Borderline personality disorder (BPD) is a mental health condition marked by intense emotions, unstable relationships, a fragile sense of self, and impulse-control difficulties. Many women in the United States live with BPD, often while juggling work, parenting, and other responsibilities. Understanding the common BPD subtypes can make symptoms feel less confusing and help you ask for more tailored support.

While subtypes are not official diagnoses in the DSM‑5, clinicians and researchers sometimes use them to describe patterns such as impulsive, discouraged (quiet), petulant, and self‑destructive BPD. This article explains what BPD is, how these subtypes differ, what they mean for treatment, and how women can seek safe, effective help.

What Is Borderline Personality Disorder?

Core Features of BPD

According to current diagnostic criteria, BPD involves a long-standing pattern of emotional and relational difficulties that typically begins by early adulthood. Common features include:

Intense, rapidly shifting emotions (for example, going from calm to very angry or very sad within hours)

• connections that are unstable and fluctuate between valuing and idealizing other people.
• A fragile or shifting sense of self (such as frequent changes in goals, values, or self-image)
• connections that are unstable and fluctuate between valuing and idealizing other people.
• Recurrent self-harm or suicidal thoughts or behaviors
• Strong fear of abandonment and frantic efforts to avoid real or perceived rejection
• Chronic feelings of emptiness
• Intense anger or difficulty controlling anger
• Short episodes of stress-related paranoia or feeling disconnected (dissociation)assessment

Not everyone with BPD has all of these symptoms, and severity can vary over time.

How Common Is BPD?

BPD is estimated to affect about 1–2% of the general population, and about three-quarters of those diagnosed in clinical settings are women, though this may partly reflect who seeks treatment. People with BPD often have co‑occurring conditions such as depression, anxiety disorders, post‑traumatic stress disorder (PTSD), eating disorders, or substance use disorders.

Why Subtypes Are Discussed

The official diagnostic manuals (DSM‑5 and ICD‑11) do not formally recognize BPD “subtypes,” but clinicians have long noticed that people with BPD can look very different from one another. Some are outwardly impulsive and dramatic, while others appear quiet, anxious, and self‑blaming

To capture this diversity, psychologist Theodore Millon and later authors described four commonly discussed patterns:

Impulsive

• Discouraged (also called “quiet” BPD)
• Petulant
• Self‑destructive

These labels are best understood as descriptive patterns—not fixed boxes or separate diagnoses—and many people with BPD fit more than one.

Overview of Common BPD Subtypes

1. Important Note on Subtypes

Subtypes are informal clinical concepts used to:

• Better understand how BPD shows up in day-to-day life
• Recognize internalizing vs. externalizing (turned inward vs. outward) symptom patterns
• Guide treatment planning (for example, more focus on self-harm, trauma, or anger)

They are not official diagnostic categories, and you do not need to “fit” one subtype perfectly to receive effective BPD treatment.

The four most commonly described subtypes are:

1. Impulsive BPD
2. Discouraged (Quiet) BPD
3. Petulant BPD
4. Self‑Destructive BPD

We’ll explore each below.

2. Impulsive Borderline Personality Disorder

Key Traits

Impulsive BPD describes people whose difficulties are especially visible in risky, spur-of-the-moment behaviors. Common features include:

Reckless or risky actions (for example, unsafe sex, binge drinking, reckless driving, or sudden quitting jobs)

• Acting quickly on strong emotions without thinking through consequences
• Difficulty tolerating boredom, emptiness, or feeling ignored
• A strong fear of abandonment, which may be masked by anger or thrill‑seeking
• Suicidal thoughts or potential self-harm during emotional 

People with impulsive BPD may be seen as charismatic, energetic, or “the life of the party” at times, but their behavior can lead to job loss, relationship conflict, or legal issues.

 Internal Experience

Even when they appear outwardly bold, many individuals with impulsive BPD feel:

• Deep shame or regret after impulsive behaviors
• Intense loneliness or emptiness when stimulation fades
• Fear that others will leave once they see the “real” person

This mix of outward externalizing behavior and inner distress is consistent with research showing BPD sits at the intersection of internalizing (anxiety, depression) and externalizing (impulsivity, substance use) tendencies.

 Treatment Considerations

Treatment often focuses on:

• Learning skills to pause before acting on urges
• Identifying triggers for risky behaviors
• Building healthier ways to manage anger, excitement, and distress

Dialectical behavior therapy (DBT) and other structured therapies have strong evidence for reducing impulsive and self-harming behaviors in BPD.

2. Discouraged (Quiet) Borderline Personality Disorder

 Key Traits

The “discouraged” or “quiet” BPD subtype is often less visible to others. Individuals may direct intense emotions inward rather than outward.

Common features include:

• Strong fear of abandonment, but instead of chasing people, they may withdraw or cling quietly
• Feelings of helplessness, insecurity, and inadequacy
• Avoiding conflict or competition; difficulty asserting needs
• High sensitivity to criticism and rejection
• Self-blame and internalized anger (anger turned inward)

Millon described the discouraged type as blending BPD traits with dependent and avoidant personality patterns. These individuals may appear modest, compliant, or high‑functioning, while struggling deeply with emptiness and self-harm urges.

Internal Experience

Women with discouraged BPD may:

• “Hold in” their anger to keep relationships, then feel depressed or self‑critical
• Hide intense mood swings, leading others to underestimate their distress
• Feel chronically unworthy, guilty, or like a burden to others

Because their distress is less obvious, they may be misdiagnosed with depression or anxiety alone, without recognizing the underlying BPD pattern.

Treatment Considerations

Helpful therapy goals can include:

• Building assertiveness and boundaries in relationships
• Learning to identify and express anger safely instead of self‑punishing
• Challenging deeply rooted beliefs of worthlessness

DBT, mentalization-based treatment (MBT), and other BPD-focused therapies can be adapted to quieter internalizing presentations.

3. Petulant Borderline Personality Disorder

Key Traits

Petulant BPD is characterized by a mix of anger, resentment, and fear of being unloved or controlled.

Common patterns include:

• Feeling easily offended, slighted, or misunderstood
• Sudden mood shifts from clinging to pushing people away
• Passive-aggressive behavior (for example, withdrawing, sulking, or “testing” partners)
• Jealousy, envy, or difficulty trusting others’ intentions
• Episodes of intense anger or rage when needs feel ignored

These individuals may deeply crave closeness but also fear depending on others, leading to cycles of demanding attention and then withdrawing or punishing others when hurt.

Internal Experience

Inside, people with petulant BPD often feel:

• Extreme guilt at being “too much” or “too needy”
• Terrified that loved ones will leave if they see their anger
• Trapped between wanting care and fearing rejection

This pattern can create chaotic relationships that reinforce their belief that others are unsafe or unreliable.

 Treatment Considerations

Therapy often emphasizes:

• Identifying early signs of anger and resentment
• Learning to communicate needs directly rather than through tests or withdrawal
• Working on trust and repair skills in relationships

Relationship-focused approaches, such as DBT, MBT, and schema therapy, may be particularly helpful.

4. Self‑Destructive Borderline Personality Disorder

Key Traits

The self‑destructive subtype highlights behaviors and thoughts that directly or indirectly harm the self.

This may include:

• Recurrent self-harm (cutting, burning) or suicidal behavior
• Disordered eating, high-risk substance use, or other unhealthy habits
• Sabotaging opportunities (quitting jobs abruptly, ending stable relationships when they feel “too good”)
• Deep feelings of emptiness, hopelessness, and self-hatred

While self-harm can occur in any BPD presentation, it is especially central in the self‑destructive pattern.

Internal Experience

Individuals with self‑destructive BPD often describe:

• Feeling fundamentally “bad” or undeserving of care
• Using pain or risk to feel something when numb, or to cope with unbearable emotional intensity
• Feeling that hurting oneself stops them from emotionally hurting other people

These experiences can be frightening both for the individual and for loved ones, but they are treatable with appropriate care and support.

Treatment Considerations

Evidence-based treatments focus on:

• Reducing self-harm and suicidal behavior as top priorities
• Building distress-tolerance and emotion-regulation skills
• Strengthening reasons to live and long-term goals

DBT has some of the strongest evidence in reducing suicide attempts and self-harming behaviors in BPD. Recent randomized trials suggest even 6 months of comprehensive DBT can significantly reduce self-harm and improve functioning.

How Reliable Are BPD Subtypes?

1. Research Perspective

Most research on BPD focuses on core symptoms rather than subtypes, but some data support the idea that people cluster into more internalizing or externalizing patterns:

Externalizing features: impulsive behavior, substance use, aggression

• Internalizing features: anxiety, depression, shame, self‑blame

Studies using large samples show BPD symptoms are strongly associated with both internalizing distress and externalizing tendencies, suggesting a spectrum of presentations rather than rigid categories.

2. Clinical Use

Clinicians may find subtypes useful to:

• Validate how different people with the same diagnosis can look and feel
• Tailor the focus of therapy (for example, more work on impulsivity vs. shame)
• Help individuals understand their patterns without labeling them as “bad”

However:

• Subtypes are not official diagnoses or checkboxes
• People can shift between patterns over time (for example, more impulsive when younger, more discouraged later)
• Effective treatments target core BPD features across subtypes

Treatment Options for Borderline Personality Disorder

BPD is highly treatable, especially with consistent, evidence-based therapy. Many people see major improvements in symptoms, relationships, and quality of life over time.

1. Psychotherapy (Talk Therapy)

Psychotherapy is the main treatment for BPD. Well-studied approaches include

Dialectical behavior therapy (DBT): Teaches skills in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Multiple randomized trials show DBT reduces self-harm, suicide attempts, and hospitalizations in BPD.

• Mentalization-based treatment (MBT): Focuses on understanding your own and others’ thoughts and feelings more accurately to reduce relationship chaos.
• Transference-focused psychotherapy (TFP): Works on understanding and integrating intense emotions and relationship patterns that show up with the therapist and others
• Schema therapy: Targets long-standing negative beliefs (schemas) about oneself and others, often rooted in early experiences.

These therapies can be delivered in various formats (individual, group, day programs), and many large health systems now offer BPD-informed services.

2. Medications

There is no medication that “cures” BPD, and medication is not the primary treatment. However, doctors may prescribe medications to target specific symptoms or co‑occurring conditions, such as:

Antidepressants for depression or anxiety

• Mood stabilizers for mood swings or impulsivity
• Atypical antipsychotics at low doses for severe anger, impulsivity, or short psychotic episodes

Medication choices should be carefully individualized and reviewed regularly.

3. Self-Care and Lifestyle Supports

While not replacements for therapy, lifestyle changes can make symptoms easier to manage:

• Regular sleep and consistent routines
• Moderate physical activity (walks, yoga, or other enjoyable movement)
• Limiting alcohol and substance use, which can worsen BPD symptoms
• Building a support network of trusted friends, family, or peer support groups

For women balancing caregiving, work, and BPD, setting boundaries and asking for practical help can be vital parts of recovery.

Frequently Asked Questions (FAQs)

Q1. Are the four BPD subtypes official diagnoses?

No. The four subtypes (impulsive, discouraged, petulant, self‑destructive) come from clinical theories, especially Theodore Millon’s work, and are used informally to describe patterns. The DSM‑5 and ICD‑11 recognize BPD as one diagnosis with a range of symptoms, not separate subtype diagnoses

Q2. Can someone have more than one BPD subtype?

Yes. Many people show traits of more than one subtype, and patterns can shift over time. For example, someone might have impulsive behaviors in their teens and twenties and later show more discouraged or “quiet” features. Subtypes are descriptive tools, not strict boxes.

Q3. Is BPD more common in women?

In community samples, BPD appears to affect men and women at similar rates, but in treatment settings, more women are diagnosed. Reasons may include differences in help‑seeking, social expectations, and how symptoms are interpreted by clinicians. Many studies of BPD treatments (such as DBT) include a high percentage of women, so we have considerable data on what helps women specifically.

Q4. Can BPD get better over time?

Yes. Long-term studies show that many people with BPD experience meaningful improvement in symptoms, functioning, and quality of life, especially when they receive structured therapy. While some vulnerability may remain (for example, sensitivity to rejection), crises often become less frequent and easier to manage with skills and support.

Q5. How can I support a loved one with BPD?

Helpful steps include:

• Learning about BPD from reliable sources (such as NIMH and peer‑reviewed research)
• Setting clear, kind boundaries and sticking to them
• Validating feelings (“I can see you’re really hurting”) without agreeing with harmful behaviors
• Encouraging treatment and offering practical help (rides, childcare, reminders)
• Considering family or partner sessions with a therapist familiar with BPD

It’s also important to protect your own mental health by seeking support, especially if you feel overwhelmed.

Conclusion

Borderline personality disorder is a complex, but highly treatable, mental health condition. The commonly discussed BPD subtypes—impulsive, discouraged, petulant, and self‑destructive—are not official diagnoses, but they can help describe how symptoms cluster differently from person to person. For women in the United States, understanding these patterns may make it easier to recognize your own experiences, ask better questions in therapy, and advocate for care that fits your needs.

Evidence-based psychotherapies, especially DBT and other BPD‑focused approaches, have been shown in randomized trials to reduce self-harm, improve emotional stability, and enhance overall functioning. Recovery is not instant, but many people see dramatic improvements over time. If these descriptions feel familiar, consider reaching out to a licensed mental health professional—preferably one experienced in personality disorders. You deserve support, and effective, compassionate treatment is available.

Medical Disclaimer

This article is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always speak with a licensed psychiatrist, psychologist, or other qualified healthcare provider about any questions you have regarding symptoms, mental health conditions, or treatment options. If you are in crisis or having thoughts of self-harm or suicide, seek emergency help immediately (for example, by calling or texting 988 in the United States, or using your local emergency number).