What Is a ‘Quiet’ Borderline?

Keisha had never been what anyone would call an extrovert. She was an observer and a listener, which can sometimes just be other words for shy. She rarely liked to put herself out there, but when she did, she went all-in. Her relationships were extremely important to her, far more than the people in them would ever have guessed. She loved fiercely, but because she’d always been incredibly sensitive, the slightest disappointments could spoil her mood and sour her on the possibility of happiness. She was intensely reactive.

Although she never raged or raised her voice in anger, when upset, she might say something quietly caustic—words a loved one found deeply hurtful and surprising, although she was equally likely to simply withdraw. During these periods of isolation, her emotions turned dark and clouded. On a too-regular basis, Keisha experienced moments of deafening depression followed by a kind of malaise, a sense of existential hopelessness that seemed to swallow her. Just as quickly, these emotions would switch to anger and resentment; feelings so chaotic, Keisha’s only defense against them was something she’d learned by observing a classmate in her all-girl’s high school—to burn the insides of her arm with the curling iron. The pain was rewarding in that it took her painfully wild inner emotions and turned them into something she could control on the outside, something tangible she could see and name.

By the time Keisha turned 22, she was still jobless and living with her mother. She had never enrolled in college and wasn’t yet seeking to. Her reason was fear; she feared it would all be too much for her—attempting to navigate the outside world and its expectations. The few people she knew were neighbors and the women who worked with her mother. Any friends she’d had in high school she’d lost or all but written off. Still, even with her mother or Ms. Helen, the woman in the apartment next door, Keisha struggled to maintain regular communication.

Borderline Personality and Acting-In Behavior

The designation “quiet borderline” describes a personality style sometimes present among people with borderline personality disorder (BPD), but one that isn’t well known. When we think of a person with BPD, we often imagine someone who angers quickly, who rages, cries and throws tantrums—who is unable to keep herself from expressing negative emotions in an outward and punishing way. Someone who is a “quiet borderline” rarely exhibits acting out behaviors and instead “acts in.” Acting in refers to hostility, aggression, anger and other potentially self-injurious emotions being internalized rather than verbalized or used to fuel behaviors that impact others. This constant internalization of intense negative emotions often means that others are unaware of the extent to which people with “quiet” BPD experience despair and pain. Even the individuals who have it may be unwilling or unable to acknowledge the possibility of a BPD diagnosis for a long time, as some of the more characteristic behaviors common to BPD may not seem to apply to them. However, any person diagnosed with BPD—whether “quiet” or not—will have met the diagnostic criteria.

People with “quiet” BPD often experience a sense of isolation and a lack of connection to the outside world. They may spend a great deal of time and energy rationalizing and denying the effects of their unstable emotions, then harming themselves psychologically or even physically, in despair over their inability to feel in control. They may feel confident one moment and deeply self-hating the next. This inconstancy in self-appraisal is common to all people who suffer from BPD; the difference is that those with “quiet” BPD are far likelier to hide this emotional reality from their loved ones in a way that eventually becomes painfully isolating.

Recovery From ‘Quiet’ BPD Is Possible

Recovery for someone with “quiet” BPD is similar to that for people with the more standard manifestation, and just as hopeful, despite the chaotic and painful effects of the diagnosis. Borderline personality disorder can be recovered from, and treatments such as cognitive behavioral therapy (CBT), and particularly dialectical behavioral therapy (DBT) and schema therapy have been found to be especially helpful in reducing the pain of momentary emotions, and helping individuals learn strategies for coping with them.

On December 26th, 2013, posted in: Mental Health by Tags: ,