevalent mental health disorders, medical experts remain uncertain about the precise causes and risk factors associated with high-functioning BPD. Some studies have found genetic links, while others have highlighted brain changes and environmental factors. All in all, common causes of quiet borderline personality disorder include the following:
- Genetic factors
- Altered levels of neurotransmitters in the brain
- Bullying and physical or sexual abuse
- Dysfunctional family relationships
- History of abandonment and rejection
- War-related trauma
Quiet BPD Signs and Symptoms
Getting diagnosed with high-functioning borderline personality disorder can be a challenging process due to the overlap with symptoms of other challenges and the person’s tendency to mask their signs.
Instead of carrying out a specific test, licensed professionals typically use a combination of assessments and interviews to diagnose borderline personality disorder. According to the DSM-5, these are the main criteria for an official diagnosis:
- Lack of emotional regulation
- Unstable relationships
- Impulsive behaviour
- Self-harm
- Distorted self-image
- Dissociation
How Quiet BPD Differs from “Typical” Borderline Personality Disorder
It differs from the “typical” or more externalising BPD in the way distress is expressed rather than in the underlying pathology.
The difference is most visible in the expression of emotions, self-perception and interpersonal relationships, self-harm and crisis patterns, the whole internal experience, the triggers and coping. In other words, quiet BPD = internalising subtype, while typical BPD = externalising subtype.
| Quiet BPD | Typical BPD |
| – Distress is hidden – Crises are internalised – People may appear “high-functioning” externally – Episodes may be long-lasting and chronic | – Distress is externalised – Crises are visible and dramatic – Often receives quicker intervention due to outward behaviour – Episodes may be intense but shorter |
Why Quiet BPD Is Often Misdiagnosed
Quiet BPD is frequently misdiagnosed because its internalised nature hides the classic, outward signs of borderline personality disorder that clinicians often rely on. The misdiagnosis is never about the person being unusual. More frequently, it’s about how BPD presents in quiet/internalising patterns.
Quiet BPD is misdiagnosed because:
- Distress is internalised rather than expressed outwardly.
- Symptoms overlap with depression, anxiety, and trauma disorders.
- Individuals mask their struggles and appear “high-functioning.”
- Clinicians’ expectations regarding BPD focus on externalising behaviours.
People who experience quiet BPD often suffer silently, and without awareness of this subtype, they may not get the specialised care they need.
Challenges and Impacts of High-Functioning BPD (Quiet BPD)
A quiet borderline personality disorder can significantly impact an individual and their loved ones in their everyday life. A quiet borderline personality disorder causes uncertainty about the person’s identity, dissatisfaction with oneself, and feelings of emptiness. People with high-functioning BPD experience frequent negative thoughts, fear of rejection, and regret about expressing their feelings.
People living with quiet BPD may oscillate between clinging to people around them in need of validation and pushing them away to avoid criticism. This leads to frequent mood swings and emotional switches, such as going from extreme excitement to profound sadness. Their outward manifestation does not always reflect their emotional turmoil and may not be related to a family history of experiencing the condition or to childhood trauma. For example, a person with quiet BPD can suddenly feel angry while simply appearing tired to those around them.
High-functioning BPD may lead people to set high expectations for academic or professional performance. If the person doesn’t meet these expectations or receives constructive criticism, they may feel hopelessness, guilt, and shattered self-esteem. In these circumstances, people with quiet BPD might resort to harmful compulsive behaviours, such as overeating, alcohol or drug abuse, and certain repetitive rituals.
Other Mental Health Conditions Co-occurring with Quiet BPD
The presence of co-occurring conditions underscores the importance of comprehensive and personalised treatment that addresses the unique needs of people with quiet BPD and their specific mental health challenges.
Many people experiencing BPD also have another mental health condition or behavioural challenge. Common co-occurring conditions associated with quiet BPD include:
- Anxiety disorder
- Depression
- Eating disorders
- Bipolar disorder
- Substance abuse
- Post-traumatic stress disorder (PTSD)
People living with quiet BPD and co-occurring mental health conditions must receive integrated care that manages the challenges of their emotional and psychological well-being. Practical treatment strategies may involve a combination of therapy, medication management, and support services tailored to address the specific challenges associated with quiet BPD and its co-occurring conditions.
⇒ Read more about The Difference Between BPD and Bipolar Disorder.
Coping Strategies and Self-Care
A sincere and insightful approach to mental health is the first step towards people reaching their full potential while dealing with quiet BPD. Sharing emotional distress is advisable, especially if the person has a tendency towards self-harm. Reaching out to reliable relatives or friends is beneficial during periods of overwhelming emotional distress.
Taking care of one’s physical well-being is an essential part of self-care for people dealing with internalised emotions and stress due to quiet BPD. Therefore, you should prioritise healthy habits such as maintaining a nutritious diet, engaging in regular physical activity, and obtaining adequate sleep. Attending regular appointments with a therapist is a vital part of overcoming the most challenging aspects of high-functioning borderline personality disorder and reaching for more mental health resources.
⇒ Read more about the mental health support Leaf Complex Care can offer.
Treatment Options
Dialectical behaviour therapy is the most favoured therapy option for people with a high-functioning BPD diagnosis. This therapy method offers people with quiet BPD a comprehensive treatment approach, including individual therapy, phone coaching between sessions, and group therapy focusing on skill building. Group therapy can improve emotion regulation and distress tolerance by equipping individuals with resources to overcome interpersonal challenges.
Medication can be combined with psychotherapy to treat symptoms of BPD. Mindfulness can be particularly beneficial for people with quiet BPD because it increases their awareness of the present moment. This enables people to build an identity separate from the overwhelming internalised emotions rather than maintaining a destructive attachment to them. Whether you seek treatment for yourself or a loved one struggling with quiet BPD, finding a therapist with relevant experience is essential.
Leaf Complex Care Supports Individuals with BPD
At Leaf Complex Care, dismantling the stigma around borderline personality disorder (BPD) and providing people with compassionate support is our goal. We deliver person-centred care to people with high-functioning BPD in their own homes, allowing them to stay in their familiar surroundings while being surrounded by their loved ones.
Our human-centred support workers strive to create a safe space for people with high-functioning borderline personality disorder. Your privacy, dignity, and human rights are imperative to our care teams. Our support workers always prioritise the independence of the people we serve and involve them in every decision about the support they receive.
Read more about our case studies and see how our support workers are involved in people’s lives to help them achieve greater independence and build a life on their own terms.
We offer high-standard, CQC-regulated care for people living with high-functioning BPD across the UK, with offices in Bristol, South East, Somerset and the Midlands.
To develop a personalised care plan meeting your loved one’s needs, connect with us today.
