Borderline Personality Disorder: Types and Treatment

Borderline Personality Disorder: Types and Treatment

Borderline personality disorder (BPD) is a chronic mental health condition that causes patterns of disturbing or unstable emotions, uncertainty about how people see themselves, and impulsiveness. This condition is classified as a cluster B personality disorder, alongside antisocial, narcissistic, and histrionic personality disorders. 

How BPD affects people can vary. Studies have identified four primary types of BPD: impulsive, discouraged, self-destructive, and petulant—which were first established by psychologist Theodore Millon in the 1990s. However, other potential subtypes of BPD are still being studied.

The hallmark symptom of impulsive borderline personality disorder is impulsivity. People with this type of BPD find it challenging to control their impulses and often engage in risky behaviors. They may also desire instant satisfaction without regard for other people or weighing the possible consequences of their actions.

People with the impulsive type of BPD may exhibit some of the following behaviors:

  • Risky: Driving under the influence, using substances, or having sex with multiple partners without protection
  • Binging: Overspending money, eating more than necessary, or excessive binge-watching
  • Aggressive: Getting violent, yelling when angry, or breaking things often

The discouraged type is also termed quiet BPD because people with this type tend to internalize their symptoms and keep their emotions hidden. They are less impulsive and less likely to express anger.

Common characteristics of the discouraged type of BPD include:

Because discouraged BPD can be “silent,” it may be challenging to diagnose. Instead, many people with discouraged BPD receive a diagnosis for another mental health condition, such as social anxiety or depression.

People with a self-destructive type of BPD often experience self-hatred, feel a sense of bitterness, or have a case of being their own “worst enemy.”

Other symptoms of self-destructive BPD may include:

  • Frequent bouts of low mood or depression
  • Constant feelings of self-doubt
  • Negatives self-image
  • Engaging in risky and self-harmful behaviors such as cutting or substance use
  • Suicidal thoughts

The petulant type of BPD is characterized by persistent, unpredictable mood swings or high emotional instability. People with petulant BPD tend to have challenges maintaining their relationships, as they often feel unworthy and unloved and tend to seek control over others.

Behaviors that frequently occur in people with this subtype of BPD include:

  • Difficulty admitting to being wrong
  • Defiance and stubbornness
  • Manipulative tendencies
  • Intense emotional or irrational outbursts
  • Passive-aggressiveness

Aside from the subtypes identified by Millon, some other researchers have come up with other classifications. However, these subtypes are newer, and research on them is still ongoing. A 2017 study, which used a person-centered approach, identified three additional subtypes of borderline personality disorder:

  • Core BPD: People categorized under this subtype are those with the most severe BPD symptoms and the lowest quality of life. They tend to be self-sacrificing and accommodating but can also be needy or domineering. They have the highest report of self-harm.
  • Extravert/externalizing BPD: This subtype is more common in people assigned male at birth and presents with the lowest level of symptom severity. People with this potential type of BPD have difficulty adjusting to social norms. They can also be highly controlling and have a tendency to hide their feelings, which causes them to become emotionally distant.
  • Schizotypal/paranoid BPD: People with this type of BPD show high levels of schizotypal symptoms (odd behaviors like extreme social anxiety and detachment from others) and paranoia. This subtype may also cause mistrust or hostility.

Diagnosing borderline personality disorder can be difficult, especially because BPD can mimic other mental health conditions. Some people with BPD don’t want to seek care for their condition, which makes research on treatment challenging as well.

If you or a loved one are experiencing a change in emotional well-being, seeing a mental healthcare provider can be helpful. During your appointment, your provider will ask about your symptoms, lifestyle, and behavioral habits. They will want to learn more about your medical history and experiences.

To receive a diagnosis for BPD, you’ll need to have five or more of the following symptoms of BPD:

  1. Fear of abandonment
  2. Unstable relationships
  3. Low self-image
  4. Impulsivity or self-destructive behavior
  5. Suicidal behavior, thoughts, or threats, or self-injury
  6. Intense mood swings
  7. Constant feelings of worthlessness or emptiness
  8. Difficulty controlling anger
  9. Dissociative episodes from reality or stress-related paranoia

Despite these diagnostic criteria, there are still chances of misdiagnosis, as BPD symptoms tend to overlap with those of other mental health conditions, such as obsessive-compulsive personality disorder (OCPD), depression, and anxiety.

As there is no standard test to detect BPD or its subtypes, your healthcare team—which may include a psychiatrist, psychologist, occupational therapist (OT), or clinical social worker—will use different diagnostic tools, including questionnaires, an in-person interview, and input from family members or close friends, to obtain substantial information about your symptoms. Together, these tools can help your provider make an accurate diagnosis.

Every person with BPD experiences their symptoms a bit differently. Your exact treatment plan will depend on your symptoms and the severity of your condition. Generally, treatment involves medication, therapy, or a combination of both.


Psychotherapy is considered the first line of treatment for borderline personality disorder. It involves one-on-one or group sessions with a trained mental health professional. Psychotherapies help you understand how you think and feel, make you feel heard, and suggest ways to resolve your symptoms.

Some types of therapy that are useful for BPD include:

  • Cognitive behavioral therapy (CBT): Helps restructure harmful thoughts, behaviors, and emotions into more positive ones
  • Dialectical behavior therapy (DBT): Encourages you to practice acceptance and embrace change to break a cycle of negative thoughts and feelings
  • Mentalization-based therapy (MBT): Teaches you how to step away from harmful thoughts and examine your feelings before acting on them
  • Schema-focused therapy: Focuses on addressing impulsivity and anger and working through childhood traumas such as abandonment or abuse
  • Art therapy: Uses drama, music, or drawing to help people who have difficulty expressing themselves verbally with their thoughts and emotions


The benefits of medications for treating personality disorders like BPD are still being debated, and no medication has been explicitly approved for treating this condition. However, evidence suggests that some prescription medications may help treat specific symptoms that typically co-occur with mental health conditions, such as:

Some healthcare providers may prescribe medications like antipsychotics and mood stabilizers to help alleviate associated symptoms of BPD, like depressive episodes, low self-esteem, and mood swings.

Many people with personality disorders are unaware they have a mental health condition. Some people with BPD also don’t see anything wrong in their behavior or thought processes, which can make diagnosis and treatment difficult.

If you feel a change in your emotional well-being or notice symptoms of BPD in a loved one, talking to a healthcare provider for support can help you or a loved one get a proper diagnosis and timely treatment.

Borderline personality disorder is a cluster B personality disorder that causes impulsivity, unstable emotions, self-doubt, and negative self-image. In the 1990s, psychologist Theodore Millon established four primary subtypes of BPD: impulsive, discouraged, petulant, and self-destructive types. However, research on additional subtypes is ongoing.

Regardless of the type you have, BPD can significantly affect your quality of life, so seeking care and receiving treatment can help you feel better in the long run.

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