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Borderline Personalities

Are There Different Types of Borderline Personalities?

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Updated April 29, 2011

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Borderline personality disorder (BPD) is associated with a number of different signs and symptoms. In order to be diagnosed with BPD, 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 the Popular Media: BPD Subtypes

In popular media and pop psychology books, there is a great deal of discussion of different BPD subtypes.

For example, in her book Understanding the Borderline Mother, Dr. Christine Lawson described four subtypes of mothers with BPD: the Waif (helpless), Hermit (fearful/avoidant), Queen (controlling), and Witch (sadistic).

In The Essential Family Guide to Borderline Personality Disorder by Randi Kreger, people with BPD are grouped into lower-functioning/conventional types versus higher-functioning/invisible types. The conventional type is described as engaging in a lot of self-destructive behavior (the authors call this "acting in," an idea that maps on to the concept of internalizing symptoms), requiring frequent hospitalization, and being very low-functioning (i.e., may not be able to work or go to school). In contrast, the invisible type is described as functioning well in most contexts but engaging a great deal of "acting out" behavior (this maps on well to the concept of externalizing symptoms) such as engaging in verbal abuse, criticizing others, or becoming violent.

These subtypes of BPD in the popular literature were derived from the authors' own expert opinions on the existence of different types of borderline personalities. More recently, researchers have tried to take a quantitative approach to describing subtypes of BPD. The research on the topic paints a more complicated picture.

The Research: Are There Different Types of Borderline Personalities?

The research on the existence of subtypes of BPD is mixed. There have been research studies that have found that BPD can be treated as a unified diagnostic entity without the presence of clear subtypes. But some other studies have identified some subtypes of BPD.

One study, which examined types of borderline personalities based on patterns of co-occurring personality problems, identified three subtypes of BPD that map onto the three clusters of personality disorders in the DSM-IV: Cluster A, Cluster B, and Cluster C. Those in the Cluster A subgroup tended to engage in more paranoid thinking and eccentric behavior, those in B tended to have more dramatic or arrogant personalities, and those in C tended to be more fearful.

Another study that examined BPD subtypes in adolescent boys and girls with BPD found reliable subtypes in girls, but not boys. Girls with BPD tended to fall into one of the following categories: high-functioning internalizing, depressive internalizing, histrionic, and angry externalizing.

A third study found three BPD subtypes: withdrawn–internalizing, severely disturbed–internalizing, and anxious–externalizing.

Interestingly, these last two studies suggest that the distinctions between internalizing versus externalizing symptoms and high versus low functioning may be an important one in BPD (and in part validate some of the popular psychology literature on the topic). However, because of the inconsistencies in the research literature, much more work is needed on this topic.

Treatment Implications

At least one study has found that individuals with different presentations of BPD may respond differently to treatment. In this study, individuals from the severely disturbed-internalizing subtype did not see symptom improvement with treatment, whereas those in the anxious-externalizing and withdrawn-internalizing subtypes did.

This suggests that the prognosis for BPD may be different depending on the subtype that an individual belongs to. However, much more research is needed before we can say anything definitive about differential treatment response.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revision. Washington, DC, Author, 2000.

Bradley R, Conklin CZ, Westen D. The borderline personality diagnosis in adolescents: Gender differences and subtypes. Journal of Child Psychology and Psychiatry, 46(9):1006-1019, 2006.

Clifton A, Pilkonis PA. Evidence for a single latent class of Diagnostic and Statistical Manual of Mental Disorders borderline personality pathology. Comprehensive Psychiatry, 48(1):70-78, 2007.

Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of co-occurring Axis II features in borderline personality disorder. British Journal of Clinical Psychology, 47(2):185-200, 2008.

Digre EI, Reece J, Johnson AL, Thomas RA. Treatment response in subtypes of borderline personality disorder. Personality and Mental Health, 3(1):56-67, 2009.

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