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Dr. Ramani Durvasula - Types of Borderline Personality Disorder

A clinical psychologist / BPD expert Dr. Ramani Durvasula discuss how to spot.

There are four subtypes. In wider spectrum, it's a very heterogenous personality disorder. It's so tricky that is why they; BPDs keep questioning how come my experience is so different than other BPD and what I've been reading. It's heterogenous because it's so scattered. Like: I want cereal. Then you're granola or cheerio? It's like under one umbrella but these subtypes are very different so it's important for us to distinguish.

All this subtypes not recognized in DSM (Diagnostic and Statistical Manual of Mental Disorders). These subtypes represent a mash-up over the years of different sources of research.

Theodore Millon, major player in coming up with these subtypes of BPD. He scales the Millon Clinical Multiaxial Inventory; a personality assessment tool. So I will go "BPD not enough, you got to give me more, tell me a little bit more about this client because I am going to have an incredibly different treatment approach or recommendation based on the kind of subtypes."

Another, the prevalence of BPD is widely disputed. So the estimates of BPD in the population range, I estimates anywhere from 2-6% or 2-7%, that kind of thing. Part of the reason it's so much variation is that it's not easy to assess. Many clients with BPD, in sort of non-research study like just sort of in traditional clinical evaluation; how they showed up in sort of chart data at clinics. Those are not enough. Clinic and hospital evaluations are they're often diagnosed with mood disorder, anxiety disorder, bipolar disorder but not BPD.

Part of that because of:

Ø Training issue

People are less likely to give that diagnosis out. They want to subsume it under other things.

Ø Marketplace issue

BPD is viewed as something difficult to treat and takes a very long time to treat. And because of that, just to not get pushed back from insurers or spaces like that, there may be more tendency of a tendency to use some of the neighboring or co-occurring some symptomatology in that person.

Ø No pills for BPD per se

You're often sort of working on it symptomatically so we haven't seen that study that gives us the optimal prevalence number. If I were to spitball a guess I would say probably somewhere between 3-5%.

So yes, it conclude these subtypes has not officially elevated into the DSM.

1. High Functioning Internalizing AKA Quiet BPD

· More pure borderline

· Very few almost no narcissistic personality whatsoever. In fact the people don't have a lot of ego strength which is why they tend to devalue themselves.

· Really fall apart and can't tolerate the stress in their lives especially around abandonment because there's almost no sense of worthiness.

· Tremendous amount of despair/fragility/tremendous abandonment crisis

· Trigger/activation because of abandonment crisis or triggering of a prior trauma

· Stress that can't be managed

· The person will rage it themselves so they will internalize it, they will talk about themselves horribly

· Might even have suicidal thoughts about themselves believing passively the world will be better without them