15 SIGNS QUIET BORDERLINE PERSONALITY DISORDER | DR. KIM SAGE

borderline personality disorder is truly and honestly one of the most complex disorders in terms of how many of us in the field were trained to understand this disorder and what it might look like and present like can truly vary it is quite a spectrum in my experience and unfortunately the sort of very high-end clinical population the very typical if there's even such a thing that type which is a lot of you know very obvious emotional and relational dysregulation and pulsivity you know things of that nature a lot of that and mood instability and all of

that has really dominated the media and literature exposure and in some ways I think trying to boil down a disorder or it's not even a disorder someone's struggle is a difficult thing to put into language but one of them that I think is important is understanding quiet board borderline now in the DSM the manual we use Which is far from perfect but that's what we have we don't have these differentiated labels about types we talk about vulnerable kind of narcissism looking a little bit like a covert like borderline in this more quiet way but we

don't have this separate criteria but what we've learned is that many people who have quiet or originally called discouraged it's also sometimes called high functioning borderline in terms of you know the language and the community and there are preferences obviously but the real difference in this one at the core the fundamental core is that when we think about classic borderline symptoms like I'm saying around you know fear of Abandonment which really is the core for for most all borderline but issues around managing mood and mind and relational stability a lot of chaos like I said

impulsivity identity issues we see a lot of things that are just about a chronic disturbance around sense of self self-concept emptiness it's like there's this constantly shifting really shifting river flowing inside for those who can struggle and it can really play out and how they manage their their perceived responses to the world and to themselves to relationships but with quiet borderline what you often don't see is how much the person is suffering internally and that is the core that a lot of the attempts to manage a lot of that internal which can feel like chaos

is it might not be something you see let's say in every day like you might see with an untreated sort of Highly clinical individual who has borderline but the core is going to be the same the numbness the sense of emptiness perhaps identity impulsivity mood dysregulation emotional dynamic but they get managed internally there's almost really an over control to kind of manage on the inside that you don't necessarily see on the outside now we'll argue though that if you have a relationship with someone like this like a parent or a partner you live with or

that you're close to or even friendships of course you're much more likely to kind of when everything kind of settles the dust settles to see these Dynamics because they're going to play out in different ways but interpersonally but you might not see it if this is something let's say your boss struggles with you might notice if you have a really close relationship with them but you might not so that's the first criteria is that we're going to see a lot of internalized Dynamics around how things are managed and it really is a direct and sort

of very pointed inward struggle for the person and so I want you to keep that in mind as we go through what else the symptoms and signs look like the next thing is like I said High highs and low lows so it's sort of like the person experiences a lot of instability a lot of mood swings a lot of things are so good okay they're not that bad they're catastrophic right it's very difficult for them to have and stay in a place of more stability and consistency in those areas now how they manage that might

be you know a way that you might see them Express something it might look like an internalized kind of victim-ness around they're very wounded it might not it might even self-protect and hide that but I'm saying close up you might see that this person really is suffering in some ways that if you don't pay close attention you might not recognize and so the way it shows up is a lot can be a lot of withdrawing and isolating if someone hurts the person who has this disorder in this format they might quickly cut them off so

it might show up in how they respond to perceived slights or wounds or how their brain is making sense or trying to make sense of what feels like a lot of sharp pointed wounds coming at them and so you also can see a lot of push and pull so don't get too close oh my gosh you're going to consume me so you might feel that there's like a tug of war going on in terms of how they're showing up in relation ship with themselves and with you and so that really is number four it's like

don't come too close but don't consume me the next one is a very common dynamic in really all forms of borderline and also narcissism which is splitting it's this pattern of idealization you're the best ever and devaluation you're the worst ever now that might show up in the person who has this disorder you know wanting to be with you then backing out because they perceived something that was going to happen that didn't feel good or that they already like internalized was meant to be hurtful of them or it could be that they're just feeling so

disregulated inside that they don't have the capacity to then kind of put all that stuff aside and be there for you so you might see this thing though where you think that they're happy with you they're not happy with you but you're not really sure and that's what they're really doing they're not only splitting on other people they do a lot of splitting internally themselves in terms of you know everything is sort of good bad right wrong of course another big core a borderline is the fear of Abandonment and so what they're really thinking here

is that there's something defective about me unlovable unworthy inherently and eventually you will leave me so that Dynamic is going on really in any form the next thing they often struggle with whether you see it or not is a lot of internalized self-blame and self-esteem issues it's like no matter what happens something is always wrong they did something wrong you're going to reject them things like that the next one is how they deal with anger now they might hide their anger or they might express it in a way that feels passive aggressive or sarcastic it's

going to be it's going to tend to be less overtly angry and obvious like when we see a lot of Rage which is actually very common anger can be very common managing anger inside with those who struggle with borderline but they're going to have a lot of anger and maybe if you have this part of you it's like you're chronically upset with people angry hurt by them but oftentimes not sharing any of that and so the next thing is that it really can show up too and all of this in your sort of mental health

symptomatology the way you show up in terms of impulsivity your mood like depression and trying to repress all of that and manage all of that so it's like the pot is being stirred in your in your emotions and behaviors and it might be that you're dropping down into a collapsed state it could be a very anxious state but you're really when you struggle like this you're really trying to keep that down and not let it be seen but it is happening a lot inside and the next one really goes with that is a massive fear

of rejection so I've already mentioned that that isn't that's worthy though it accompanies other areas other criteria is a very significant one it's like that is happening all the time and as a result of that they're often scanning because they're deeply sensitive and Hyper Vigilant the hyper Vigilant serves to scan for any signs of rejection or wounding and so that's happening all the time whether you experience it like as a as a a friend or a parent or whatever or partner so there's this like sense inside that there's a lot of wounding going on and

I need to like be mindful of it if I have this this difficulty and and search for it all of the time so I can get ready to protect myself we can definitely see a lot of numbing and emptiness that can that can really coincide with your classic borderline a sense of identity or just feeling dis separate from yourself or not know who you are the separate part can lead into a more dissociation which can be very common when we have stress where we kind of go into these places when we need to retreat and

we're feeling overwhelmed and that can be happening and then the last few things are being really victim easily victims to shame spirals to feeling like this really deeply directed internalized anger and guilt and Badness about the self and really just trying to manage that by yourself all the time of course there are more but I think that the core of this is going to be about the person who's just trying so hard to contain all of this inside and yes it could manifest in things like addiction or binge you know watching or shopping things like

that which is also common but at the core that might that might be more noticeable those types of symptoms but the suffering is this very internalized suffering so it's also true that borderline and complex PTSD can have some overlap and we don't tend to see the fear of Abandonment in complex trauma like we do in borderline but that being said those who have complex trauma May avoid relationships based on feeling unlovable and unworthy it's just that they're trying to self-protect in a way that is about removing themselves so those can both happen for both those

can overlap and we can see that people with complex trauma might avoid relationships altogether just to try to protect them ourselves and so that might be also similar to borderline but it's more about the trauma trigger than about the fear of Abandonment if that makes sense and of course we can see internalized shame and blame in both of those Dynamics and that can make it difficult for people to figure out like what's really going on here we tend to see that interpersonal stress can really trigger self-wounding behaviors in those who have BPD and we're less

less likely to see that specific response in those who have complex trauma so I've made a video here you can go check it out on comparing these two and although I wasn't specifically comparing quiet borderline with complex trauma it really gets difficult and I think we have a lot of work to do I know there's conversations about they're the same I do not believe they are the same I don't believe ADHD it's the same thing as complex trauma having you know a child come out of the womb with these some of these disorders like ADHD

but I do think they all do connect and overlap and we can never underestimate the the kind of like Collision of our inner intergenerational trauma of our genetics of our environment like there's just so much going on and how all of that is shaping our brains as we're as we're developing and so it can make it really difficult to to figure out what the treatments are and what you need but it's really important that for example if you think you have you know if you think you have borderline or complex trauma to try to seek

out licensed mental health professionals who specialize ideally in those areas because the nuances are significant and we've historically seen a lot of misdiagnosing I think especially around complex trauma people have been diagnosed with borderline and sometimes that can be helpful and oftentimes it is not helpful because the way we're directing treatment is not not necessarily targeting the right things the thing about treatment for borderline is really about managing your interpersonal Dynamics your emotional dysregulation learning to tolerate distress and being more mindful so that be like a more DBT a dialectical behased dialectical behavior therapy based

treatment that really was designed more from borderline than anything else but a lot of those skills can also be helpful with complex trauma so DBT can be really helpful how do you manage that swirling dervish thing inside it's like an 80. but how do you manage that chaos inside right learning the skills to tolerate people's emotions to manage your emotions to not be impulsive to self-regulate all of those I think have some really good skills for all of us regardless of our different difficulties whatever this might be mentalization-based therapies can be helpful I'll list a

few more down below that have been listed to help with borderline but the point is that when you have somebody who struggles with this specific disorder especially around the quiet version it may be that you know something is that they're suffering and off and something is wrong but you don't really know what it is but you often what I describe is you get this if you're if you're an empathic and a sensitive person and those who often have complex trauma and borderline often have a great sensitivity in fact an oversensitivity to things and they've also

developed very heightened hyper Vigilant skills we can be really good at reading each other so you can be feeling that but they're saying things are fine but there's a sense that this person is really suffering and so whatever it is if this was you it's also important to know that everything I just said in some way could also easily be attributed if we don't look at the nuances into something like complex trauma and so I don't want you to watch this please do not self-diagnose although I think self-diagnosing has a very important place and can

be helpful when we're getting into very specific disorders that have frankly some heavy labels attached to them just being completely honest unfortunately still exists there's still a huge stigma and because I think therapists are not really well trained have not been historically trained especially looking at borderline and what a strong relationship to Childhood trauma like the symptoms of childhood trauma many of these also match what I just said if you had neglect or it was like an eggshell dynamic you can see why it gets difficult not just for us as clinicians but for especially for

those who suffer trying to get the right support and right treatments so that is what the quiet borderline presentation can look like if you have any more information you want to add please feel free to do that I think where this gets difficult would be like an apparent it can feel like an apparent a parent who is easily wounded very sensitive to rejection I think many times we can when we have this disorder in this way people can feel almost um like they're not they never really grew up not that they are childlike there's a

part of them that's underdeveloped in terms of managing all of these things and so there's like this childness about them and immaturity in terms of managing emotional dysregulation and I don't mean that in the negative way I mean it's like it's more like a developmental arrest that's a better way of saying it I should say than immaturity and so it's like you can feel like this parent is so in their own space of wounding that they have a hard time seeing me or they take things so personally and and and just like with classic borderline

they're going to be more likely to maybe not understand boundaries to violate boundaries to put you in the role of best friend or therapist or parentify you or also and also being nudged with you especially if they have a difficult self-concept they don't really have a good one developed if they have a great fear of Abandonment like nothing is more um seemingly safe than a child who can't leave you it's just that children grow up and begin to push away and if you remain untreated for example all of that can feel really threatening but there's

a consumingness about this disorder I think when you're the child experiencing from the parent in some way and no matter what whether it's the quiet presentation or the more classic clinical one if you are a child to a parent who struggles like this you have learned to pay an extreme amount of attention to their mood shifts maybe they're more subtle or not their sensitivities what triggers them you know you're going to become oftentimes an eggshell reader yourself the eggshells are maybe more quiet literally you know they're just less like less crunchy than the Smashing sound

but I would really argue that if you have a parody who has remained untreated that as a child you may also not have this disorder you may but I would say that it would be potentially a place for you to work on things like your own silent trauma hyper vigilance because it's a very good chance that you learned to be an expert reader of this parent's more nuanced subtle shifts but still a hyper Vigilant hyper aroused in your body in your trauma self and in your sort of you know mind and core belief self about

how to be and what the demands are in terms of relationships so thank you for being here please stay safe and well and I'll see you soon take care bye thank you foreign [Music]