BPD Research on Borderline Personality Disorder Subtypes By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Learn about our editorial process Updated on September 23, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Westend61/Getty Images Table of Contents View All Table of Contents Subtypes in Popular Media Research on Subtypes Treatment Implications Borderline personality disorder (BPD) is associated with a number of different signs and symptoms. In order to be diagnosed with BPD, an individual must meet just five out of a total of nine diagnostic criteria, meaning that BPD in one person can look very different from BPD in another. This has led some experts to wonder whether there are actually distinct types of borderline personalities. BPD Subtypes in Popular Media 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. These subtypes of BPD in popular literature were derived from the authors' own expert opinions on the existence of different types of borderline personalities. 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. Some research studies have found that BPD can be treated as a unified diagnostic entity without the presence of clear subtypes. But other studies have identified some subtypes of BPD. 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. 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. 6 Facts About Borderline Personality Disorder 3 Sources 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. Chanen AM, Thompson KN. Prescribing and borderline personality disorder. Aust Prescr. 2016;39(2):49-53. doi:10.18773/austprescr.2016.019 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 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. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for BPD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.