Subsets of Borderline Personality Disorder

My last two Blogs focused on the different types of Borderline Personality Disorder (BPD), and that it is a huge disservice to those of us who live with this disorder to lump us all together into a single category. The first Blog I wrote in this 3 part series was Are You A Quiet BPD. The second blog was, “Four Types of BPD”. Now I am going to talk about the “Subsets of Borderline Personality Disorder” that I mentioned previously. I invite you to check out my other blogs and to follow me!

While working with NAMI (National Alliance For Mentally Ill) and coming out with my own story in 2016, of living with BPD and other disorders that I’ve lived with throughout my life, has led me to gain knowledge of the fact that there is no one “typical” BPD. I began to notice I would see marked differences vs. what I lived with, in those who claimed BPD as their diagnosis. I wondered if they were indeed “Borderline” or if so, how could they display so differently than I did? This brought me to search for answers as to WHY those around me with BPD didn’t exhibit in the same manner. I will list the criteria of BPD since we who live with BPD have certain criterion that meets the “standardized” protocol to label us as having BPD.

  1. Frantic efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as "splitting")
  3. Identity disturbance: Markedly or persistently unstable self-image or sense of self
  4. Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  5. Recurrent suicidal behavior, gestures, or threats, or self-harming behavior
  6. Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms

 In order for a diagnosis of Borderline Personality Disorder, five of more of these criteria must exist. You can also learn more at  www.verywellmind.com

 In the July 2017 edition of the online publication Borderline Personality Disorder and Emotion Dysregulation, a team of researchers from the Netherlands published an article proposing a new set of BPD Subtypes, based on the principles of Cluster Analysis. In my last Blog on theFour Types of BPD, I wrote about the research done by Theodore Millon ((August 18,1928 - January 29,2014) was an American Psychologist known for his work on personality disorders),  in categorizing the Four Types of BPD. These researchers from the Netherlands dug even deeper into the diagnosis and used criteria based on:

Number of Borderline Symptoms Displayed

Severity of symptoms

Relationship issues

Quality of life considerations

Personality functioning

Levels of attachment

Exposure to Trauma

After analyzing the above criteria, what they came up with were three categories or subtypes of BPD. They described these subsets as:

Core BPD

Extravert/Externalizing

Schizotypal/Paranoid

 

 Core BPD

 This subtype of BPD is also known as “Classic Borderline Personality Disorder”. Those grouped in this Core category display the more traditional symptoms of BPD (see Criteria List above) yet they display them in a more severe form. They tend to have a very unstable self-image. Control over their emotional responses is lacking in situations they encounter and they have high levels of anxiety. Although they possess a desire for intimacy in relationships, they fear the consequences of intimacy. For this reason, their interpersonal relationships and interactions are skewed with contradiction. They may come across as overly accommodating and seemingly unassertive. In a relationship, they will go out of their way to please people, as their need for closeness is very powerful. This behavior conflicts with their fear of abandonment, which can thus lead them to come across as excessively controlling, manipulating and intrusive. Those in the Core BPD Group tend to have suffered lower levels of childhood trauma. This would suggest that genetic influences had more effect in their development of BPD as opposed to environmental.

Extravert/Externalizing

This Subtype Group displays stark dimensions of narcissistic, antisocial, and histrionic behavior in addition to the baseline criteria for Borderline. They are very reluctant to form attachments and tend to be very self-centered and domineering. Their intensity of the BPD Criteria Symptoms is somewhat low; however, they present as being very extremely critical of others and tend to externalize or blame their problems on unsupportive loved ones, society, or even the dog. Males with BPD mostly present in this Group. Also represented are those who experienced high levels of trauma during childhood. As opposed to the Core BPD, the Extravert/Externalizing are highly influenced by environmental factors they went through vs. genetic factors. They do possess the genetic propensity to have BPD; however, their environment and trauma they went through in early childhood play a huge role in the development of the disorder.

Schizotypal/Paranoid

This Subtype, in addition to having the basic BPD traits, also exhibit symptoms of schizotypal personality and paranoid personalities. (The medical definition of schizotypal, according to Webster Dictionary is characterized by, exhibiting, or being patterns of thought, perception, communication, and behavior suggestive of schizophrenia but not of sufficient severity to warrant a diagnosis of schizophrenia.) Borderlines in this Subtype are likely to feel disconnected from reality. Although they do not suffer from full-blown psychosis, such as schizophrenia, they have symptoms that are quite debilitating. They create a “world” where they can manage to function in accordance with the parameters of that “world”. This Subtype lacks greatly in self-confidence and assertiveness. They tend to be very accommodating and indifferent in relationships, isolate from society as much as possible and do not have a great need for closeness or intimacy. They are highly distrustful of people with personalities that are dominating or manipulative. If this Subtype feels threatened by such a display, they will withdraw back into their own created “world”.

This classification scheme of Subsets or Subtypes of Borderline has yet to “catch on” with mainstream psychiatry. In my personal opinion of writing and researching for these three Blogs, I do see that much of what Theodore Millan discovered and what they discovered in these Subtypes of BPD is legitimate and sheds more light on a difficult and complex diagnosis called Borderline Personality Disorder. Personally, many puzzle pieces fell into place for me in doing these Blogs. It has helped me greatly in being able to differentiate from my own personal experience with BPD and others who have BPD yet display quite differently. For example, I can clearly see and more readily characterize my father’s BPD as opposed to mine now. He displayed as the Extravert/Externalizing BPD, where I feel I display more in the Core BPD Subtype. I had many questions as to the differences displayed by those with BPD that I now feel can be answered in a more definitive way. I hope you too have learned something more as I continue to Empathize, Educate, and Advocate for those living with BPD.

With You On The Journey, Alice

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