Research on Borderline Personality Disorder Subtypes

Key Takeaways

• Research shows there may be different subtypes of BPD, which can impact treatment.
• Popular books and studies suggest BPD might be categorized based on whether symptoms are internalizing versus externalizing.
• Some BPD subtypes respond differently to treatment, highlighting the need for more research.

Borderline personality disorder (BPD) is associated with various signs and symptoms. An individual must meet just five out of a total of nine diagnostic criteria for a BPD diagnosis, meaning that BPD in one person can look very different from BPD in another. This has led experts to explore the possibility of distinct BPD subtypes.

BPD Subtypes in Popular Media

BPD subtypes are referenced in both popular media and pop psychology books, despite the fact that DSM-V does not recognize them formally. 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 self-destructive behavior that frequently requires intervention and as very low-functioning, meaning they’re unable to work or go to school. The author calls this self-destructive behavior “acting in,” similar to 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 mimics the concept of externalizing symptoms.

These subtypes of BPD in popular literature were derived from the authors’ expert opinions. 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.

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.

Some studies have found that BPD can be treated as a unified diagnostic entity without the presence of clear subtypes, whereas others have identified some subtypes of BPD.

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: withdrawn–internalizing, severely disturbed–internalizing and anxious–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.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Chanen AM, Thompson KN. Prescribing and borderline personality disorder. Aust Prescr. 2016;39(2):49-53. doi:10.18773/austprescr.2016.019

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. ISBN:978-0-89042-554-1

3. Smits, M. L., Feenstra, D. J., Bales, D. L., de Vos, J., Lucas, Z., Verheul, R., & Luyten, P. (2017). Subtypes of borderline personality disorder patients: A cluster-analytic approach. Borderline Personality Disorder and Emotion Dysregulation, 4(1), 16. doi:10.1186/s40479-017-0066-4

4. Dehlbom, P., Wetterborg, D., Lundqvist, D., Maurex, L., Dal, H., Dalman, C., & Kosidou, K. (2022). Gender differences in the treatment of patients with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 13(3), 277–287. doi:10.1037/per0000507

5. Smits ML, Feenstra DJ, Bales DL, et al. Subtypes of borderline personality disorder patients: a cluster-analytic approach. Borderline Personal Disord Emot Dysregul. 2017;4:16. doi:10.1186/s40479-017-0066-4

6. Digre EI, Reece J, Johnson AL, Thomas RA. Treatment response in subtypes of borderline personality disorder. Personal Ment Health. 2009;3:56–67. doi: 10.1002/pmh.64

Additional Reading

• Bradley R, Conklin CZ, Westen D. The Borderline Personality Diagnosis in Adolescents: Gender Differences and Subtypes. Journal of Child Psychology and Psychiatry, 46(9):1006-1019, 2006.

• Clifton A, Pilkonis PA. Evidence for a Single Latent Class of Diagnostic and Statistical Manual of Mental Disorders Borderline Personality Pathology. Comprehensive Psychiatry, 48(1):70-78, 2007.

• Critchfield KL, Clarkin JF, Levy KN, Kernberg OF. Organization of Co-occurring Axis II Features in Borderline Personality Disorder. British Journal of Clinical Psychology, 47(2):185-200, 2008.

By Kristalyn Salters-Pedneault, PhD

 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.

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