Research on Borderline Personality Disorder Subtypes

Research on Borderline Personality Disorder Subtypes BPD Print Research on Borderline Personality Disorder Subtypes By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Learn about our editorial policy Kristalyn Salters-Pedneault, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on September 19, 2019 Westend61/Getty Images More in BPD Diagnosis Treatment Living With BPD Related Conditions Borderline personality disorder (BPD) is associated with a number of different signs and symptoms. In order to be diagnosed with BPD, an individual must meet just five out of a total of nine diagnostic criteria, meaning that BPD in one person can look very different from BPD in another.?? This has led some experts to wonder whether there are actually distinct types of borderline personalities. BPD Subtypes  in Popular Media In popular media and pop psychology books, there is a great deal of discussion of different BPD subtypes. For example, in her book Understanding 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). In The Essential Family Guide to Borderline Personality Disorder by Randi Kreger, people with BPD are grouped into lower-functioning/conventional types versus higher-functioning/invisible types. The conventional type is described as engaging in a lot of self-destructive behavior that requires frequent hospitalization, and being very low-functioning, meaning he or she may not be able to work or go to school. The author calls this self-destructive behavior acting in, an idea that correlates with the concept of  internalizing 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 correlates well with the concept of  externalizing symptoms. These subtypes of BPD in popular literature were derived from the authors own expert opinions on the existence of different types of borderline personalities. 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. Research on Subtypes The research on the existence of subtypes of BPD is mixed. Some research studies have found that BPD can be treated as a unified diagnostic entity without the presence of clear subtypes. But other studies have identified some subtypes of BPD. 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 the Diagnostic 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. 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: withdrawnâ€"internalizing, severely disturbedâ€"internalizing and anxiousâ€"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 the prognosis for BPD may 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 Common Myths About Borderline Personality Disorder