Types of Borderline Personality Disorder
There is no scientific consensus about borderline personality disorder subtypes. Nevertheless, several models of classification have been offered to explain the variety of BPD symptoms experienced by different people, and all seem to have at least some validity and explanatory power. As long as subtypes remain grounded in the real signs and symptoms of borderline personality disorder, they can help BPD sufferers and therapists broaden their perspectives on a complex mental health condition.
How Are BPD Symptoms Classified?
Borderline personality disorder (BPD) is a distinct condition with a clear, defining set of characteristics.
But the unity that connects people diagnosed with BPD is deceptive. Because the disorder’s symptoms are so diverse, BPD can appear in a vast number of permutations or versions, all of which are recognizable (to trained mental health professionals) as borderline personality disorder, but still unique enough to suggest the existence of different BPD subtypes.
As of now, there is no firm consensus about what the subtypes of borderline personality disorder actually are. Many theories have been developed, but none are universally accepted by mental health professionals. There is an inevitable subjective aspect to the search for BPD subtypes, which may make it impossible for any classification system to capture every possible nuance of this profoundly life-altering mental health condition.
Nevertheless, the search for precise and diagnostically useful BPD subtypes continues, and the classification systems created so far have helped BPD sufferers, their family members, and the clinicians responsible for their treatment gain a greater understanding about how the disorder manifests in the real world.
Theodore Millon’s Borderline Personality Disorder Subtypes
One popular and widely recognized system of classification for BPD subtypes was created by American psychologist Theodore Millon.
As a contributor to early editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Millon was a highly respected authority on personality disorders, and his theories on borderline personality disorder have given mental health professionals additional analytical tools to aid in their treatment of patients with a BPD diagnosis.
Individuals exhibiting discouraged borderline symptoms often seem needy and dependent, but they secretly harbor a lot of anger towards others and are easily disillusioned. Those who fit the discouraged borderline profile have a strong desire for acceptance and approval, but they are haunted by feelings of inadequacy and inferiority, which makes them prone to depression.
People with discouraged borderline tendencies are more likely than other BPD sufferers to resort to self-harm as a coping mechanism, and if they don’t get the help they need they can eventually become suicidal.
People with impulsive borderline symptoms can be energetic, charismatic, and exciting to be around. But they are easily bored and are quick to become angry or upset when others let them down (according to their perceptions), and as a result they are frequently involved in conflicts. Impulsive borderline types like to be noticed but also have strong antisocial instincts, meaning they prefer to control the direction of their social engagements.
Their need to be the center of attention and avoid boredom can lead them to practice a wide range of risky behaviors. Men and women with impulsive borderline tendencies often act rashly without considering the consequences, and they frequently suffer injuries or fall victim to addiction as a result of their capricious actions.
Individuals showing petulant borderline characteristics are unpredictable and difficult to please. They are often irritable and prone to outbursts of anger and frustration, and they are impatient with other people and quick to become disillusioned when they don’t get what they want.
As a consequence of their tendency to be willful and defiant, people with petulant borderline traits are often stubborn, defensive, and unwilling to admit when they are wrong. Their relationships can be loving but are always complex, and they often engage in passive-aggressive behaviors as a way of lashing out at people who displease them.
As the name suggests, people exhibiting self-destructive borderline symptoms are their own worst enemies. They are prone to all types of dangerous behavior, and they have a tendency to sabotage themselves when it appears they might be making progress in life.
Those who suffer from self-destructive borderline systems lack a stable sense of self, and they are so dependent on others that their fear of abandonment often runs out of control. Men and women with self-destructive borderline symptoms are frequently moody, bitter, and filled with anger they may or may not express. Much of their difficulty is caused by unconscious and unacknowledged desires, which can interfere with their ability to benefit from therapy.
In Theodore Millon’s system, there is no presumption that a person will suffer the symptoms of only one subtype. The boundaries of BPD are too fluid and vulnerable to environmental influences to be reduced to a simple formula.
Cluster Analysis: A New Approach to BPD Subtypes
In the July 2017 edition of the online peer-reviewed publication Borderline Personality Disorder and Emotion Dysregulation, a team of researchers from the Netherlands published an article proposing a new set of BPD subtypes, based on the principles of cluster analysis.
Other research teams have proposed similar theoretical schemes, but this latest attempt is more comprehensive than most such efforts. The investigators relied on a long list of parameters to uncover commonalities between diverse BPD sufferers, including:
- Number of borderline symptoms
- Severity of symptoms
- Relationship issues
- Quality of life considerations
- Personality functioning
- Levels of attachment
- Exposure to trauma
After analyzing the clustering of symptoms and BPD-related consequences, the researchers identified three categories or subtypes of BPD:
This subtype is virtually synonymous with “classic” borderline personality disorder. Individuals grouped in the core BPD category experience more traditional BPD symptoms and in a more severe form. Their self-image is unstable and control over their emotional responses is lacking, and frequent anxiety limits their ability to respond to a wide variety of situations.
The relationships of core BPD sufferers are marked by a desire for intimacy but a fear of its consequences, and as a result their interpersonal interactions are marked by contradiction. At times, they may be overly accommodating and unassertive, going out of their way to please the people they are close to. But their need for closeness is powerful and their fear of abandonment strong, and on some occasions they can be excessively controlling and intrusive.
Compared to the other two groups, people in the core BPD group have lower levels of childhood trauma, suggesting that genetic influences are more important than environmental influences in the development of classical BPD symptoms.
In addition to their borderline personality disorder characteristics, people in the extravert/externalizing subtype also display dimensions of narcissistic, antisocial, and histrionic personality disorders. Extravert/externalizing types are reluctant to form attachments and their interpersonal style is self-centered and domineering. Overall, the intensity of their BPD symptoms is low, but they can be highly critical of others, externalizing their problems by blaming it on unsupportive loved ones, society, or the world.
Men are overrepresented in this group, as are those who experienced significant levels of trauma during childhood. Unlike core BPD types, those who fall under this category appear to be highly influenced by environmental factors, although genetic factors have a strong impact on the development of all types of borderline personality disorder.
Exhibiting symptoms consistent with schizotypal and paranoid personalities in addition to their BPD traits, people who belong to this subtype are more likely to feel disconnected from reality. Their symptoms are not as powerful and debilitating as those who suffer from full-blown psychosis, however, and they can usually function fairly well within the parameters of the worlds they create.
Men and women who exhibit the characteristics of the schizotypal/paranoid subtype lack self-confidence and assertiveness, and when they do form relationships they tend to be highly accommodating and deferential. But in general, they are socially isolated and do not express an overriding need for closeness or intimacy. BPD sufferers in this subtype are distrustful of people with dominating or manipulative personalities, and when they feel threatened or besieged by others they may withdraw into their own worlds.
This new classification scheme has a lot of overlap with systems proposed by other mental health researchers, as its creators acknowledge. It remains to be seen if these BPD subtypes catch on, but their grounding in extensive and detailed research undoubtedly gives them legitimate diagnostic and analytical value.
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Borderline Personality Disorder Treatment: The One True Path to Healing
Regardless of where they fit in any system of subtypes, individuals with borderline personality disorder have access to good treatment options that can help them overcome their most intimidating and overwhelming symptoms.
Working with subtype concepts might help BPD sufferers and their therapists identify specific areas of concern that require special attention. But the basic symptomatic framework of borderline personality disorder remains distinct and irreducible, as do the pathways to healing that have helped so many BPD sufferers find their way back from the darkness.
New proposals for borderline personality disorder subtypes will continue to be offered, and as long as they are evidence-based and relate to real aspects of the disorder they can be valuable additions to the ever-growing database on a complex mental health condition.