Understanding the Quiet Borderline Personality
Monday, June 24, 2024. This is for MT, who asked.
As a couples therapist, I've occassionally encountered folks who struggle with Borderline Personality Disorder (BPD) in a way that doesn't fit the classic, more observable symptoms.
This subtler presentation is known as"Quiet Borderline" personality.
Unlike their more overt counterparts, those with Quiet BPD direct their intense emotions inward rather than outward, making their struggles less visible but equally challenging.
Key Characteristics of Quiet BPD
Internalized Anger: Instead of lashing out, individuals with Quiet BPD tend to turn their anger inward. This can result in self-harm, self-blame, and a persistent feeling of worthlessness.
Avoidance of Conflict: Folks with Quiet BPD often go to great lengths to avoid conflict, even at their own expense. They might suppress their feelings and needs to maintain peace in relationships, leading to resentment and emotional withdrawal.
Chronic Feelings of Emptiness: They often experience a pervasive sense of emptiness and disconnection, which can be mistaken for depression or other mood disorders.
Extreme Sensitivity to Rejection: Despite their outward calm, individuals with Quiet BPD are extremely sensitive to perceived rejection or abandonment, which can trigger intense emotional pain.
People-Pleasing Behavior: They might engage in people-pleasing behaviors to avoid abandonment, often sacrificing their needs and boundaries.
Best Practices for Treating Quiet BPD in Couples Therapy
Addressing Quiet BPD in couples therapy requires a nuanced approach, focusing on fostering communication, building trust, and developing healthier coping mechanisms. Here are some best practices:
Psychoeducation: Educating both partners about the nature of Quiet BPD can foster understanding and empathy. Explaining the difference between Quiet BPD and more overt forms can help partners recognize underlying issues. According to Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), understanding the emotional dysregulation in BPD is crucial for effective treatment (Linehan, 1993).
Emotion Regulation Skills: Teaching emotion regulation techniques is crucial. Mindfulness, deep breathing exercises, and grounding techniques can help individuals with Quiet BPD manage their intense emotions without turning them inward. Research has shown that mindfulness-based therapies can significantly reduce symptoms of BPD (Kahl, Winter, & Schweiger, 2012).
Communication Training: Improving communication skills is essential. Helping the partner with Quiet BPD express their needs and emotions more openly can reduce misunderstandings and resentment in the relationship. Techniques like nonviolent communication (NVC) can be particularly effective. According to Marshall Rosenberg, the founder of NVC, this method can transform relationships by fostering empathy and understanding (Rosenberg, 2003).
Validation and Support: Encouraging the partner of the folks with Quiet BPD to offer validation and support can strengthen the relationship. Validating the individual's feelings, even if they seem irrational, can help reduce their sense of isolation and rejection. Linehan emphasizes the importance of validation in DBT, as it helps individuals feel understood and accepted (Linehan, 2014).
Setting Boundaries: Both partners need to learn about healthy boundaries. For the spouse with Quiet BPD, this means recognizing and asserting their own needs. For their partner, it involves respecting those boundaries while maintaining their own. Setting boundaries is crucial for maintaining a balanced and healthy relationship (Tatkin, 2011).
Individual Therapy: While couples therapy is beneficial, it may not be the initial “go-to” therapeutic modality. Individual therapy for those with Quiet BPD can address deeper issues such as self-esteem, trauma, and identity. Dialectical Behavior Therapy (DBT) is particularly effective for BPD. A study by Stoffers-Winterling et al. (2012) found that DBT significantly reduces symptoms and improves overall functioning in folks with BPD. In other words, family therapy or couples therapy may have to wait.
Building Trust: Rebuilding trust is crucial, especially if the relationship has experienced significant conflict or emotional withdrawal. Consistent, reliable behavior from both partners can help restore a sense of safety and stability. Trust-building exercises and consistent communication can aid in this process (Chapman & Gratz, 2009).
Final thoughts
Treating Quiet BPD in couples therapy involves a delicate balance of empathy, education, and practical skill-building. By understanding the unique challenges faced by folks with quiet BPD and employing targeted therapeutic strategies, couples can navigate these complexities and build a healthier, more fulfilling relationship.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
Kahl, K. G., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioral therapies: what is new and what is effective? Current Opinion in Psychiatry, 25(6), 522-528.
Rosenberg, M. B. (2003). Nonviolent Communication: A Language of Life. PuddleDancer Press.
Linehan, M. M. (2014). DBT Skills Training Manual. Guilford Publications.
Chapman, A. L., & Gratz, K. L. (2009). The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD. New Harbinger Publications.
Stoffers-Winterling, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, (8).
Tatkin, S. (2011). Wired for Love: How Understanding Your Partner's Brain and Attachment Style Can Help You Defuse Conflict and Build a Secure Relationship. New Harbinger Publications.
