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.

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. 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 A third study found three BPD subtypes: withdrawn–internalizing, severely disturbed–internalizing and anxious–externalizing.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.

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.