Ep 17: Quiet Borderline | A Closer Look at BPD Subtypes

In this episode of the Personality Couch Podcast, we continue to explore the complexities of Borderline Personality Disorder (BPD), particularly focusing on the lesser-known subtype: Quiet BPD. We delve into the historical origins of the term ‘borderline,’ discuss the various subtypes of BPD, and highlight the differences between Quiet and Noisy BPD. The conversation also touches on the lack of recent empirical research on Quiet BPD and the cultural emergence of the term. We further emphasize the importance of understanding the internal versus external presentations of BPD symptoms and the implications for treatment. The discussion emphasizes the importance of recognizing the different types of BPD and the need for nuanced understanding in both clinical practice and societal perceptions.

Chapters

• 00:00 BPD Name and Subtypes in History
• 04:32 As-If Patients and Quiet BPD Connection
• 11:09 Quiet BPD and Millon’s Discouraged Type
• 14:44 Current Research on BPD Subtypes
  • 15:52 Internalizing BPD
  • 20:24 Externalizing BPD
  • 25:42 Mixed-Ambivalent BPD
• 31:30 Quiet BPD Today and Subtype Importance
• 34:10 Summary and Closing

References

• Cohen, C. P., & Sherwood, V. R. (1991). Becoming a constant object in psychotherapy with the borderline patient. Jason Aronson.
• Deutsch, H. (1942). Some forms of emotional disturbance and their relationship to schizophrenia. The Psychoanalytic Quarterly, 11(3), 301-321. https://doi.org/10.1002/j.2167-4086.2007.tb00257.x
• Gunderson, M. D. (2010). Revising the borderline diagnosis for DSM-V: An alternative proposal. Journal of Personality Disorders, 24, 694–708.
• Johnston, J. (2010). Being disturbed: Integration and disintegration in the patient and professional relationship. Psychoanalytic Psychotherapy, 24(3), 231-251. https://doi.org/10.1080/02668734.2010.502306
• Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc.
• Rosse, I. C. (1890). Clinical evidences of borderland insanity. The Journal of Nervous and Mental Disease, 15(10), 669-683.
• Sherwood, V. R., & Cohen, C. P. (1994). Psychotherapy of the quiet borderline patient: The as-if personality revisited. Jason Aronson.
• Stern, A. (1938). Borderline group of neuroses. The Psychoanalytic Quarterly, 7, 467–489.
• Wolf, K., Scharoba, J., Noack, R., Keller, A., & Weidner, K. (2023). Subtypes of borderline personality disorder in a day-clinic setting—Clinical and therapeutic differences. Personality Disorders: Theory, Research, and Treatment, 14(5), 555–566. https://doi.org/10.1037/per0000624