Types of BPD: What you should know about the three main subtypes

Borderline personality disorder (BPD) is a mental illness characterized by:

• severe and sudden mood swings
• impulsive and self-destructive behavior
• emotional challenges
• unstable relationships

People who live with BPD often have a deep fear of abandonment and struggle with self-esteem and identity. 

While the DSM-5 — a tool used by healthcare providers to diagnose and classify mental disorders — only recognizes one main type of BPD, researchers have identified a series of subtypes that share common features. Examining these categories leads to a more nuanced understanding of BPD and supports better treatment outcomes for those affected by the condition.

What is borderline personality disorder?

BPD is a mental health condition that affects about 1.4% of the adult population in the U.S. Over 75% of people diagnosed with the condition are women. Unlike more common mental health concerns like anxiety or depression, BPD is often misunderstood. 

People with BPD worry constantly about being left alone and tend to have roller-coaster-like relationships. They act on impulse in ways that harm themselves and others, experience rapid mood changes, and often feel a deep sense of emptiness inside. The way they view their identity can shift rapidly and they may feel disconnected from the world around them, especially in times of stress. These symptoms occur frequently and are severe enough to impact their day-to-day life negatively.

Sometimes, people may think that people living with BPD just want attention or that their manipulative behavior is a sign that they’re a “toxic person.” BPD symptoms are also sometimes miscategorized as willful moodiness or evidence that someone doesn’t actually want to be in a relationship. 

Sadly, these misconceptions fuel the stigma often associated with BPD and can make it more difficult to seek treatment. But the truth is that many people living with BPD are aware of how their condition affects their lives and they don’t consciously choose harmful or dangerous behaviors. Many of them want to gain control of their symptoms so they can improve their well-being and learn to build healthy connections with others. 

How is BPD diagnosed?

To be diagnosed with BPD, a therapist or other mental health professional will meet with you to review your history, discuss your present concerns, and learn more about your symptoms. They’ll also consult the diagnostic criteria for BPD listed in the DSM-5 and ask you about how your symptoms impact your daily life. While there’s no replacement for a professional evaluation, you may be living with BPD if you exhibit several of the symptoms listed below.

• Fear of abandonment: You worry frequently about being left alone, even when there’s no tangible evidence you should feel that way.
• Unstable relationships: Your relationships tend to be rocky and intense. One minute you idealize someone and the next you believe they’re terrible. 
• Changing self-image: The way you view yourself and your worth changes all the time. One day you feel great about yourself and the next you feel disgusted with yourself.
• Impulsive behaviors: You do things without thinking about the consequences and it causes harm to yourself or others. For example: Overspending, engaging in risky sexual behavior, speeding, and gambling. 
• Self-harm: Sometimes you think about harming yourself and/or you engage in self-harming behavior, like cutting or attempting suicide.
• Mood swings: You can easily go from feeling elated and euphoric to being devastated or depressed in a short period of time. 
• Chronic emptiness: No matter what you do, you feel like there’s always something missing inside you.
• Intense anger: You get angry frequently, often over inconsequential things, and have a short temper. 
• Suspicion about others: You have trouble trusting people and you often have feelings of paranoia, especially when under stress.

The three BPD types and treatment options 

Researcher Maaike Smits studied a sample of 187 people diagnosed with BPD and found three prevalent subtypes with shared clusters of symptoms. Collectively known as the Smits subtypes, they include:

1. Core BPD: this subtype is known to cause characteristic BPD symptoms like relationship problems and an unstable self-image. It’s considered one of the most common types of BPD. It typically does not co-occur alongside other types of personality disorders but may affect people with a disorganized attachment style.
2. Extravert BPD: This form of BPD is often accompanied by features of other personality disorders like narcissistic personality disorder and antisocial personality disorder. The prevalence of narcissistic and antisocial characertistics often leads to a self-centered attitude and behaviors, trouble adhering to social norms, and more avoidant relationship styles.
3. Paranoid BPD: According to Smit’s research this is the least common subtype of BPD. People living with this subtype tend to mistrust others, leading to social isolation. An inability to form close relationships may be connected to heightened levels of attachment anxiety.

Examining these subtypes can help you and your loved ones gain a better understanding of what it’s like to live with a specific form of BPD. 

No matter which type of BPD you might be living with, know that help is available. While it can be difficult to treat, research indicates that a specific form of talk therapy called dialectical behavioral therapy (DBT) can help improve BPD symptoms. 

DBT focuses on skill-building around mindfulness, distress tolerance, emotional regulation, and building healthy relationships. These components can work together to address common BPD challenges through individual therapy, group therapy, or both.

Find support for BPD with Rula 

Sometimes, the hardest part of finding support for BPD is knowing where to turn for help. The misconceptions about this condition and the lack of information about effective treatment can make it difficult to know where to begin. 

But at Rula, we believe that finding the right treatment for your unique needs shouldn’t have to be complicated. In less than 30 seconds, we can match you with a therapist who takes your insurance and offers the specialized care you deserve. And our network of over 8,000 therapists means you can be seen this week.

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