Table of ContentsView AllTable of ContentsSubtypes in Popular MediaResearch on SubtypesTreatment Implications

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Subtypes in Popular Media

Research on Subtypes

Treatment Implications

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Borderline personality disorder(BPD) is associated with varioussigns and symptoms. An individual must meet just five out of a total of ninediagnostic criteriafor a BPD diagnosis, meaning that BPD in one person can look very different from BPD in another.This has led experts to explore the possibility of distinct BPD subtypes.

BPD subtypes are referenced in both popular media and pop psychology books, despite the fact that DSM-V does not recognize them formally.For example, in her bookUnderstanding the Borderline Mother, Dr. Christine Lawson describes four subtypes of mothers with BPD: the Waif (helpless), the Hermit (fearful/avoidant), the Queen (controlling), and the Witch (sadistic).

The conventional type is described as engaging in self-destructive behavior that frequently requires intervention and as very low-functioning, meaning they’re unable to work or go to school. The author calls this self-destructive behavior “acting in,” similar to the concept ofinternalizing symptoms.

In contrast, the invisible type is described as functioning well in most contexts, but engaging in a great deal of “acting out” behavior, such as verbal abuse, criticizing others, or becoming violent. This description mimics the concept ofexternalizing symptoms.

These subtypes of BPD in popular literature were derived from the authors' expert opinions. More recently, researchers have tried to take a quantitative approach to describe subtypes of BPD. The research on the topic paints a more complicated picture.

The research on the existence of subtypes of BPD is mixed.

One study, which examined types of borderline personalities based on patterns of co-occurring personality problems, identified three subtypes of BPD that map onto the three clusters of personality disorders in theDiagnostic and Statistical Manual of Mental Disorders: Cluster A,Cluster B, and Cluster C. Those in the Cluster A subgroup tended to engage in more paranoid thinking and eccentric behavior, those in B tended to have more dramatic or arrogant personalities, and those in C tended to be more fearful.

Some studies have found that BPD can be treated as a unified diagnostic entity without the presence of clear subtypes, whereas others have identified some subtypes of BPD.

Another study that examined BPD subtypes in adolescent boys and girls with BPD found reliable subtypes in girls, but not boys. Girls with BPD tended to fall into one of the following categories: high-functioning internalizing, depressive internalizing,histrionic, and angry externalizing.

A third study found three BPD subtypes: withdrawn–internalizing, severely disturbed–internalizing and anxious–externalizing.Interestingly, these last two studies suggest that the distinctions between internalizing versus externalizing symptoms and high versus low functioning may be an important one in BPD, and may in part validate some of the popular psychology literature on the topic.

Because of the inconsistencies in the research literature, much more study is needed on this topic.

BPD Treatment Implications

At least one study has found that individuals with different presentations of BPD may respond differently to treatment. In this study, individuals from the severely disturbed-internalizing subtype did not see symptom improvement with treatment, whereas those in the anxious-externalizing and withdrawn-internalizing subtypes did.

This suggests that theprognosis for BPDmay be different depending on the subtype that an individual belongs to. However, much more research is needed before we can say anything definitive about differential treatment response.

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chanen AM, Thompson KN. Prescribing and borderline personality disorder.Aust Prescr. 2016;39(2):49-53. doi:10.18773/austprescr.2016.019American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Publishing. ISBN:978-0-89042-554-1Smits, M. L., Feenstra, D. J., Bales, D. L., de Vos, J., Lucas, Z., Verheul, R., & Luyten, P. (2017). Subtypes of borderline personality disorder patients: A cluster-analytic approach.Borderline Personality Disorder and Emotion Dysregulation,4(1), 16. doi:10.1186/s40479-017-0066-4Dehlbom, P., Wetterborg, D., Lundqvist, D., Maurex, L., Dal, H., Dalman, C., & Kosidou, K. (2022).Gender differences in the treatment of patients with borderline personality disorder.Personality Disorders: Theory, Research, and Treatment,13(3), 277–287. doi:10.1037/per0000507Smits ML, Feenstra DJ, Bales DL, et al.Subtypes of borderline personality disorder patients: a cluster-analytic approach.Borderline Personal Disord Emot Dysregul. 2017;4:16. doi:10.1186/s40479-017-0066-4Digre EI, Reece J, Johnson AL, Thomas RA.Treatment response in subtypes of borderline personality disorder.Personal Ment Health. 2009;3:56–67. doi: 10.1002/pmh.64Additional ReadingBradley R, Conklin CZ, Westen D. The Borderline Personality Diagnosis in Adolescents: Gender Differences and Subtypes.Journal of Child Psychology and Psychiatry, 46(9):1006-1019, 2006.Clifton A, Pilkonis PA. Evidence for a Single Latent Class of Diagnostic and Statistical Manual of Mental Disorders Borderline Personality Pathology.Comprehensive Psychiatry, 48(1):70-78, 2007.Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of Co-occurring Axis II Features in Borderline Personality Disorder.British Journal of Clinical Psychology, 47(2):185-200, 2008.

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chanen AM, Thompson KN. Prescribing and borderline personality disorder.Aust Prescr. 2016;39(2):49-53. doi:10.18773/austprescr.2016.019American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Publishing. ISBN:978-0-89042-554-1Smits, M. L., Feenstra, D. J., Bales, D. L., de Vos, J., Lucas, Z., Verheul, R., & Luyten, P. (2017). Subtypes of borderline personality disorder patients: A cluster-analytic approach.Borderline Personality Disorder and Emotion Dysregulation,4(1), 16. doi:10.1186/s40479-017-0066-4Dehlbom, P., Wetterborg, D., Lundqvist, D., Maurex, L., Dal, H., Dalman, C., & Kosidou, K. (2022).Gender differences in the treatment of patients with borderline personality disorder.Personality Disorders: Theory, Research, and Treatment,13(3), 277–287. doi:10.1037/per0000507Smits ML, Feenstra DJ, Bales DL, et al.Subtypes of borderline personality disorder patients: a cluster-analytic approach.Borderline Personal Disord Emot Dysregul. 2017;4:16. doi:10.1186/s40479-017-0066-4Digre EI, Reece J, Johnson AL, Thomas RA.Treatment response in subtypes of borderline personality disorder.Personal Ment Health. 2009;3:56–67. doi: 10.1002/pmh.64Additional ReadingBradley R, Conklin CZ, Westen D. The Borderline Personality Diagnosis in Adolescents: Gender Differences and Subtypes.Journal of Child Psychology and Psychiatry, 46(9):1006-1019, 2006.Clifton A, Pilkonis PA. Evidence for a Single Latent Class of Diagnostic and Statistical Manual of Mental Disorders Borderline Personality Pathology.Comprehensive Psychiatry, 48(1):70-78, 2007.Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of Co-occurring Axis II Features in Borderline Personality Disorder.British Journal of Clinical Psychology, 47(2):185-200, 2008.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Chanen AM, Thompson KN. Prescribing and borderline personality disorder.Aust Prescr. 2016;39(2):49-53. doi:10.18773/austprescr.2016.019American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Publishing. ISBN:978-0-89042-554-1Smits, M. L., Feenstra, D. J., Bales, D. L., de Vos, J., Lucas, Z., Verheul, R., & Luyten, P. (2017). Subtypes of borderline personality disorder patients: A cluster-analytic approach.Borderline Personality Disorder and Emotion Dysregulation,4(1), 16. doi:10.1186/s40479-017-0066-4Dehlbom, P., Wetterborg, D., Lundqvist, D., Maurex, L., Dal, H., Dalman, C., & Kosidou, K. (2022).Gender differences in the treatment of patients with borderline personality disorder.Personality Disorders: Theory, Research, and Treatment,13(3), 277–287. doi:10.1037/per0000507Smits ML, Feenstra DJ, Bales DL, et al.Subtypes of borderline personality disorder patients: a cluster-analytic approach.Borderline Personal Disord Emot Dysregul. 2017;4:16. doi:10.1186/s40479-017-0066-4Digre EI, Reece J, Johnson AL, Thomas RA.Treatment response in subtypes of borderline personality disorder.Personal Ment Health. 2009;3:56–67. doi: 10.1002/pmh.64

Chanen AM, Thompson KN. Prescribing and borderline personality disorder.Aust Prescr. 2016;39(2):49-53. doi:10.18773/austprescr.2016.019

American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Publishing. ISBN:978-0-89042-554-1

Smits, M. L., Feenstra, D. J., Bales, D. L., de Vos, J., Lucas, Z., Verheul, R., & Luyten, P. (2017). Subtypes of borderline personality disorder patients: A cluster-analytic approach.Borderline Personality Disorder and Emotion Dysregulation,4(1), 16. doi:10.1186/s40479-017-0066-4

Dehlbom, P., Wetterborg, D., Lundqvist, D., Maurex, L., Dal, H., Dalman, C., & Kosidou, K. (2022).Gender differences in the treatment of patients with borderline personality disorder.Personality Disorders: Theory, Research, and Treatment,13(3), 277–287. doi:10.1037/per0000507

Smits ML, Feenstra DJ, Bales DL, et al.Subtypes of borderline personality disorder patients: a cluster-analytic approach.Borderline Personal Disord Emot Dysregul. 2017;4:16. doi:10.1186/s40479-017-0066-4

Digre EI, Reece J, Johnson AL, Thomas RA.Treatment response in subtypes of borderline personality disorder.Personal Ment Health. 2009;3:56–67. doi: 10.1002/pmh.64

Bradley R, Conklin CZ, Westen D. The Borderline Personality Diagnosis in Adolescents: Gender Differences and Subtypes.Journal of Child Psychology and Psychiatry, 46(9):1006-1019, 2006.Clifton A, Pilkonis PA. Evidence for a Single Latent Class of Diagnostic and Statistical Manual of Mental Disorders Borderline Personality Pathology.Comprehensive Psychiatry, 48(1):70-78, 2007.Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of Co-occurring Axis II Features in Borderline Personality Disorder.British Journal of Clinical Psychology, 47(2):185-200, 2008.

Bradley R, Conklin CZ, Westen D. The Borderline Personality Diagnosis in Adolescents: Gender Differences and Subtypes.Journal of Child Psychology and Psychiatry, 46(9):1006-1019, 2006.

Clifton A, Pilkonis PA. Evidence for a Single Latent Class of Diagnostic and Statistical Manual of Mental Disorders Borderline Personality Pathology.Comprehensive Psychiatry, 48(1):70-78, 2007.

Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of Co-occurring Axis II Features in Borderline Personality Disorder.British Journal of Clinical Psychology, 47(2):185-200, 2008.

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