4 Types of Borderline Personality Disorder

Dr. Romney Love and Kyle Kiddleson discuss the first subtype of Borderline Personality Disorder (BPD), characterized by high functioning individuals who internalize their struggles. These individuals often experience intense despair, fragility, and abandonment crises, leading to self-directed rage and self-criticism. Despite their high-functioning status, they are prone to depression and anxiety, with a tendency to self-blame and self-harm. They are typically found in helping professions but struggle with stress and minor setbacks, which can trigger severe reactions. The discussion also touches on the broader spectrum of BPD and its heterogeneity, making it challenging to diagnose and treat.

The second subtype of BPD is described as petulant or histrionic, with a focus on attention-seeking and emotionally dysregulated behavior. This subtype is associated with manipulative and victimized presentations, often displaying a sense of entitlement. There is a noted overlap with covert narcissism, and the discussion highlights the complexity of differentiating BPD from other personality disorders, especially narcissistic personality disorder. The prevalence of BPD is also discussed, with estimates ranging from 2% to 7%, and the challenges in accurate diagnosis due to its presentation often being subsumed under other disorders.

This paragraph delves into the angry externalizing impulsive subtype of BPD, which is notorious for its disregulated rage and acting-out behaviors. Individuals with this subtype may exhibit dangerous impulsivity, including substance abuse, reckless driving, and risky sexual behavior. The discussion suggests a potential overlap with narcissistic personality traits and emphasizes the seriousness of threats made by those with this subtype. The subtype is also associated with a high risk of suicide and self-harm, making it crucial for mental health practitioners to take these threats seriously and provide appropriate support.

The depressive internalizing subtype of BPD is characterized by a persistently dysphoric and depressive presentation, which can significantly impact an individual's ability to maintain employment and relationships. This subtype is at a higher risk for self-harm and suicidal behavior, particularly in response to abandonment or similar crises. The central focus of treatment often becomes the depression itself, given its potential to exacerbate during times of stress. The subtype is distinguished by a lack of access to social support due to depression and isolation, which can complicate treatment and recovery.

The final paragraph emphasizes the importance of understanding the varied presentations of BPD and the need to move beyond negative stereotypes. It discusses the significance of distress tolerance and trauma-informed care in treating individuals with BPD. The conversation underscores the risk of overlooking the nuances of BPD presentations and the importance of tailoring therapeutic approaches to the specific subtype. The video concludes with a reminder of the resilience and strength of those living with BPD and the support available to them.