What are the types of Borderline Personality Disorder (BPD)?

From the Guidelines

Borderline Personality Disorder (BPD) is not explicitly classified into subtypes in the provided evidence, but it is commonly associated with four main subtypes: Discouraged (Quiet) BPD, Impulsive BPD, Petulant BPD, and Self-Destructive BPD. The provided evidence focuses on the treatment of BPD, particularly dialectical behavior therapy (DBT), which is a well-established treatment for BPD 1. DBT combines elements of cognitive behavioral therapy (CBT), skills training, and mindfulness techniques to help patients develop skills in emotion regulation, interpersonal effectiveness, and distress tolerance. Some key characteristics of BPD include:

• Internalized emotions, people-pleasing behaviors, and fear of abandonment, often appearing high-functioning while struggling internally
• Intense emotional reactivity, risk-taking behaviors, and difficulty with impulse control
• Unpredictable mood swings, irritability, and passive-aggressive behaviors
• Self-harm, suicidal ideation, and self-sabotaging behaviors It's essential to note that individuals may exhibit traits from multiple subtypes, and proper diagnosis requires assessment by a mental health professional. Treatment typically involves DBT, CBT, and sometimes medication to manage specific symptoms like depression or anxiety 1. The evidence suggests that DBT is effective in reducing nonsuicidal and suicidal self-directed violence among patients with BPD and recent self-directed violence 1. A study by Hawton and colleagues found that DBT reduced posttreatment suicidal ideation and repetition of self-directed violence among patients with BPD 1. In terms of treatment approaches, DBT for adolescents (DBT-A) has been modified to include the participation of a relative in the skills training group, aiming to improve the home environment and teach relatives to model and reinforce adaptive behaviors for the adolescent 1. DBT-A has been shown to be acceptable to teenagers and reduces rates of psychiatric hospitalization 1. The most effective treatment approach for BPD is DBT, which should be considered as the first-line treatment for patients with BPD, particularly those with recent self-directed violence 1.

From the Research

Types of Borderline Personality Disorder (BPD)

The types of Borderline Personality Disorder (BPD) can be understood through various studies that have identified different subtypes and characteristics of the disorder. Some of the key findings include:

• BPD is a heterogeneous disorder with respect to the array of personality traits patients may exhibit, admitting of many subtypes 2
• Characterologic subtypes of BPD may include histrionic, narcissistic, or antisocial personality patterns, as well as Kraepelinian temperaments such as depressive, manic, irritable, or cyclothymic 2
• Finer-scale subtypes may include traits such as mercurial, unreasonable, infantile, volatile, demanding, and going-to-extremes, which can influence the direction of therapeutic efforts and long-term outcome 2
• A study using factor mixture modeling identified three subtypes of BPD features: Asymptomatic, Unstable, and Empty, with the Unstable and Empty classes displaying elevated BPD symptomatology along a single continuum of BPD severity 3
• The Unstable class is characterized by a high frequency of reckless and self-damaging behaviors, while the Empty class is characterized by high levels of emptiness and dissociation, emotional distress, and attachment avoidance 3

Subtypes and Characteristics

Some of the subtypes and characteristics of BPD include:

• Unstable subtype: characterized by reckless and self-damaging behaviors 3
• Empty subtype: characterized by high levels of emptiness and dissociation, emotional distress, and attachment avoidance 3
• Histrionic subtype: characterized by dramatic and attention-seeking behavior 2
• Narcissistic subtype: characterized by grandiosity and a need for admiration 2
• Antisocial subtype: characterized by a disregard for others' rights and feelings 2

Diagnostic Considerations

It's worth noting that BPD can be difficult to diagnose due to its overlapping symptoms with other disorders, such as bipolar spectrum disorders, major depression, schizophrenia, attention-deficit/hyperactivity disorder, and posttraumatic stress disorder 4