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4 types of borderline personality disorder


The Four Types of Borderline Personality Disorder - OPI Residential Treatment Center for Young Adults

Borderline personality disorder, commonly known as BPD, is a mental disorder usually diagnosed in young or early adulthood and affecting between 1.6 and 5.9 percent of Americans, according to Psych Central. It is commonly misdiagnosed or missed altogether as some of the symptoms can mirror other disorders, and BPD often coexists with another disorder. The major indicators of BPD are an inability to maintain healthy relationships, intense mood swings, and impulsivity leading to risky behavior.

Symptoms of BPD

In order to be diagnosed with Borderline Personality Disorder, at least five of the following BPD symptoms must be present and also form a chronic and repetitive pattern:

  • Extreme fear of rejection and abandonment, both real and imagined
  • Stormy personal relationships swinging from idealization to devaluation
  • Unstable self-image
  • Inappropriate bouts of intense anger
  • Chronic feelings of boredom or emptiness
  • Emotional instability, including irritability and anxiety
  • Paranoid and dissociative thoughts
  • Impulsivity leading to reckless and harmful behavior

Sufferers of BPD tend to do whatever they can to avoid any form of perceived abandonment or rejection, having extreme reactions to things such as a vacation or someone being a few minutes late to an appointment. These feelings can trigger intense anger and lead to impulsive and self-harming behavior. Sometimes these behaviors include suicidal tendencies, although usually, the intent is not to follow through.

Relationships are tough for those who suffer from BPD as feelings can quickly shift from one of intense love to a feeling of the recipient not caring enough or not being there for them. Usually, BPD causes turmoil in all relationships, not just personal ones, but can extend into the workplace as well. Those who suffer from BPD are extremely sensitive to their environment, and seemingly innocuous events can be a trigger.

Impulsive thoughts and actions can lead to self-harming actions like substance abuse, reckless driving, eating disorders, self-mutilation, risky sexual behavior, and inappropriate spending. According to Psychiatric Times, 50 to 70 percent of individuals diagnosed with borderline personality disorder also suffer from a substance abuse disorder, usually involving alcohol abuse.

An unstable sense of self, or self-image is indicative of BPD also. This can lead to quick changes in goals, careers and the like. Opinions of self tend to fluctuate from high to low rapidly. Sufferers of BPD sometimes describe “out-of-body” experiences and feelings of separateness.

Types of Borderline Personality Disorder

According to field expert Theodore Millon, there are four different types of borderline personality disorder:

  • Discouraged borderline personality disorder
  • Impulsive borderline personality disorder
  • Petulant borderline
  • Self-destructive borderline

Someone suffering from BPD may or may not fall into one of these subcategories, and some may even fall into more than one category. Over time, these symptoms can change and manifest differently as well.

The discouraged borderline exhibits clingy and codependent behavior, tending to follow along in a group setting although seeming dejected. They are usually brimming with disappointment and anger under the surface directed at those around them. Discouraged borderlines are more likely to engage in self-mutilation and even suicide. They seek approval but also tend to avoid people, feel unworthy, and can trend toward depression.

An impulsive borderline is often highly charismatic, energetic and engaging. They can be superficial, flirtatious and elusive, seeking thrills and becoming quickly bored. Impulsive borderlines thrive on attention and excitement and often get themselves into trouble after acting first and thinking later. This can lead to substance abuse and self-injurious behavior as they seek approval from those around them and seek to avoid disappointment and abandonment.

Unpredictability, irritability, defiance and impatience signify the petulant borderline. They tend to be stubborn, pessimistic and resentful as well. They teeter between extreme feelings of being unworthy and anger. They can explode with these episodes of anger. Petulant borderlines fear being disappointed by others but also can’t seem to help wanting to rely on them. They tend to be passive-aggressive and can display self-harming behavior to get attention.

The self-destructive borderline engages in self-destructive behavior. At times they may or may not even be aware of its destructive nature. They are bitter and self-loathing. They have no sense of self and are terrified of being abandoned. They may hurt themselves in an effort to feel something. A self-destructive borderline is most likely to engage in risky behavior like reckless driving and degrading sexual acts.

Education is important in treating any type of borderline personality disorder. The more you know, the easier it can be to address the issue. Defining a subtype or learning you don’t fit a specific one can help in learning how to cope and treat BPD.

The 4 Types of Borderline Personality Disorder — Talkspace

Borderline personality disorder (BPD) is a mental health condition (personality disorder) that affects roughly 1.6% of the population. Symptoms can result in distress due to an inability to effectively regulate emotions, conflict within interpersonal relationships, a low sense of self-worth, and an enhanced tendency for impulsivity. Further, BPD is linked to self-harm and higher rates of suicide. According to research, this complex condition is often associated with major depressive disorder and dysthymia (high-functioning depression). 

People who experience BPD often face difficult relationship issues and have severely skewed views of themself and the world around them. BPD can be difficult to diagnose because not all symptoms appear with every diagnosis. Adding to the challenge, there are several subcategories of BPD, and some BPD symptoms can overlap with each other and with other mental health conditions (like bipolar disorder, depression, and certain eating disorders).

The research of noted psychologist and author Theodore Millon helped classify four distinct BPD types. The different types of BPD have specific characteristics in common, but each also has its own symptoms, challenges, and optimal treatment techniques.

What are the Different Types of BPD?

While continued research indicates the likelihood of even more subcategories for the various BPD types, here we’re focusing on the 4 borderline personality disorder types characterized by Millon’s research.

  • Discouraged borderline personality disorder (quiet BPD)
  • Impulsive borderline personality disorder
  • Petulant borderline personality disorder
  • Self-destructive borderline personality disorder

“Learning the signs and symptoms of borderline personality disorder can feel both overwhelming and empowering – knowing what you need to best support, like the right therapist and psychiatrist, can be incredibly beneficial to your health and your life. You deserve support!”

Talkspace therapist Kate Rosenblatt, MA, LPC, LMHC

1. Discouraged borderline personality disorder

Millon described discouraged borderline personality disorder (also known as quiet BPD) as being marked by frequent feelings of shame, guilt, emotional attachments, social anxiety, feelings of inadequacy, and obsessions.

Symptoms of discouraged borderline personality disorder
  • Marked interpersonal difficulties
  • Fear of abandonment
  • Unstable self-image
  • Self-blame
  • Rage
  • Feelings of emptiness
  • Being emotionally attached
  • Helplessness
  • Paranoid ideation
  • Obsessive-compulsive tendencies
  • Social retreat
  • Perfectionism
  • Anxiety

2.

Impulsive borderline personality disorder

Impulsivity is a common trait in BPD in general, but it’s prevalent enough in some people to be considered one of the 4 types of BPD addressed by Millon. Those with impulsive borderline personality disorder have an intense need for immediate gratification and often discount delayed rewards. They tend to experience intense emotions of rejection and anger.

Symptoms of impulsive borderline personality disorder
  • Preference for immediate gratification
  • Discounting long-term results
  • Feelings of rejection
  • Feelings of anger

3. Petulant borderline personality disorder

People with petulant BPD can display outbursts of anger that aren’t appropriate for a given situation. They might have an unstable self-image accompanied by feelings of being unloved. They feel a strong urge to manipulate or control others and tend to become possessive, resulting in difficulty maintaining interpersonal relationships. Overall, they’re likely to lack emotional stability.

Symptoms of petulant borderline personality disorder
  • Inability to enjoy harmonious relationships
  • Difficult to satisfy
  • Feelings of extreme anger and frustration 
  • Frequent irrational, emotional outbursts
  • Impatience with others in normal social situations
  • Seldom can admit they are wrong
  • Often behave in a passive-aggressive manner

4. Self-destructive borderline personality disorder

These BPD types can be their own worst enemies. People with self-destructive borderline personality disorder frequently self-sabotage relationships with family members and friends. They might engage in dangerous or risky behaviors, and generally have little regard for the consequences of their actions.

Symptoms of self-destructive borderline personality disorder
  • Substance abuse
  • Self-hatred
  • Self-harming behavior 
  • Frequent depression
  • Feelings of bitterness
  • Suicidal thoughts 
  • Emotional bitterness

How to Treat the 4 Types of BPD

The different types of BPD use slightly different treatment modalities, which can include a combination of medications for specific BPD symptoms combined with various modalities of talk therapy.  

Research suggests that each of the 4 types of borderline personality disorder seems to reflect biologically determined temperaments that could be linked to neuro-biologically based predispositions and vulnerabilities. While we don’t fully understand what causes borderline personality disorder, we are learning more every day about how to treat borderline personality disorder. Some people want to know how to treat BPD naturally,so treatment can vary not only depending on the type of BPD someone has, but also on their personal treatment plan. 

Borderline personality disorder is not necessarily treatable with medication. That is, no medication has been discovered that can cure the mental health condition itself. However, people diagnosed with the various types of BPD can be prescribed medication to help them manage symptoms, like anxiety and mood swings, that stem from BPD. BPD medication can also be effective in decreasing the likelihood of self-harm and may help prevent suicide.

“If you or someone you care about might be experiencing symptoms of borderline personality disorder, consult with a therapist who specializes in this so you can get the best evaluation and treatment recommendations.”

Talkspace therapist Kate Rosenblatt, MA, LPC, LMHC

Treatment for discouraged BPD 

Psychotherapy is the predominant treatment modality for treating discouraged BPD types. Dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), and mentalization-based therapy have all been found effective therapy. Therapeutic interventions like antidepressant medications might be recommended if comorbidity with depression presents.

Treatment for impulsive BPD 

Impulsive BPD types can be effectively treated with cognitive behavioral therapy and dialectical behavioral therapy (DBT). 

Treatment for petulant BPD

Therapy is also recommended to treat petulant BPD. Dialectical behavior therapy is the most recommended form of BPD therapy and can teach things like emotion regulation and distress tolerance. It can also help with interpersonal skills. Other forms of therapy that are known to be effective include cognitive behavioral therapy (CBT), mentalization-based therapy, and psychodynamic therapy. 

Treatment for self-destructive BPD

Dialectical behavioral therapy and another form of therapy that uses elements of CBT, known as schema-focused therapy, have been found effective in treating self-destructive BPD. Therapy can help identify triggers, which makes a huge difference in learning to manage any type of mental health condition, including self-destructive BPD. Medication is also commonly recommended. 

Which Type of BPD Do I Have?

Self-diagnosis is never recommended to diagnose any of the borderline personality disorder types. Unfortunately, there isn’t any one single test that can accurately determine if someone has BPD, let alone which type they may have. Thorough testing by a qualified mental health professional is the only reliable method of diagnosis. As noted, making a BPD diagnosis can be difficult given the possibly overlapping nature of symptoms. If you want to learn more about your symptoms you can even take a BPD test as a first step. However, be sure to seek in-person or online therapy to get a proper diagnosis. 

Identifying types of BPD can involve using a variety of testing and assessment measures, including the Personality Assessment Inventory (PAI) and the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 offers a detailed list of criteria used to identify traits and symptoms that must be present in order to make an accurate diagnosis. Also included in the diagnostic process can be health assessments and interviews. 

While there’s no clinical recognition in terms of diagnosing each type of BPD, narrowing them down can help a mental health provider decide on the most effective treatment plan, which can be essential is overall BPD treatment success. Zeroing in on the precise types of BPD that need attention is the best way to gauge the most effective treatment modalities.

Using Millon’s BPD subtype concepts has the potential to help people living with borderline personality disorder figure out the most important areas of concern. Then, they can quickly focus on the most needed, most effective type of treatment. New investigations into the subtypes of BPD, as outlined by Millon, continue with the goal of finding better BPD treatment solutions for optimal care and possibly, one day, a cure. 

See references

  • Chapman J, Jamil R, Fleisher C. Borderline Personality Disorder. Ncbi.nlm.nih.gov.
  • Paris, MD J. Why Psychiatrists are Reluctant to Diagnose.
  • Lawrence K, Allen J, Chanen A. Impulsivity in Borderline Personality Disorder: Reward-Based Decision-Making and its Relationship to Emotional Distress.
  • Kolbeck K, Moritz S, Bierbrodt J, Andreou C. Borderline Personality Disorder: Associations Between Dimensional Personality Profiles and Self-Destructive Behaviors.
  • Bornovalova M, Hicks B, Iacono W, McGue M.
  • Bornovalova M, Hicks B, Iacono W, McGue M. Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: A longitudinal twin study.
  • Bell-Pringle V, Pate J, Brown R. Assessment of Borderline Personality Disorder Using the MMPI-2 and the Personality Assessment Inventory. Assessment.
  • Lubit, MD, PhD R. What are the DSM-5 diagnostic criteria for borderline personality disorder (BPD)?. Medscape.com.

What are the types of borderline personality disorder?

May 30, 2021 comments 0

Impulsivity, moodiness, unstable self-esteem, inappropriate temper tantrums, intense and turbulent relationships, self-harm or thoughts of self-harm.

.. Although people with borderline personality disorder may have some of the same symptoms, they are not all the same.

Theodore Millon, an APA award winner whose theories have helped shape how scientists think about personality and personality disorders, identified four distinct subtypes of borderline personality disorder. These subtype concepts can help people with borderline personality disorder and their therapists identify specific issues that need special attention.

While someone with BPD may or may not fall into one of these subcategories, others may even fall into more than one of them. Symptoms can change over time and present differently in different people.

What exactly are the types of borderline personality disorder and their individual characteristics?
  • Impulsive Borderline Personality: People with impulsive borderline disorder are perceived as thrill-seekers, risk takers, unpredictable, charismatic, very energetic and easily bored. Their endless appetite for attention and adventure often leads them to act without any appreciation of the consequences. These people often act without thinking and are also prone to self-harm and suicidal thoughts and actions.

  • Discouraged Borderline: These people tend to appear clingy, dependent, and less assertive. Their strong desire for approval and acceptance, as well as their feelings of inferiority and inferiority towards others, often make them prone to depression. They are more likely than other BDP types to use self-harm as a coping mechanism. They may eventually become suicidal if they don't get the help they need.

  • Touchy Borderline: This subtype is characterized by being critical, pessimistic, impatient, unpredictable, irritable and prone to outbursts of anger or frustration, especially when they are disappointed by other people. They waver between trusting people and keeping their distance, fearing disappointment. Their feelings of unworthiness and anger can make them quite explosive. It's really hard for them to admit they're wrong. They tend to be headstrong, often stubborn and defensive, using passive-aggressive behavior as a way to lash out at people they don't like. These people also show symptoms of depression as well as a paranoid personality.

. They tend to conform to other people's beliefs and expectations due to the rejection of intense fear. They have common features of depression. Their self-destructive behavior can be presented in many ways, such as poor medical care, reckless driving, etc. They are prone to a high rate of suicide.

What are the treatment options?

About 70% of people with borderline personality disorder make at least one suicide attempt during their lifetime. Seeking help in a timely manner can prevent you or your loved one from being part of these statistics.

Although there is no cure for borderline personality disorder, therapy and certain medications (such as antidepressants, mood stabilizers, and neuroleptics) can reduce the frightening and overwhelming symptoms of this serious disorder. If you or your loved one suffers from any of the BPD subtypes presented here, you must find an effective treatment plan.

Visit us now at www.acandassociates.com to schedule a real-time video consultation with a healthcare professional to help you diagnose and choose the best treatment plan for you.

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We look forward to helping you on your journey of healing and well-being!

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Borderline personality disorder

Borderline personality disorder is associated with unstable mood and behavior that has a significant impact on a person's daily life

Borderline personality disorder is a type of personality disorder in which a person experiences periods of tension, unstable moods and behaviors, and an altered "feeling of self". 1 All of these can result in impulsive actions and relationship problems with friends and family members, impairing the person's ability to cope with everyday life. 1.2

Borderline personality disorder is a serious illness associated with self-harm and suicidal attempts. One in ten patients complete suicide. 2

Facts About Borderline Personality Disorder

Borderline personality disorder is a type of personality disorder in which a person experiences periods of tension, unstable mood and behavior, and an altered sense of self. 1

One in ten patients complete suicide. 2

Patients with borderline personality disorder are very sensitive to changes in their environment, and may respond inappropriately and acutely to such changes. They may, for example, be afraid of being abandoned by a loved one. 2 If the person whom patient
is expecting arrives late, the patient easily changes the feeling of attachment to dislike or anger.1,2 This reflects the extreme perception of the world by the patient, who sees everything and everyone - including oneself – either good or bad.1,2

People with borderline personality disorder are often insecure, may suddenly change their life goals and views on career, life values ​​and friends. .2 They may develop intense unwarranted anger or feelings of emptiness, and are prone to self-harm.2 Patients with borderline personality disorder may also experience depression and anxiety.1,2

Facts about Borderline Personality Disorder

Estimates of the proportion of people who have borderline personality disorder vary from less than 1% to around 6%. 2-4

Borderline personality disorder affects a roughly equal number of men and women, but appears to be more disabling in women the same frequency in men and women, but in women it is more severe. 3

Symptoms of borderline personality disorder most often first appear during adolescence.4 The disease is most severe and problematic in young adults and tends to improve with age.2 Symptoms may persist throughout life, but most patients with borderline personality disorder by the age of 30-40 have a stable job and a home.2

People with borderline personality disorder are emotionally and functionally unstable, which places a significant burden on their families.5 Mood swings are a source of stress for both the patient and his/her others, which can lead to the development of mental disorders in the latter.1,5

People who are concerned that they – or their loved ones – are experiencing symptoms of borderline personality disorder should see their doctor for help and advice.

Borderline personality disorder is diagnosed by a mental health professional using interviews and discussions about symptoms and medical history. 1

Psychotherapy can help people with borderline personality disorder by, for example, teaching them how to interact with others and to express their thoughts and feelings more clearly. 1 It may also be beneficial for caregivers and family members of those affected to receive therapy and guidance on how best to care for a person with borderline personality disorder. 1 There is currently no cure, but one study showed that, after 10 years, 50% of people with borderline personality disorder had recovered, being able to function at work and maintain personal relationships. 6

  1. National Institute of Mental Health. borderline personality disorder. NIH publication number QF 17-4928. Available from: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml [accessed 30 September 2019].
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  3. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–545.
  4. National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. Available from: https://www.nice.org.uk/guidance/cg78/resources/borderline-personality-disorder-recognition-and-management-pdf-975635141317 [accessed 30 September 2019].
  5. Bailey RC, Grenyer BFS. Burden and support needs of carers of persons with borderline personality disorder: a systematic review. Harv Rev Psychiatry. 2013;21(5):248–258.
  6. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatry. 2010;167(6):663–667.

1. National Institute of Mental Health. borderline personality disorder. NIH publication number QF 17-4928. Available from: https://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml [accessed 30 September 2019].
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
3. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–545.
4. National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. Available from: https://www.nice.org.uk/guidance/cg78/resources/borderline-personality-disorder-recognition-and-management-pdf-975635141317 [accessed 30 September 2019].

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