December 17, 2024 • 37 mins
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
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Personality Couch podcast,
where we discuss all things personality
and clinical practice.
I'm your host, Doc Bok, and I'm here
with my co-host, Doc Fish.
We're both licensed clinical
psychologists in private practice,
and today we'll be concluding our
(00:21):
Borderline Personality Disorder series.
Culturally, we seem to have taken an
interest in a subtype of
Borderline called Quiet BPD.
But in order to understand this subtype,
we have to look at where this name and
the name Borderline actually came from.
(00:42):
So join us as we discuss the origins of
the Borderline name and dive into
subtypes and popular
current terms such as Quiet BPD.
Let's get right to it.
So, Doc Fish, what do you know about the
subtypes or flavors of BPD?
So, our favorite personality shrink, Dr.
(01:05):
Theodore Milan, in his book, Disorders of
Personality, on page
891, has a perfect quote.
"Borderline may be analogized to the
dumplings on Chinese menus.
So they look alike on the outside, but
can be filled with any number of inner
ingredients, pork, chicken, various
vegetables, and so on.
(01:27):
So, too, the Borderline classification
may be composed internally with a wide
range of diverse, coexisting, other Axis
I and II disorders."
So in other words, they have a whole lot
of other psych stuff on the inside.
That's so interesting.
Wow.
(01:47):
Quiet BPD is not in the DSM.
In order to make criteria for a diagnosis
of Borderline, five out of nine of the
criteria must be met.
So Gunderson, who's another great
personality theorist, he did the math,
and this allows for 256 different
combinations of the criteria from which
(02:09):
it's possible to
achieve a diagnosis of BPD.
Holy cow.
That is so many variations of BPD.
Yeah.
And then not only that, this means that
two people diagnosed with Borderline can
have a minimal overlap
of only one criteria.
Wow.
You can have two next to each other and
you don't even know.
(02:30):
They look so different.
Yeah.
Yeah.
Anytime we're looking at BPD, the
possibilities and subtypes and just how
they present, it's literally endless.
No kidding.
Woo.
Yes.
But Doc Bach, do you want to tell us more
about the early history
of the name Borderline?
I would love to.
(02:51):
Okay.
So Borderline didn't really have a name,
let alone subtypes until the 1930s.
We can trace its earliest origins back to
a paper in 1890 actually outlining
conditions of the psychological and
medical in-betweens.
(03:12):
So the patients that did not fit neatly
into medical categories at the time.
So these patients were said
to be living in the Borderland.
Outside the boxes.
Yeah.
Exactly.
Living in the Borderland.
So then fast forward.
So from 1890 to 1938, Adolf Stern's
(03:36):
seminal 1938 paper was the first to bring
the term Borderline
into well-known existence.
He noticed that these patients got worse
rather than better during
traditional psychoanalysis.
An infant in the box.
Exactly.
Exactly.
(03:56):
So then we have the short but important
lineage to Quiet Borderline.
Okay.
This was 1942.
So from 1938 to 1942, just a few years
later, Halina Deutsch coined a new term.
Can you guess what it was, Dogfish?
I bet it wasn't Quiet Borderline.
(04:18):
No, that would be too easy.
No, it was not Quiet BPD.
How was it?
Oh, it was as if personalities.
Okay.
As if personalities.
Yeah.
And I bet that you know
something about as if patients.
Sure do.
(04:39):
Yes.
Enlighten us.
Interesting.
Yes.
So interesting.
As if patients are like essentially empty
shell personalities.
They mirror everyone around them to blend
in, but they have no
stable sense of self.
They don't really have a sense of self.
Well flag this, borderlines have an
unstable sense of self.
(05:01):
These patients seem to
have no sense of self.
Like they're on the
verge of a psychotic break.
Whoa.
Yeah.
It's like an empty shell casing, like
kind of like an M&M.
That's the color it's supposed to be to
be in the package
with all the other M&Ms.
But there's nothing in it.
Like you bite into it.
There's no chocolate in it.
(05:21):
What?
It's only existing to be an M&M because
like the other M&Ms.
Whoa.
Hold on.
Hold on.
Hold on.
So it's just an empty shell.
It's an empty shell casing.
It's not even really an M&M, but it looks
like an M&M, but there's no core.
So there's no personality
core of the as if patients.
(05:46):
Right.
The absence of self or
the absence of personality.
But hold on.
Hold on.
So this this doesn't quite
sound like quiet BPD though.
So what what in the world?
What what happened?
Yeah, so technically this condition may
(06:06):
fall into like a flavor of DSM
Sportalign in today's classification, but
it wasn't high-functioning.
It's not even necessarily like a quiet
versus noisy presentation.
It was ever-changing.
It's like I'm going to go
hang out with the red M&M.
Now I'm a red M&M.
Can go hang out with the yellow one.
(06:27):
Now I'm yellow.
But you eat it and there's
still no chocolate inside.
There's it's an absence of the self.
So this is all interesting.
But what about connecting the as if
patient to the quiet borderline label?
Right, right.
So this is where a lot of time passes.
(06:48):
So like 50 years later, so
as if was coined in 1942.
Let's jump to 1991.
Okay, and then later revamped in 1994 by
authors Cohen and Sherwood who proposed
(07:10):
that these as if personalities are really
quiet borderlines in
comparison to noisy borderlines.
I read an article in Johnson 2010 and he
described these patients
like the noisy versus the quiet
within an inpatient setting outside in
(07:32):
like the common areas in the rooms.
The nurses had to pay attention to all of
the dramatic presentations, the
self-harm, the dramas, the madness.
And they forgot about the other quiet
borderline who was in the bathroom
struggling with her own things.
Oh, and she was just in there by herself.
(07:55):
Oh, so she had I mean, she had her own
psychological like concerns and symptoms,
but she was removed and she was quiet.
Like she was so quiet. They
literally forgot about her.
Oh my goodness. Okay, so these people
have the same core stuff going on, but
how they deal with it is very different.
(08:17):
Very different. Okay, so Cohen and
Sherwood are calling
this noisy versus quiet.
And in that article 2010, they're seeing
the same types of things.
Like some patients are more openly
demonstrative about their symptoms versus
others are more quietly expressive or
take it out on themselves.
(08:40):
So yeah, yeah, so quiet borderlines were
not as dramatic, but they still had the
same challenges and treatment because the
core is still the same.
They're not responding to psychoanalysis
or the types of treatment at the time.
Okay, so going back to Cohen and
Sherwood, so the ones that kind of tied
(09:02):
together as if and quiet BPD.
So they noted that individuals with with
quiet borderline are more compliant and
insecure versus what they call dramatic
entitled and pushing boundaries.
(09:22):
That quiet borderlines would also isolate
themselves from the impact of others.
So this is directly from their book like
they're comparing contrasting these
again, same core same different things
that we've been talking
about this whole series,
but how they present is
like vastly different.
(09:43):
But what are they saying?
Okay, so they're saying essentially that
we have different presentations of like
like an inward pain versus an outward
pain or internalizing versus
externalizing or even anger turned
towards the self
versus anger turned outward.
Different presentations.
We have that like it like a gob stopper.
(10:05):
We have that same core, but it looks it's
a different color on the outside.
What about the 50 years in between?
So like 1940s to 1990s, like you'd be
hard pressed to find any recent empirical
research on quiet
(10:25):
borderline in the past 20 years.
And obviously there was a huge gap of
time in that 50 year time span.
But then we're there's also been nothing
really, I don't think since the 90s, not
empirically anyway that we could find.
Right, which I think is super sad.
Also, somehow it's on social media and
(10:47):
the internet like you can Google like
quiet borderline just popped up, but we
haven't seen research on
it in the past 20 years.
Where did it come from?
I don't know.
I have no idea.
I mean, like the research on borderline
subtypes in general
that hasn't disappeared.
(11:08):
Right.
So if you do a quick Google search,
you'll probably see Milan's
four subtypes of borderline.
Uh-huh.
And then often you'll see that his
discouraged type is also people also call
that the quiet BPD, but it's not.
Yes, I'm quite passionate that it's not.
Why?
(11:28):
So, okay, descriptions of quiet
borderline and the
discouraged type does overlap.
It's still not a perfect
fit, but it does overlap.
The bottom is the severity.
So the discouraged subtype is
the severe type of borderline.
And this is going to be impatient or
residential stuff, which means like we're
(11:50):
kind of out of the borderline
organizational level and we're going,
we're falling apart.
We're out of reality.
We're going into the psychotic place.
Okay, that's really interesting.
Okay.
So the words of Milan's discouraged type
map on to quiet borderline.
(12:13):
Yeah, I think if I would
pick one, it would be that one.
Sure.
But Milan also talks about the severity
levels with borderline.
And what he's saying is this is like
impatient or residential stuff, which
interesting that 2010 paper that you
reference that was also.
Yeah, it was.
That was impatient
(12:34):
versus outpatient treatment.
And maybe that's where we've kind of
missed the mark in some of this research,
like impatient versus
outpatient level of severity.
But yeah, his discouraged type was more
severe needing inpatient treatment.
And I think that the individuals who are
(12:56):
relating to the quiet borderline type
that they're finding on the internet, I
don't think they're an impatient.
Right.
I don't think so either.
What we're doing is essentially we're
taking an older term and using it
completely out of context.
Oh, why do we keep
doing that in our field?
We're so good about doing that.
And then it's just really good at it.
(13:17):
Like way confusing.
Yeah, it's so confusing.
Oh my gosh.
Okay, so quiet borderline was something
and then we tried to fit it into Milan
and it's not a thing.
And now it's something else.
We don't really know how it became that
thing, but it's something else.
Let's go back to the research.
Okay, we can rely on the research.
(13:39):
Okay, so help me out here, Doc Fish.
Let's fast forward
then to more current info.
So like you said, there's
still research on subtypes.
So maybe we can find a nugget somewhere
to help us out here with kind of what's
going on colloquially.
So what we know is that lots of
researchers tried to explore the subtypes
(14:02):
of BPD by severity, symptoms, self-harm,
co-occurring conditions, features of
other personality disorders, and internal
versus external factors.
So many.
Shocker.
No consensus has been achieved, right?
(14:22):
There's so many different flavors of
borderline that in research, we've not
been able to all agree on different
subtypes of what it
could possibly look like.
I think there's probably some things that
we do know, especially because we have a
research ninja, Doc Fish, who did some
sleuthing and compiling of research to
(14:45):
help us narrow down these subtypes and
where quiet BPD might
actually fit into this.
Today.
So I looked at so much research, so much.
And there's a ton of different
descriptive words for like describing a
subtype or a presentation.
Out of that, I think there's three main
(15:06):
categories that overlap
with most of the subtypes.
But impulsivity kind of
spans all the categories.
We have internalizing, we have
externalizing, and then
we have mixed ambivalent.
What's ambivalent?
That's a big word.
Ambivalent is like a back
and forth or wishy washy.
Hmm.
(15:26):
Okay.
Not necessarily just like a mix of
internalizing and externalizing.
It's still that like
wishy washy conflict kind of.
Right.
Because we can't just have two categories
that would be too simple.
There has to be one that's.
Well, remember, we're trying to describe
a category that's
(15:47):
outside of the boxes anyways.
True.
Help me understand what you were able to
extrapolate from this research.
So let's talk about internalizing first.
So the internalizing type, they're going
to be the ones that withdraw.
They pull away because
of rejection sensitivity.
(16:08):
They're basically turtles.
Oh, I know.
They're more of a like schizoidy type.
They're not aggressive, pretty passive.
They don't want to stand out.
They just want to blend in.
They don't want to go against social
norms and they don't have
like any paranoia, anxiety,
anything like that.
(16:29):
Okay.
So these are the more maybe withdrawn
types that aren't overtly expressive.
So they still have that
borderline core though.
Right.
And those symptoms are likely to come out
in their closest relationships because by
nature, right, turtles don't make waves.
(16:51):
Oh, unless one gets on a log and it's too
many on the log and
then the log knocks them
all off.
A little splash.
But turtles, yes, they don't make waves.
They, if anything, they go with the flow.
They especially see turtles.
They ride the waves.
They just roll with it.
They're so sensitive though.
(17:12):
They're extremely sensitive and they're
in deep emotional pain.
They can feel vastly empty, depressive.
Thus they can be more self-harming even.
Oh, wow.
So they take it out on
themselves versus other people.
And their impulsivity seems to be more
towards like self-focus
(17:32):
things such as again, self-harm,
setting the self up to be hurt or
rejected, maybe impulsive
speech or writing, extending
a text that is immediately regretted.
Difficulty with adult responsibilities.
So like working or doing homework.
They kind of take this air of like, I
(17:53):
didn't feel like it.
Oh, wow.
Like more depressive.
Okay.
Okay.
And it sounds like there's so much
happening inside that shell.
Like you don't really see the extent of
what's going on because
it's inside the shell and
they're maybe taking it out on themselves
in the shell, like on
(18:14):
their bodies or in how
they set themselves up for failure or
maybe impulsivity comes
out like in, oh, didn't
mean to send that text, but not like
overtly dramatic, theatrical.
I'm just thinking back of like the
different presentations of
borderline that I've seen
over the years and these types, when they
(18:35):
come into treatment, it
may not be for overtly
borderline things or they may not present
as kind of a quote
unquote classic borderline.
They can seem more heady, kind of thinky
in their thoughts,
thinking deeply about things,
like associative.
So like out of body or
(18:56):
really in like their fantasy land.
I've seen a lot of pretty extensive like
fantasy worlds in these
types that are more introverted
sometimes more like
looking inward towards the self.
But I think out of that sometimes, not in
all cases, but sometimes they can be seen
(19:17):
as higher functioning because inside that
shell, like you can't
really see everything
that's going on because they
keep to themselves so much.
So you don't know what's happening in the
shell, but these
types can also very easily
fall apart.
And I've seen these types also fall out
of reality rather
(19:38):
easily, especially with these
deep dissociative fantasy worlds that
they can just kind of
lose touch with reality,
lose touch with sometimes
even social, the social world.
So this is where I think it seems to
overlap more with the psychodynamic
(19:59):
schizoid personality,
which is more inward to themselves.
Yeah, but they still have that borderline
core and all that
chaos is just kept inside.
And this is also where personalities are
like gobstoppers
because what's on the outside,
sometimes it doesn't
match what's in the core.
(20:19):
And this sounds like the case
with this more internalizing.
It's a borderline core with like a heady,
schizoid exterior perhaps.
So then we have the opposite.
We have externalizing.
So they are going to be
intrusive with their pushing.
(20:40):
They're oriented towards others.
They're like lantern flies.
How?
Yeah, so they're
flashy, but they're intrusive.
They're not where they're supposed to be.
They can maybe make you angry.
I see.
I see.
The showy, flashy, come look at me is
(21:01):
more of like cluster B presentation.
So like just the more showy, like the
lantern flies, but at
the core, they're not where
they're supposed to be.
Right.
Okay.
Okay.
And this is where we're going to see more
of the cluster B presentation.
(21:22):
So flavors of narcissism, like the
self-absorbed or focused on
self-interest, histrionic.
So that again, the showy, flashy, shallow
emotions, but
theatrical, even antisocial.
So like the social rules don't apply to
me or like who cares
about the law, but like
a lantern fly, I'm going to be here even
(21:43):
though I'm not supposed to be.
Cluster B is in the DSM.
We have different clusters of
personality, A, B, and C. So
borderline technically falls
in the cluster B category, which means
that there's going to
be a lot of overlap with
its neighbors.
So it's neighbors in cluster B being
narcissistic personality disorder,
(22:04):
histrionic personality
disorder, antisocial
personality disorder.
So unsurprising, a lot of these more
overtly showy, flashy,
dramatic presentations are
sounds a lot like our DSM classic
borderline presentation here.
Now one interesting thing about the
(22:24):
externalizing flavor is
like, so anger and aggression.
Aggression is most often in males.
Okay.
Whereas like over anger is in males as
well, but definitely in females.
Females usually lack the
physical aggression piece.
(22:45):
Okay.
Impulsive wise, they're going to be extra
impulsive in all the external ways.
So substance abuse, reckless driving,
indiscriminate intimate
partners, but they're not overtly
anxious.
So they're going to reject any of their
anxiety and they're going
to react against it like
(23:05):
running into the fire.
So like being more reckless
and like, and brave and peacocky.
Okay.
Like a peacock like,
Oh, look at me over here.
It's kind of that pretty showy, but it's
a reaction against anxiety.
It's a counter, it's a counter move.
(23:25):
Yeah.
And like, I can see how the recklessness
could play into that as well.
Like running into the fire, doing just
engaging in more
reckless, impulsive behaviors.
But this is, it's risky.
So it's, it's kind of,
um, self-harm in that risk.
Like they're risking harm to themselves
(23:46):
in all of these ways.
But again, it's external.
Right.
Right.
So you have the turtle that's more
internal, maybe, Oh, maybe
taking it out on their shell.
We don't know what's going on, carving up
their shell or doing something.
It's so sad.
And then we have the lantern flies that
are just where, where
(24:06):
they're not supposed to
be.
Yeah.
They're risking being stepped on.
Yeah.
They're risking their life being in some
place that they're not supposed to be.
Right.
Oh dear.
Wow.
Very different presentations, but same,
same course, same stuff
we've been talking about
this whole series, like all that internal
ingredients of the
dumpling, the borderline
(24:27):
ingredients is there.
One nerdy fact before we go on to the
other one, more trauma is
associated with this type.
However, and this is like a big, however,
most of the studies
didn't dive into the different
types of trauma.
So we're not super sure about it.
Like how much, like, do we know that
(24:47):
there wasn't trauma in
the other types or was it
just not as quote unquote dramatic trauma
or there's lots of questions about that.
Exactly.
Too many questions.
We don't have answers yet.
No, that sounds like our field, right?
Oh my gosh.
Yeah.
So the DSM definition of borderline.
(25:11):
So the classification system that we use
today is more in line.
It sounds like with this externalizing,
especially because it's,
it has a lot of features of
other cluster B antisocial, histrionic,
uh, narcissistic features.
Yeah.
Our DSM is more sensitive to the dramatic
presentation, but I
(25:31):
think out of that sometimes
misses these other potential
presentations of the same condition.
Yes.
Oh boy.
But let's just, you know,
make it even more complicated.
We have the mixed
ambivalent piece, right?
Right.
Cause we can't just have two categories.
We need three.
Yes.
So they're going to look like, like a
(25:51):
core BPD or like the
classic push pool, like porcupines
on a cold night, right?
They're going to prick each other when
they're cuddling to get
warm, going to hurt each other.
But when they distant, they're lonely,
they're empty, they're cold.
That's quite the conflict.
I know.
And it is, it's a major conflict about
(26:11):
like the anxiety of
keeping the attachments versus
their need for independence.
Mm.
Right?
So like I need you, but I don't like that
I need you, which then
means that either unconscious
or not, they don't
always like their attachments.
Ah.
So they can be like passive aggressive.
(26:32):
Yes.
Resentful.
Right.
That's the push pool.
Like I'm resentful of the
fact that I'm dependent on you.
So I'm going to do the opposite.
It's another counter move.
Mm hmm.
So we have flavors of this too, kind of
aligning with a compulsive
personality or an obsessive
compulsive personality disorder.
(26:53):
Maybe the gop stopper, right?
Still borderline core.
We still have that core.
But there's types that have a really
strong compulsive shell.
Yes.
So they work so hard to keep themselves
together, to conform and people please.
But there's that deep internal pain and
anger that they have to act this way.
(27:15):
Sure.
So they can have so much repressed anger
and that results in
resentment and they can keep
their compulsive shell, right?
They can keep themselves
together until they can't.
Until they can't, right?
Yeah.
And then that's when they start seeking
treatment when their
(27:35):
shell starts to crack.
Exactly.
Because life happens.
Like life happens.
And I'm just thinking
back to the turtles.
I know this is the porcupine section, but
like with a turtle
with a cracked shell, like
that's trauma, right?
Yeah.
Like nothing happened to the shell and we
can't hold it together anymore.
(27:57):
Like because life and there's just too
much to try to hold
back that repressed anger,
the resentment, the need to conform and
people please like the,
the damn breaks and then
they come into treatment.
Yeah.
Wow.
Okay.
So like the compulsive part or the DSM
(28:20):
might say OCPD, even like a really
compulsive obsessive
compulsive personality holding back that
anger with lots of rules
and structure and rigidity.
Yes.
Yeah.
Then we also have like a dependent
flavor, but that's paired.
This is important.
It's paired with its opposite, the
(28:40):
avoidant or counterdependent, right?
So dependent, I need you.
Avoidance, go away.
Of course.
This type, they need others to function
because they have to
fulfill their needs for like
compliance, deference, connection.
They have to keep the attachment and they
still don't like it.
And that leads to the
resentment and then the avoidance.
(29:03):
Mm-hmm.
Yeah.
I'm seeing some counter, counter moves
here in this push pool.
Yes.
Like lots of reactions to like the
internalizing embraces
it within themselves.
The externalizing, yeah, we have puts it
on other people and
then this is kind of that
conflict the, I'm going to react in the
(29:25):
equal and opposite way.
Then we have the negativistic flavor.
So they're going to really sit in that
bitterness towards others
and the world really, because
they have to be dependent.
They don't like that they're dependent
and they're bitter about it.
Sure.
But instead of avoiding,
they're just angry and bitter.
(29:45):
They project their own dislike of
themselves onto others.
It's their anger of
themselves turned outward.
Got it.
Okay.
So this is really the classic example of
projection where the
example that I think is relatable
to many people is when that one person
(30:07):
around the dinner table
passes gas and then they
look at someone else and
it's like, oh, you did that.
It's like, nope, that stink is coming
from you from within,
not from anyone else at the
table, but the blame is on everyone else
because they can't handle
the stank inside themselves.
(30:28):
So it's the world's problem.
It's everyone else's stank.
That's perfect.
That is a perfect example of projection.
Yeah.
Oh my gosh.
So yeah.
So they're bitter kind of negativistic
chip on their shoulder.
It's the world's problem, but that's a
way that they're
dealing with that conflict of
(30:50):
closeness and independence.
There were three subtypes in this kind of
mixed ambivalent, the
more compulsive shell
that holds it together and is like maybe
excessively deferential or
compliant until they can't be
and they break and then the dependent,
(31:12):
dependency avoidant, like
that push-pull who responds
in a counterdependent way.
And then the one that's just more
negative and bitter
towards the world in general.
So I get that.
I get the three main types
that you were able to synthesize.
Where does that leave quiet BPD?
(31:34):
Right.
So quiet BPD as far as what we're seeing
around us in the
culture, probably going to
fall somewhere between
internalizing and mixed.
So internalizing because it's inherently
quieter, it's on the
inside, it's not overtly dramatic,
we can't necessarily see it.
(31:54):
But sometimes it's also the higher
functioning individuals
that hide their symptoms behind
this really durable compulsive shell,
which works until the
trauma of life cracks it,
and then I mean we can't control
everything so it's going to crack.
And that's when we start to see those
(32:16):
borderline symptoms in
that borderline core.
Sure.
Sure.
Okay.
So this is why it's important to talk
about the different
flavors of BPD because it's
so vast and yeah, 256 flavor combinations
to be exact at this ice
cream shop, personality
ice cream shop.
(32:36):
What are we scooping today?
And yeah, the DSM really favors the more
dramatic externalizing
flavor and not necessarily the
others.
So this is why it's important I think to
have language around like quiet
borderline or subtypes.
And it makes sense what you're saying
from the research that
(32:57):
you've done from like the
past 20 years since the 90s, what you've
been able to synthesize
that some of the internalizing
maybe is the quieter borderline because
it's inside, it's not
overtly dramatic or the more
compulsive shell types that nobody really
(33:18):
knows until the
trauma of life cracks that
shell.
Right.
And like too, so not only does the DSM
favor the dramatic
externalizing, I think the media
also does in society, right?
Like that's what you're going to think of
when you think of
borderline anger, chaos,
going after people
(33:39):
like in the media, right?
Violence even.
So it does make sense that we're
searching as a society even
for something that captures
a flavor that's different than that.
Right.
Oh, exactly.
I can see that.
Yeah.
Cause drama sells.
(34:00):
Yeah.
Drama gets the attention every time.
And so then the quiet borderline can fall
between the cracks
because it's not necessarily
overtly dramatic.
Right.
Okay.
So let me, let me get this straight.
Make sure I understand.
So as if personality of the 1940s.
So as if was the empty shell borderline.
(34:23):
And then that became
quiet borderline in the 1990s.
Right.
Then all was quiet.
There was no research.
And then it became borderline with a
compulsive shell
colloquially quiet borderline did.
So today then quiet BPD is likely a well
(34:47):
hidden borderline that
keeps their pathology
under tight control except for probably
their closest
relationships might feel that push
pool probably will feel that push pool,
but it's, it's kind of
smoke and mirrors because
that core is still borderline.
Right.
And the court is what matters here.
(35:08):
Yes, exactly.
Exactly.
So, so if it's a job stopper personality,
gob stopper
borderline at the core is still
borderline whether they're internalizing,
externalizing, noisy,
quiet, compulsive, antisocial,
histrionic, narcissistic.
(35:30):
If it's a borderline
core, it's still a borderline.
So it's, I think it's really important to
have this language to
know, to look for things,
presentations, I should say, to look for
presentations outside
of maybe what's been
hyped in the media or what we as
professionals even, you know, come to
(35:51):
think of as, as borderline
just because of how the DSM
is, I would say skewed a bit.
Yeah, that's fair.
Okay.
So for today, I think we should probably
land the plane because we
could talk forever about
BPD subtypes, but we do
need to wrap up for now.
(36:11):
Thank you for joining us today on this
episode of the personality couch.
Make sure to check out our blogs that
coincide with these episodes for more
in-depth information
at www.personalitycouch.com.
And as always, don't forget to give us a
thumbs up or rate and
review us on your favorite
(36:32):
podcast app.
Be well, be kind, and we'll see you next
time on the personality couch.
Welcome to the Personality Couch podcast,
where we discuss all things personality
and clinical practice.
I'm your host, Doc Bok, and I'm here
with my co-host, Doc Fish.
We're both licensed clinical
psychologists in private practice,
and today we'll be concluding our
(00:21):
Borderline Personality Disorder series.
Culturally, we seem to have taken an
interest in a subtype of
Borderline called Quiet BPD.
But in order to understand this subtype,
we have to look at where this name and
the name Borderline actually came from.
(00:42):
So join us as we discuss the origins of
the Borderline name and dive into
subtypes and popular
current terms such as Quiet BPD.
Let's get right to it.
So, Doc Fish, what do you know about the
subtypes or flavors of BPD?
So, our favorite personality shrink, Dr.
(01:05):
Theodore Milan, in his book, Disorders of
Personality, on page
891, has a perfect quote.
"Borderline may be analogized to the
dumplings on Chinese menus.
So they look alike on the outside, but
can be filled with any number of inner
ingredients, pork, chicken, various
vegetables, and so on.
(01:27):
So, too, the Borderline classification
may be composed internally with a wide
range of diverse, coexisting, other Axis
I and II disorders."
So in other words, they have a whole lot
of other psych stuff on the inside.
That's so interesting.
Wow.
(01:47):
Quiet BPD is not in the DSM.
In order to make criteria for a diagnosis
of Borderline, five out of nine of the
criteria must be met.
So Gunderson, who's another great
personality theorist, he did the math,
and this allows for 256 different
combinations of the criteria from which
(02:09):
it's possible to
achieve a diagnosis of BPD.
Holy cow.
That is so many variations of BPD.
Yeah.
And then not only that, this means that
two people diagnosed with Borderline can
have a minimal overlap
of only one criteria.
Wow.
You can have two next to each other and
you don't even know.
(02:30):
They look so different.
Yeah.
Yeah.
Anytime we're looking at BPD, the
possibilities and subtypes and just how
they present, it's literally endless.
No kidding.
Woo.
Yes.
But Doc Bach, do you want to tell us more
about the early history
of the name Borderline?
I would love to.
(02:51):
Okay.
So Borderline didn't really have a name,
let alone subtypes until the 1930s.
We can trace its earliest origins back to
a paper in 1890 actually outlining
conditions of the psychological and
medical in-betweens.
(03:12):
So the patients that did not fit neatly
into medical categories at the time.
So these patients were said
to be living in the Borderland.
Outside the boxes.
Yeah.
Exactly.
Living in the Borderland.
So then fast forward.
So from 1890 to 1938, Adolf Stern's
(03:36):
seminal 1938 paper was the first to bring
the term Borderline
into well-known existence.
He noticed that these patients got worse
rather than better during
traditional psychoanalysis.
An infant in the box.
Exactly.
Exactly.
(03:56):
So then we have the short but important
lineage to Quiet Borderline.
Okay.
This was 1942.
So from 1938 to 1942, just a few years
later, Halina Deutsch coined a new term.
Can you guess what it was, Dogfish?
I bet it wasn't Quiet Borderline.
(04:18):
No, that would be too easy.
No, it was not Quiet BPD.
How was it?
Oh, it was as if personalities.
Okay.
As if personalities.
Yeah.
And I bet that you know
something about as if patients.
Sure do.
(04:39):
Yes.
Enlighten us.
Interesting.
Yes.
So interesting.
As if patients are like essentially empty
shell personalities.
They mirror everyone around them to blend
in, but they have no
stable sense of self.
They don't really have a sense of self.
Well flag this, borderlines have an
unstable sense of self.
(05:01):
These patients seem to
have no sense of self.
Like they're on the
verge of a psychotic break.
Whoa.
Yeah.
It's like an empty shell casing, like
kind of like an M&M.
That's the color it's supposed to be to
be in the package
with all the other M&Ms.
But there's nothing in it.
Like you bite into it.
There's no chocolate in it.
(05:21):
What?
It's only existing to be an M&M because
like the other M&Ms.
Whoa.
Hold on.
Hold on.
Hold on.
So it's just an empty shell.
It's an empty shell casing.
It's not even really an M&M, but it looks
like an M&M, but there's no core.
So there's no personality
core of the as if patients.
(05:46):
Right.
The absence of self or
the absence of personality.
But hold on.
Hold on.
So this this doesn't quite
sound like quiet BPD though.
So what what in the world?
What what happened?
Yeah, so technically this condition may
(06:06):
fall into like a flavor of DSM
Sportalign in today's classification, but
it wasn't high-functioning.
It's not even necessarily like a quiet
versus noisy presentation.
It was ever-changing.
It's like I'm going to go
hang out with the red M&M.
Now I'm a red M&M.
Can go hang out with the yellow one.
(06:27):
Now I'm yellow.
But you eat it and there's
still no chocolate inside.
There's it's an absence of the self.
So this is all interesting.
But what about connecting the as if
patient to the quiet borderline label?
Right, right.
So this is where a lot of time passes.
(06:48):
So like 50 years later, so
as if was coined in 1942.
Let's jump to 1991.
Okay, and then later revamped in 1994 by
authors Cohen and Sherwood who proposed
(07:10):
that these as if personalities are really
quiet borderlines in
comparison to noisy borderlines.
I read an article in Johnson 2010 and he
described these patients
like the noisy versus the quiet
within an inpatient setting outside in
(07:32):
like the common areas in the rooms.
The nurses had to pay attention to all of
the dramatic presentations, the
self-harm, the dramas, the madness.
And they forgot about the other quiet
borderline who was in the bathroom
struggling with her own things.
Oh, and she was just in there by herself.
(07:55):
Oh, so she had I mean, she had her own
psychological like concerns and symptoms,
but she was removed and she was quiet.
Like she was so quiet. They
literally forgot about her.
Oh my goodness. Okay, so these people
have the same core stuff going on, but
how they deal with it is very different.
(08:17):
Very different. Okay, so Cohen and
Sherwood are calling
this noisy versus quiet.
And in that article 2010, they're seeing
the same types of things.
Like some patients are more openly
demonstrative about their symptoms versus
others are more quietly expressive or
take it out on themselves.
(08:40):
So yeah, yeah, so quiet borderlines were
not as dramatic, but they still had the
same challenges and treatment because the
core is still the same.
They're not responding to psychoanalysis
or the types of treatment at the time.
Okay, so going back to Cohen and
Sherwood, so the ones that kind of tied
(09:02):
together as if and quiet BPD.
So they noted that individuals with with
quiet borderline are more compliant and
insecure versus what they call dramatic
entitled and pushing boundaries.
(09:22):
That quiet borderlines would also isolate
themselves from the impact of others.
So this is directly from their book like
they're comparing contrasting these
again, same core same different things
that we've been talking
about this whole series,
but how they present is
like vastly different.
(09:43):
But what are they saying?
Okay, so they're saying essentially that
we have different presentations of like
like an inward pain versus an outward
pain or internalizing versus
externalizing or even anger turned
towards the self
versus anger turned outward.
Different presentations.
We have that like it like a gob stopper.
(10:05):
We have that same core, but it looks it's
a different color on the outside.
What about the 50 years in between?
So like 1940s to 1990s, like you'd be
hard pressed to find any recent empirical
research on quiet
(10:25):
borderline in the past 20 years.
And obviously there was a huge gap of
time in that 50 year time span.
But then we're there's also been nothing
really, I don't think since the 90s, not
empirically anyway that we could find.
Right, which I think is super sad.
Also, somehow it's on social media and
(10:47):
the internet like you can Google like
quiet borderline just popped up, but we
haven't seen research on
it in the past 20 years.
Where did it come from?
I don't know.
I have no idea.
I mean, like the research on borderline
subtypes in general
that hasn't disappeared.
(11:08):
Right.
So if you do a quick Google search,
you'll probably see Milan's
four subtypes of borderline.
Uh-huh.
And then often you'll see that his
discouraged type is also people also call
that the quiet BPD, but it's not.
Yes, I'm quite passionate that it's not.
Why?
(11:28):
So, okay, descriptions of quiet
borderline and the
discouraged type does overlap.
It's still not a perfect
fit, but it does overlap.
The bottom is the severity.
So the discouraged subtype is
the severe type of borderline.
And this is going to be impatient or
residential stuff, which means like we're
(11:50):
kind of out of the borderline
organizational level and we're going,
we're falling apart.
We're out of reality.
We're going into the psychotic place.
Okay, that's really interesting.
Okay.
So the words of Milan's discouraged type
map on to quiet borderline.
(12:13):
Yeah, I think if I would
pick one, it would be that one.
Sure.
But Milan also talks about the severity
levels with borderline.
And what he's saying is this is like
impatient or residential stuff, which
interesting that 2010 paper that you
reference that was also.
Yeah, it was.
That was impatient
(12:34):
versus outpatient treatment.
And maybe that's where we've kind of
missed the mark in some of this research,
like impatient versus
outpatient level of severity.
But yeah, his discouraged type was more
severe needing inpatient treatment.
And I think that the individuals who are
(12:56):
relating to the quiet borderline type
that they're finding on the internet, I
don't think they're an impatient.
Right.
I don't think so either.
What we're doing is essentially we're
taking an older term and using it
completely out of context.
Oh, why do we keep
doing that in our field?
We're so good about doing that.
And then it's just really good at it.
(13:17):
Like way confusing.
Yeah, it's so confusing.
Oh my gosh.
Okay, so quiet borderline was something
and then we tried to fit it into Milan
and it's not a thing.
And now it's something else.
We don't really know how it became that
thing, but it's something else.
Let's go back to the research.
Okay, we can rely on the research.
(13:39):
Okay, so help me out here, Doc Fish.
Let's fast forward
then to more current info.
So like you said, there's
still research on subtypes.
So maybe we can find a nugget somewhere
to help us out here with kind of what's
going on colloquially.
So what we know is that lots of
researchers tried to explore the subtypes
(14:02):
of BPD by severity, symptoms, self-harm,
co-occurring conditions, features of
other personality disorders, and internal
versus external factors.
So many.
Shocker.
No consensus has been achieved, right?
(14:22):
There's so many different flavors of
borderline that in research, we've not
been able to all agree on different
subtypes of what it
could possibly look like.
I think there's probably some things that
we do know, especially because we have a
research ninja, Doc Fish, who did some
sleuthing and compiling of research to
(14:45):
help us narrow down these subtypes and
where quiet BPD might
actually fit into this.
Today.
So I looked at so much research, so much.
And there's a ton of different
descriptive words for like describing a
subtype or a presentation.
Out of that, I think there's three main
(15:06):
categories that overlap
with most of the subtypes.
But impulsivity kind of
spans all the categories.
We have internalizing, we have
externalizing, and then
we have mixed ambivalent.
What's ambivalent?
That's a big word.
Ambivalent is like a back
and forth or wishy washy.
Hmm.
(15:26):
Okay.
Not necessarily just like a mix of
internalizing and externalizing.
It's still that like
wishy washy conflict kind of.
Right.
Because we can't just have two categories
that would be too simple.
There has to be one that's.
Well, remember, we're trying to describe
a category that's
(15:47):
outside of the boxes anyways.
True.
Help me understand what you were able to
extrapolate from this research.
So let's talk about internalizing first.
So the internalizing type, they're going
to be the ones that withdraw.
They pull away because
of rejection sensitivity.
(16:08):
They're basically turtles.
Oh, I know.
They're more of a like schizoidy type.
They're not aggressive, pretty passive.
They don't want to stand out.
They just want to blend in.
They don't want to go against social
norms and they don't have
like any paranoia, anxiety,
anything like that.
(16:29):
Okay.
So these are the more maybe withdrawn
types that aren't overtly expressive.
So they still have that
borderline core though.
Right.
And those symptoms are likely to come out
in their closest relationships because by
nature, right, turtles don't make waves.
(16:51):
Oh, unless one gets on a log and it's too
many on the log and
then the log knocks them
all off.
A little splash.
But turtles, yes, they don't make waves.
They, if anything, they go with the flow.
They especially see turtles.
They ride the waves.
They just roll with it.
They're so sensitive though.
(17:12):
They're extremely sensitive and they're
in deep emotional pain.
They can feel vastly empty, depressive.
Thus they can be more self-harming even.
Oh, wow.
So they take it out on
themselves versus other people.
And their impulsivity seems to be more
towards like self-focus
(17:32):
things such as again, self-harm,
setting the self up to be hurt or
rejected, maybe impulsive
speech or writing, extending
a text that is immediately regretted.
Difficulty with adult responsibilities.
So like working or doing homework.
They kind of take this air of like, I
(17:53):
didn't feel like it.
Oh, wow.
Like more depressive.
Okay.
Okay.
And it sounds like there's so much
happening inside that shell.
Like you don't really see the extent of
what's going on because
it's inside the shell and
they're maybe taking it out on themselves
in the shell, like on
(18:14):
their bodies or in how
they set themselves up for failure or
maybe impulsivity comes
out like in, oh, didn't
mean to send that text, but not like
overtly dramatic, theatrical.
I'm just thinking back of like the
different presentations of
borderline that I've seen
over the years and these types, when they
(18:35):
come into treatment, it
may not be for overtly
borderline things or they may not present
as kind of a quote
unquote classic borderline.
They can seem more heady, kind of thinky
in their thoughts,
thinking deeply about things,
like associative.
So like out of body or
(18:56):
really in like their fantasy land.
I've seen a lot of pretty extensive like
fantasy worlds in these
types that are more introverted
sometimes more like
looking inward towards the self.
But I think out of that sometimes, not in
all cases, but sometimes they can be seen
(19:17):
as higher functioning because inside that
shell, like you can't
really see everything
that's going on because they
keep to themselves so much.
So you don't know what's happening in the
shell, but these
types can also very easily
fall apart.
And I've seen these types also fall out
of reality rather
(19:38):
easily, especially with these
deep dissociative fantasy worlds that
they can just kind of
lose touch with reality,
lose touch with sometimes
even social, the social world.
So this is where I think it seems to
overlap more with the psychodynamic
(19:59):
schizoid personality,
which is more inward to themselves.
Yeah, but they still have that borderline
core and all that
chaos is just kept inside.
And this is also where personalities are
like gobstoppers
because what's on the outside,
sometimes it doesn't
match what's in the core.
(20:19):
And this sounds like the case
with this more internalizing.
It's a borderline core with like a heady,
schizoid exterior perhaps.
So then we have the opposite.
We have externalizing.
So they are going to be
intrusive with their pushing.
(20:40):
They're oriented towards others.
They're like lantern flies.
How?
Yeah, so they're
flashy, but they're intrusive.
They're not where they're supposed to be.
They can maybe make you angry.
I see.
I see.
The showy, flashy, come look at me is
(21:01):
more of like cluster B presentation.
So like just the more showy, like the
lantern flies, but at
the core, they're not where
they're supposed to be.
Right.
Okay.
Okay.
And this is where we're going to see more
of the cluster B presentation.
(21:22):
So flavors of narcissism, like the
self-absorbed or focused on
self-interest, histrionic.
So that again, the showy, flashy, shallow
emotions, but
theatrical, even antisocial.
So like the social rules don't apply to
me or like who cares
about the law, but like
a lantern fly, I'm going to be here even
(21:43):
though I'm not supposed to be.
Cluster B is in the DSM.
We have different clusters of
personality, A, B, and C. So
borderline technically falls
in the cluster B category, which means
that there's going to
be a lot of overlap with
its neighbors.
So it's neighbors in cluster B being
narcissistic personality disorder,
(22:04):
histrionic personality
disorder, antisocial
personality disorder.
So unsurprising, a lot of these more
overtly showy, flashy,
dramatic presentations are
sounds a lot like our DSM classic
borderline presentation here.
Now one interesting thing about the
(22:24):
externalizing flavor is
like, so anger and aggression.
Aggression is most often in males.
Okay.
Whereas like over anger is in males as
well, but definitely in females.
Females usually lack the
physical aggression piece.
(22:45):
Okay.
Impulsive wise, they're going to be extra
impulsive in all the external ways.
So substance abuse, reckless driving,
indiscriminate intimate
partners, but they're not overtly
anxious.
So they're going to reject any of their
anxiety and they're going
to react against it like
(23:05):
running into the fire.
So like being more reckless
and like, and brave and peacocky.
Okay.
Like a peacock like,
Oh, look at me over here.
It's kind of that pretty showy, but it's
a reaction against anxiety.
It's a counter, it's a counter move.
(23:25):
Yeah.
And like, I can see how the recklessness
could play into that as well.
Like running into the fire, doing just
engaging in more
reckless, impulsive behaviors.
But this is, it's risky.
So it's, it's kind of,
um, self-harm in that risk.
Like they're risking harm to themselves
(23:46):
in all of these ways.
But again, it's external.
Right.
Right.
So you have the turtle that's more
internal, maybe, Oh, maybe
taking it out on their shell.
We don't know what's going on, carving up
their shell or doing something.
It's so sad.
And then we have the lantern flies that
are just where, where
(24:06):
they're not supposed to
be.
Yeah.
They're risking being stepped on.
Yeah.
They're risking their life being in some
place that they're not supposed to be.
Right.
Oh dear.
Wow.
Very different presentations, but same,
same course, same stuff
we've been talking about
this whole series, like all that internal
ingredients of the
dumpling, the borderline
(24:27):
ingredients is there.
One nerdy fact before we go on to the
other one, more trauma is
associated with this type.
However, and this is like a big, however,
most of the studies
didn't dive into the different
types of trauma.
So we're not super sure about it.
Like how much, like, do we know that
(24:47):
there wasn't trauma in
the other types or was it
just not as quote unquote dramatic trauma
or there's lots of questions about that.
Exactly.
Too many questions.
We don't have answers yet.
No, that sounds like our field, right?
Oh my gosh.
Yeah.
So the DSM definition of borderline.
(25:11):
So the classification system that we use
today is more in line.
It sounds like with this externalizing,
especially because it's,
it has a lot of features of
other cluster B antisocial, histrionic,
uh, narcissistic features.
Yeah.
Our DSM is more sensitive to the dramatic
presentation, but I
(25:31):
think out of that sometimes
misses these other potential
presentations of the same condition.
Yes.
Oh boy.
But let's just, you know,
make it even more complicated.
We have the mixed
ambivalent piece, right?
Right.
Cause we can't just have two categories.
We need three.
Yes.
So they're going to look like, like a
(25:51):
core BPD or like the
classic push pool, like porcupines
on a cold night, right?
They're going to prick each other when
they're cuddling to get
warm, going to hurt each other.
But when they distant, they're lonely,
they're empty, they're cold.
That's quite the conflict.
I know.
And it is, it's a major conflict about
(26:11):
like the anxiety of
keeping the attachments versus
their need for independence.
Mm.
Right?
So like I need you, but I don't like that
I need you, which then
means that either unconscious
or not, they don't
always like their attachments.
Ah.
So they can be like passive aggressive.
(26:32):
Yes.
Resentful.
Right.
That's the push pool.
Like I'm resentful of the
fact that I'm dependent on you.
So I'm going to do the opposite.
It's another counter move.
Mm hmm.
So we have flavors of this too, kind of
aligning with a compulsive
personality or an obsessive
compulsive personality disorder.
(26:53):
Maybe the gop stopper, right?
Still borderline core.
We still have that core.
But there's types that have a really
strong compulsive shell.
Yes.
So they work so hard to keep themselves
together, to conform and people please.
But there's that deep internal pain and
anger that they have to act this way.
(27:15):
Sure.
So they can have so much repressed anger
and that results in
resentment and they can keep
their compulsive shell, right?
They can keep themselves
together until they can't.
Until they can't, right?
Yeah.
And then that's when they start seeking
treatment when their
(27:35):
shell starts to crack.
Exactly.
Because life happens.
Like life happens.
And I'm just thinking
back to the turtles.
I know this is the porcupine section, but
like with a turtle
with a cracked shell, like
that's trauma, right?
Yeah.
Like nothing happened to the shell and we
can't hold it together anymore.
(27:57):
Like because life and there's just too
much to try to hold
back that repressed anger,
the resentment, the need to conform and
people please like the,
the damn breaks and then
they come into treatment.
Yeah.
Wow.
Okay.
So like the compulsive part or the DSM
(28:20):
might say OCPD, even like a really
compulsive obsessive
compulsive personality holding back that
anger with lots of rules
and structure and rigidity.
Yes.
Yeah.
Then we also have like a dependent
flavor, but that's paired.
This is important.
It's paired with its opposite, the
(28:40):
avoidant or counterdependent, right?
So dependent, I need you.
Avoidance, go away.
Of course.
This type, they need others to function
because they have to
fulfill their needs for like
compliance, deference, connection.
They have to keep the attachment and they
still don't like it.
And that leads to the
resentment and then the avoidance.
(29:03):
Mm-hmm.
Yeah.
I'm seeing some counter, counter moves
here in this push pool.
Yes.
Like lots of reactions to like the
internalizing embraces
it within themselves.
The externalizing, yeah, we have puts it
on other people and
then this is kind of that
conflict the, I'm going to react in the
(29:25):
equal and opposite way.
Then we have the negativistic flavor.
So they're going to really sit in that
bitterness towards others
and the world really, because
they have to be dependent.
They don't like that they're dependent
and they're bitter about it.
Sure.
But instead of avoiding,
they're just angry and bitter.
(29:45):
They project their own dislike of
themselves onto others.
It's their anger of
themselves turned outward.
Got it.
Okay.
So this is really the classic example of
projection where the
example that I think is relatable
to many people is when that one person
(30:07):
around the dinner table
passes gas and then they
look at someone else and
it's like, oh, you did that.
It's like, nope, that stink is coming
from you from within,
not from anyone else at the
table, but the blame is on everyone else
because they can't handle
the stank inside themselves.
(30:28):
So it's the world's problem.
It's everyone else's stank.
That's perfect.
That is a perfect example of projection.
Yeah.
Oh my gosh.
So yeah.
So they're bitter kind of negativistic
chip on their shoulder.
It's the world's problem, but that's a
way that they're
dealing with that conflict of
(30:50):
closeness and independence.
There were three subtypes in this kind of
mixed ambivalent, the
more compulsive shell
that holds it together and is like maybe
excessively deferential or
compliant until they can't be
and they break and then the dependent,
(31:12):
dependency avoidant, like
that push-pull who responds
in a counterdependent way.
And then the one that's just more
negative and bitter
towards the world in general.
So I get that.
I get the three main types
that you were able to synthesize.
Where does that leave quiet BPD?
(31:34):
Right.
So quiet BPD as far as what we're seeing
around us in the
culture, probably going to
fall somewhere between
internalizing and mixed.
So internalizing because it's inherently
quieter, it's on the
inside, it's not overtly dramatic,
we can't necessarily see it.
(31:54):
But sometimes it's also the higher
functioning individuals
that hide their symptoms behind
this really durable compulsive shell,
which works until the
trauma of life cracks it,
and then I mean we can't control
everything so it's going to crack.
And that's when we start to see those
(32:16):
borderline symptoms in
that borderline core.
Sure.
Sure.
Okay.
So this is why it's important to talk
about the different
flavors of BPD because it's
so vast and yeah, 256 flavor combinations
to be exact at this ice
cream shop, personality
ice cream shop.
(32:36):
What are we scooping today?
And yeah, the DSM really favors the more
dramatic externalizing
flavor and not necessarily the
others.
So this is why it's important I think to
have language around like quiet
borderline or subtypes.
And it makes sense what you're saying
from the research that
(32:57):
you've done from like the
past 20 years since the 90s, what you've
been able to synthesize
that some of the internalizing
maybe is the quieter borderline because
it's inside, it's not
overtly dramatic or the more
compulsive shell types that nobody really
(33:18):
knows until the
trauma of life cracks that
shell.
Right.
And like too, so not only does the DSM
favor the dramatic
externalizing, I think the media
also does in society, right?
Like that's what you're going to think of
when you think of
borderline anger, chaos,
going after people
(33:39):
like in the media, right?
Violence even.
So it does make sense that we're
searching as a society even
for something that captures
a flavor that's different than that.
Right.
Oh, exactly.
I can see that.
Yeah.
Cause drama sells.
(34:00):
Yeah.
Drama gets the attention every time.
And so then the quiet borderline can fall
between the cracks
because it's not necessarily
overtly dramatic.
Right.
Okay.
So let me, let me get this straight.
Make sure I understand.
So as if personality of the 1940s.
So as if was the empty shell borderline.
(34:23):
And then that became
quiet borderline in the 1990s.
Right.
Then all was quiet.
There was no research.
And then it became borderline with a
compulsive shell
colloquially quiet borderline did.
So today then quiet BPD is likely a well
(34:47):
hidden borderline that
keeps their pathology
under tight control except for probably
their closest
relationships might feel that push
pool probably will feel that push pool,
but it's, it's kind of
smoke and mirrors because
that core is still borderline.
Right.
And the court is what matters here.
(35:08):
Yes, exactly.
Exactly.
So, so if it's a job stopper personality,
gob stopper
borderline at the core is still
borderline whether they're internalizing,
externalizing, noisy,
quiet, compulsive, antisocial,
histrionic, narcissistic.
(35:30):
If it's a borderline
core, it's still a borderline.
So it's, I think it's really important to
have this language to
know, to look for things,
presentations, I should say, to look for
presentations outside
of maybe what's been
hyped in the media or what we as
professionals even, you know, come to
(35:51):
think of as, as borderline
just because of how the DSM
is, I would say skewed a bit.
Yeah, that's fair.
Okay.
So for today, I think we should probably
land the plane because we
could talk forever about
BPD subtypes, but we do
need to wrap up for now.
(36:11):
Thank you for joining us today on this
episode of the personality couch.
Make sure to check out our blogs that
coincide with these episodes for more
in-depth information
at www.personalitycouch.com.
And as always, don't forget to give us a
thumbs up or rate and
review us on your favorite
(36:32):
podcast app.
Be well, be kind, and we'll see you next
time on the personality couch.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com