Borderline personality disorder is a very complex disorder, with a myriad of personalities that fit the bill. So before you assume anything about anyone considered to have borderline personality disorder (BPD) make sure you understand the four unique subtypes that fall under the criteria for the disorder.
BPD is a personality disorder, which differs from a mental disorder because it is harder to treat, and is considered to be composed of longstanding personality traits and tendencies that can make it hard to have relationships, regulate emotions and affectively interact with others around us.
We often feel things much deeper than others and to put this into perspective, Marsha Linehan, the most notable BPD expert to date says that “People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”
MedCircle makes wonderful videos about various mental disorders, and as someone who isn't an expert, but someone who is actually diagnosed with and living with BPD, I truly appreciate their content, so shoutout to them!
In the following video, one of my favorite experts, Dr. Ramani Durvasula explains the 4 recognized subtypes of the disorder. I would like to note, as she does, that these subtypes are not listed in the DSM (the diagnostic manual for mental health) but are instead recognized by various research studies and the common sense combinations of symptoms that fall under the disorder.
What I find most fascinating about this, is the notion that many of my past doctors and therapists ignored, that there isn't one specific stereotype of BPD, but instead, a myriad of personalities that fall under the diagnosis. When I first received my diagnosis- I was in a full blown episode, and seemed to be malignantly acting out. It was obvious to the healthcare provider treating me at that time that I fit the bill. However, in the periods in between my episodes, I would seem mostly calm on the outside and not acting out and lashing out. I was extremely high-functioning, and most people refused to believe anything was wrong. Because of this, after I received the diagnosis, and later changed doctors, my doctors would sometimes refuse to believe I have BPD.
No matter how much I tried to explain to them the things I had done, or the internalized symptoms I had, they wouldn't have it that I had BPD, but instead assumed I was bipolar. And while I won't argue that I most likely have both, I absolutely without a shadow of a doubt KNOW I have borderline personality disorder. As someone who has experienced EVERY. SINGLE. SYMPTOM - I can't believe otherwise.
I would like to note that I am NOT a doctor, psychologist, or even an expert on borderline personality disorder. Instead, I am someone who has qualified for the diagnosis for almost all of my life. Please use this information to help and not hinder you. Do not get tied down so much in feeling like you CANNOT change. Because as Dr. Ramani says time and time again- with a good team of caretakers and proper therapy, and at the very least, some implemented DBT skills, there is a HUGE chance for someone with BPD to find relief and also to have functioning relationships.
So without further ado, these are the four subtypes, and the information that Dr. Ramani explains in the video. Please be sure to check out the video at the end of the article. It is amazing!
High Functioning, Internalized (Quiet) Borderline Subtype
As I mentioned above, this is the category that seems to fit me best. (But not always.) There are times when I may seem more malignant and outward, usually when I am under extreme stress or have had something traumatic happen to me. Ramani explains that this subtype is often someone who may "rage at themselves," or may "internalize" their pain and despair when under duress.
She says this subtype is almost a more pure BPD subtype, and I assume she says this because of the fact that many of the symptoms of BPD include self-harm, self-sabotage, and a tendency to talk about themselves in a very negative manner. She does go on to explain that suicide risk is high with this subtype, because they feel as though the world would be better off without them.
She notes that in her opinion, the key takeaway is that they are in fact, high-functioning. Most of them, she says, have jobs in high-powered positions, or in positions that allow them to take care of others, such as nursing, therapeutic careers, and so on and so fourth. She states that for the most part, they do their jobs and do them well. The worst case scenario, though, is when the person who is BPD makes an error, and no matter how small the error may be, it is likely that the person with BPD will have a strong, self - blaming reaction to the event. What's worse, is that this self-blaming reaction can harm their career.
Those who fall under this subtype are most likely to have co-occurring depression, and anxiety, which can lead their needed diagnosis of BPD to be overlooked, because their practitioner may only see the symptoms displayed instead of the internalized feelings of self-loathing.
To me, the key takeaway, is that this particular subtype, instead of lashing out and raging at others when under duress, is likely to look within and quietly rage at themselves, or torment themselves. Because of this- many may overlook the most painful symptoms that are locked within.
Petulant BPD Subtype
In the petulant subtype, there is a lot of overlap with narcissistic and histrionic personality disorders (which are listed in the same category as borderline personality disorder, and are often confused with the disorder due to this specific subtype.) Ramani explains this is due to the fact that when faced with disappointment, this subtype of BPD can cause the person suffering to feel abandoned and unable to deal with their fears of abandonment, most likely because of past traumas in their life.
In turn, the person may feel disrespected and invalidated, and they may lash out at the person who triggered their feelings of disappointment and invalidation, or even at others, in very extreme ways.
Ramani also describes this subtype as the attention seeking and acting out sort of borderline patient that reacts to their overwhelming pain in extreme ways. She also says that this specific type of borderline is most likely to throw tantrums frequently. She notes that in histrionic personality disorder, you won't see as much of these tendencies being triggered by something that someone else has done, but instead is almost entirely attention seeking and superficial. The borderline patient acts out when they feel triggered or are reminded of something painful and similar to abandonment and disappointment.
Angry, Externalizing and Impulsive BPD Subtype
The angry, externalizing and impulsive subtype is known to act out in ways that can be unsettling to others. Unfortunately, when this subtype has poor emotional regulation skills, they can make a bad name for those who react to their distress in other ways, and for the disorder as a whole. I would personally like to note that while I mainly identify as the quiet subtype, when I am under extreme stress or feel pushed to the brink, I have been known to exhibit many of the behaviors that define this subtype.
I also feel like that when I had medically induced (by accident) mania when I took the wrong anti-depressant, that I exhibited these symptoms full fledged, and also when I wasn't taking care of myself and was using hard drugs like methamphetamine. I am unsure if there is a link between the two, but wanted to note it for those who may benefit or relate to my statement.
Ramani says that oftentimes, when feelings of disappointment, abandonment and invalidation arise in this particular subtype, you will see a lot of overlap with narcissistic personality disorder, in that their behaviors will seem attention seeking and abusive to the extreme. She adds that the behaviors of this subtype are extremely externalized at the people in the person around the angry BPD subtype, and that there is oftentimes a lot of impulsive and reckless behavior that can be dangerous to both the person with the disorder and those around them.
Some of those impulsive behaviors may include drugs, alcohol, unprotected sex with multiple partners, driving dangerously, engaging in dangerous fights, extreme self-sabotage, spending a lot of money, etc. Ramani points out that it is this particular display of emotion that can often lead to the incorrect diagnosis of bipolar mania, as the impulsive borderline can often mimic someone who is going through a manic episode.
Depressive & Internalized BPD Subtype
The depressive and internalized BPD subtype, unlike the quiet and high-functioning subtype, may find it harder to secure a place in life, because of their tendency to react to their stressors in life by self-sabotaging and self-destruction. Ramani describes this subtype as more uniformly depressed, which can make it difficult for them to mount the energy and effort towards their goals and desires.
Ramani also warns that with this particular subtype, there is a higher risk for self-harm. And this risk is increased in the face of abandonment, invalidation, disappointment, and emotional pitfalls.
Unfortunately, those who fall under this category are more likely to be missed when being diagnosed, and will instead be diagnosed with major depressive disorder, which can make it more difficult to get them to the proper treatment and can cause even deeper problems for them in the long run.
Another risk factor is that this particular subtype may not be as prone to reaching out for help, because of the social aspects of treatment, and because of how isolated they are from others.
The Major Takeaway
Before I conclude, I really wanted to emphasize and important note from Ramani during the video. While each of these subtypes have the same undercurrents, such as lack of sense of self, emotional dysregulation and difficulty with interpersonal relationships- the difference is how each react to their personal triggers and how they deal with the symptoms that come with this painful disorder.
If you feel like you relate to these criteria, explanations and symptoms- DO NOT diagnose yourself. Please reach out to a professional and find out what it is that you are dealing with, and work with that professional to create a plan to help you deal with these symptoms. There are so many disorders, with so many overlapping symptoms. Please use the information in my article and in the original vide from MedCircle to help educate you and your friends and family.
Kommentare