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Are There Subtypes of Borderline Personality Disorder?

By January 30, 2011

In order to be diagnosed with borderline personality disorder, an individual must meet just five out of a total of nine diagnostic criteria, meaning that BPD in one person can look very different from BPD in another. This has led some experts to wonder whether there are actually distinct types of borderline personalities. In fact, if you join an online BPD community or read some of the popular BPD books, you will often come across descriptions of subtypes of BPD.

Researchers have begun to take up this question -- is BPD a unified diagnostic category, or are there subtypes of BPD? Read more...

Comments
February 1, 2011 at 11:46 pm
(1) kevin blumer says:

with bpd with the people i know with bpd there all diffrent to me in some respect the way they go on or the way that tihngs has happened to them personaly i think a lot more research should be done with bpd if i ever pass my degree i want a PH.d in bpd i would research it fully out and i would redefine it i ahve lerant in my time there are some that really suffor form it and some that dont they have clasifyed me as impulsive but what they dont do is a timescale im fine at the minute in fact the last 6 mounth i have been fine tihs has happend all my life but then there is a black hole then the impulsivness kicks in but they dont messure this they just define you as bpd doctors for example they really dont know when you are up or down or if you are going to do something to your self they probably use a sad scale or something like that doctors really dont know bpd well enuff it has taken them 29 years to prognose me with the best doctor saying he rally didnt know mutch about it he admited that to me i know so many people with bpd but i think the criteria for bpd is all wrong and i think there should be more catagorys so we can be defyed better and we can then be treated better

February 2, 2011 at 9:57 pm
(2) Annie says:

My own mother up until recently has fit the high-functioning Queen/Witch type of bpd sub-type most closely. Her executive function is deteriorating now (possibly due to senile dementia) and she is showing her traits and behaviors in public now, whereas earlier in her life she only emotionally and physically attacked her immediate family behind the safety and privacy of closed doors.

I am leaning toward the the theory that the “invisible”, very-high-functioning bpds of the Witch/Queen variety are actually a sub-type of psychopathy. (RE Dr. Hare’s Psychopathy Checklist.)

From the posts at support groups for the adult children of bpd parents, it would seem that Lawson’s 4 sub-types: the Waif, The Hermit, The Queen, and the Witch, are all well-represented, in combination with the high-functioning or low-functioning criteria, so there are many possible permutations of bpd, so much so that a Low-functioning Waif type seems like an entirely different disorder than a High-functioning Witch.

This makes me think it would be more workable to simply use the term “Personality Disorder” as an umbrella term, and then list ALL the possible traits and behaviors in checklist form rated by frequency and intensity. An extremely tailored, individual diagnosis. So someone would be diagnosed with “Personality Disorder with (a through z or any combo) features.”

February 21, 2011 at 1:03 pm
(3) Randi Kreger says:

I was very careful to say in all my books that the types of BPD I discussed were not official but the result of a number of years (3-15) of observation. I think any types of studies on this will be limited to those people with BPD who 1) meet the BPD definition AS ALREADY LISTED both in the DSM or an instrument such as the Gunderson DIB used to qualify subjects as “borderline.” This will, of course, eliminate all those with BPD who 1) fit into those boxes and 2) consent to treatment.

The bigger question is “How is any of this useful?” I think Lawson’s definitions are very useful to those with BPD mothers. (BTW, the “queen” is BPD comorbid with NPD.) Hopefully any research will not just be for research’s sake, but will help us pinpoint differences with some utility.

February 21, 2011 at 1:20 pm
(4) roni beadle says:

Randi, I agree with you and you say it so succinctly. I am a psychotherapist and tend to work with phenomenology rather than diasgnostics…not any better, just different and more in line with how I am currently seeing things.

I also am aware how most of us share some BPD traits, whether diagnosed with BPD or not. Maybe it is a conditon of human nature in varying degrees; and I think in the Western Cultures, we live in a much more borderline society these days.

Thankyou for your conribution to psych literature and work..I ahve muc enjoyed reading you.

Kind regards, Roni Beadle

February 21, 2011 at 1:31 pm
(5) Gigi says:

My 23 year old daughter has been diagnosed with BPD recently after being in the hospital. On some levels I agree with the diagnosis but others I wasn’t sure. She has been diagnosed with ADHD since the 3rd grade and has always had problems with emotional regulation. I always thought this was the ADHD. She has been like this for years and on many levels is highly functioning. She is very creative, insightful, conscientious and responsible in so many ways and doesn’t play games or have typical BPD relationship problems.So this is why I am confused until I read this article. She is self critical which has led her to bouts of depression, and hospitalization. After reading about the sub-types I Googled sub types and found an article that had a sub-type of high functioning internalizing that seemed to fit her better than anything I have read. It gives me hope that with therapy will help her to overcome this disorder.

What frustrates me is that this disorder has such a bad rap and stereotype and so much of what you read out there is so disturbing. Getting a therapist who is not afraid of BPD and actually believes they can get better can be challenging. Hopefully there will be more research into the disorder to better understand it.

February 21, 2011 at 2:51 pm
(6) bpd says:

Hi all,

To be honest, this is precisely the type of research that I think is critically important– we need to really understand this disorder in order to treat it effectively. And, in order to understand it in an objective way (i.e., in a way that is not subject to our own biases and based on the select group of people that we happen to come into contact with), we need to study it.

I am a clinician and a researcher, and I strongly believe that the two go hand-in-hand– the clients that I see feed my research, and research guides how I treat my clients. Science yields slow progress, and I think this is frustrating for many. But, we’ve come a long way in our understanding and treatment of BPD through science.

–Kristalyn

February 21, 2011 at 5:12 pm
(7) Oldsoldier2411 says:

Thank you Annie and Randi for your comments and explanations. Some of us who are affected by the sufferers have needed your insight. To put the ref to waif, hermits, Queens and witches puts it in a more simpler form that we laypersons can understand a bit better. I also agree with Kristalyn with regards to clinicians and research going hand in hand. Thanks again.

Ian

February 26, 2011 at 5:34 pm
(8) callie says:

How common is the connection of BPD with paranoid personality disorder? I have a family member who seems to be influenced by both. It is very difficult.

February 27, 2011 at 1:14 pm
(9) Babs says:

Criteria #9 for diagnosing borderline pd is: “Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.”

The key point with bpd paranoia is that it is “transient” or short-lived. Have you noticed that your mother expresses paranoid thoughts or feelings when she is in stressful situations?

If the paranoia is more pervasive, meaning, she expresses paranoid thoughts and feelings *most of the time*, then, yes, possibly she also has paranoid personality disorder, or possibly paranoid schizophrenia?

Only a psychiatrist can make a real, valid diagnosis. I’m just speculating and giving a non-professional, personal opinion.

The various personality disorder Clusters have overlapping symptoms, and it is not uncommon for someone with personality disorder to have more than one mental illness at the same time. That’s called “having a co-morbidity.”

February 27, 2011 at 3:26 pm
(10) callie says:

This is a wife of 40 years. I have walked the extra mile for this time, but the condition is gradually getting worse. Yes, there seems to be many of the characteristics of both BPD and PPD. The most prominent is never letting go of anything that appears to be a slight. The benign action (to others) might be in the form of a comment, or action. This stays for decades and is just as meaningful (to her) 30-35 years later. In many cases the feeling is enhanced through time. The reaction is anger, or distrust. The paranoid part is difficult. It might be a walk with the dog that takes 10 minutes too long (“who did you talk to?), or going to a high school ballgame with a friend (“did you ask him, or did he ask you?). There is no end to the situations. There is no ongoing schizophrenia, but a series of short situations that are easily triggered. The anger might last for an hour, or days. She can remember exactly how my 2nd grade “girlfriend” was standing (talking with me), what she was wearing, and how her hair was, at our 15th high school reunion. This was 25 years ago. My conversation with that person was less than 5 minutes and was my only contact since high school. I made the mistake (I totally forgot) of talking with that person at our reunion a couple of years ago for a few minutes. The anger and distrust exploded when we got home. So in 45 years these were my only contacts with this person. This is just an example, there are endless others.

February 28, 2011 at 12:11 pm
(11) Babs says:

@ Callie. I recommend “Stop Walking On Eggshells” to give you techniques to help manage your wife’s negative, acting-out behaviors. It was written for those who have a loved one with borderline pd, and it offers advice on how to set boundaries with someone who is thinking and behaving irrationally. I think its worth a shot, at least.

I don’t know what to recommend if her paranoia is getting worse, other than therapy. Not couple’s therapy, individual therapy for her. There are two major obstacles with that option, though.

(1) Most individuals with personality disorder refuse to consider therapy because they believe there is nothing wrong with them (its always everyone else who is causing them problems, its never their own fault.) This is referred to as an “ego-syntonic” condition, and its why personality disorder and mental retardation are grouped together in a separate Axis than other mental illnesses: these conditions are considered to be unresponsive to either talk therapy or drug therapy.

(2) Most psychotherapists will not treat patients with personality disorder, or if they do, they only take one or two in their caseload at a time. Personality disorder is not covered for treatment under most insurance plans (under the current DSM-IV it is considered “untreatable”) and because if the patient with pd actually does want treatment, it usually takes years of intensive therapy to show any progress at all IF the person with pd is willing to stay in therapy.

So, the path of least resistance is to go into therapy yourself and learn techniques that will allow you to emotionally distance yourself from your wife and calm her down when she is being irrational and negative so that the emotional abuse she inflicts on you doesn’t destroy your own feelings of self-worth.

March 1, 2011 at 12:29 pm
(12) callie says:

I really appreciate the comments. I thank anyone who understands the difficulty of living with this. I have found out that it is hard to handle this in a logical manner. My logic does not make sense with her. Our grown children understand this very well and are in this with me. I am learning how intertwined the BPD and PPD are. It is almost that the symptoms feed on each other. The PPD seems to trigger the anger of the BPD. The “black and white” personality of BPD enhances the feelings of PPD.

I have read as much as I can to find the appropriate way for my actions/responses. I am familiar with “Stop Walking On Eggshells”. I have discovered how (very) difficult it is to deal with this while not becoming an enabler.

My wife did start going to a into therapy last year when I said to her that I (and family) are struggling to recognize the person who we previously knew. After a couple of sessions the therapist had her go to a psychiatrist to see about medication (which was prescribed). The therapy/medication has seemed to tone down the anger, but it could be that I have stayed away from any conversation/action that might trigger feelings in her. This is difficult in that almost any meaningful conversation has to be avoided. Anything that somehow can be interpreted negatively, will be. I have attended two of the therapy sessions (not easy). It seemed to take her right back in the difficult frame of mind. The “black” of the “black and white personality” completely overpowers the “white” (if that makes sense). I most likely will not go to these sessions in the future. The sessions are the same for her as when she is vacuuming. See can be vacuuming and start thinking about a conversation from 30-40 years prior and be angry the rest of the day. She can have a negative dream and be angry for some time.

March 1, 2011 at 12:32 pm
(13) callie says:

continuation ……

The part that is difficult for me is that my life has had to change considerably to accommodate this behavior. No more high school reunions, very limited contact with friends (if I do, I’m waiting to get “caught”. Then if caught I’m being dishonest for trying to hide a conversation/contact), no genealogy (why would “dead” relatives be important?). The list is endless.

Another difficult part of this is that my wife is a very nice, well meaning person in so many ways and to other people. These problems are pretty much confined to our family. Others, outside of family, do not realize the extent of the behavior and pass it off as part of her personality.

March 12, 2011 at 3:45 pm
(14) Babs says:

@ Callie

As you have noted, this is a very, very long-term pattern that you and your wife have of relating to each other.

So in some way, I’m suggesting that you are both getting some benefit out of her being the “volcano” and you being the “vulcanologist.” It must be more of a benefit than it is a problem, otherwise you (or both of you) would have gone into therapy and/or left the relationship much earlier.

I don’t intend this in a mean way, but I think you’re not understanding how to set boundaries for yourself RE her negative, acting out behaviors.

Here’s a specific example: let’s say you want to go out for a night of playing cards with the boys once a month, and your wife is upset about that. Your boundary would be, you will go play cards once a month, and you will not listen to her saying mean, horrid things to you about your once-a-month poker night.

When she starts in on that, you leave the room or the house, saying. “I won’t listen to you when you’re calling me names and saying untrue things about me/my friends. I’ll come back in an hour and we can discuss this when you’re feeling calmer.” If she keeps it up, you do the same thing again, and be consistent.

If her motivation to keep you with her is stronger than her motivation to be in control and be abusive to you, she will change her behaviors.

But if you take the path of least resistance and cave in to her manipulative behaviors, you’ll just reward her and it will make her resolved to remain negative and abusive and keep it up longer the next time.

Setting boundaries isn’t easy, but its a valid way to protect yourself from abuse. You can’t make her change, but you can change the way you react to her abusive behaviors and your resolve and consistency will hopefully give her the motivation to change herself.

Babs

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