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 approachBorderline Personality Disorder and Emotion Dysregulation4(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 disorderPersonality Disorders: Theory, Research, and Treatment13(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 disorderPersonal 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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Inattentive ADHD in Women


Key Takeaways

  • Inattentive ADHD is more common in women, and it often goes undiagnosed because its traits can look like stress or anxiety.
  • Women with inattentive ADHD may face challenges in work and school, but can benefit from accommodations and support.
  • Treatment for inattentive ADHD varies; some people benefit from medication, therapy, or a combination.

Conversations around ADHD used to mostly center on young boys who were portrayed as loud and boisterous in the classroom. Lately, you may have noticed more and more women you know getting diagnosed as adults. There’s been a big shift in our understanding of this type of neurodivergence, including recognizing that ADHD tends to show up a bit differently in girls and women. Women are more likely to experience inattention rather than hyperactivity.

Inattentive attention deficit hyperactivity disorder (ADHD) is characterized by difficulty with focusing and concentrating, as well as impulsivity. While inattentive ADHD is often thought of as a childhood disorder, it can persist into adulthood.

What Does ADHD Look Like?

Attention deficit hyperactivity disorder (ADHD) is a type of neurodivergence that affects people of all ages. That means that people with ADHD tend to process, behave, and learn differently than what is considered ‘typical.’

You’re probably already familiar with some of the main features of ADHD, including increased energy and hyper-focus. Many people with ADHD are naturally curious and creative.

ADHD can also present challenges, such as difficulties with focus, impulsiveness, and/or hyperactivity. People with ADHD may have unique requirements to help them thrive in social, academic, and work settings.

There are three types of ADHD:

  1. Inattentive type: Difficulty sustaining attention and concentration
  2. Hyperactive-impulsive type: Difficulties with impulsiveness and/or hyperactivity
  3. Combined type: Difficulties with all three areas—sustaining attention, impulsiveness, and hyperactivity

Inattentive ADHD is more common in women than men. In women, inattentive ADHD often goes undiagnosed because some of its traits are confused with signs of stress or anxiety.

What Is Inattentive ADHD?

Inattentive ADHD is a form of attention deficit hyperactivity disorder (ADHD). People with inattentive ADHD may need to find unique ways to sustain their attention, as they struggle to focus on certain tasks. They may also experience impulsive behavior and/or hyperactivity.

Though it is often thought that ADHD is most impactful during childhood, inattentive ADHD traits still occur in adulthood and can be even more distressing without the right accommodations.

Inattentive ADHD may manifest differently in women than it does in men. Without adaptive coping mechanisms, women with inattentive ADHD may have difficulty with work, school, or personal relationships. They may also struggle with anxiety, depression, and other mental health issues.

Having inattentive ADHD means that your mind works uniquely. In general, people with ADHD have a unique perspective of the world around them. With the right strategies, those with inattentive ADHD can find more ease and efficiency with the daily tasks they may struggle with.

Traits of Inattentive ADHD

The traits of inattentive ADHD can vary from person to person. Common ones include the following:

  • Becoming easily distracted
  • Being interested in many things simultaneously
  • Creativity
  • Difficulty sustaining attention on just one thing
  • Disorganization
  • Fast-paced thinking
  • Feeling extremely energetic
  • Forgetfulness
  • Losing track of time
  • Moving on to another task without finishing the first
  • Procrastination
  • Seeing the world in unique ways
  • Trouble following instructions

While the traits of inattentive ADHD are the same for men and women, they may be more difficult to identify in women. This is because some of the traits of inattentive ADHD can be similar to those of other mental health conditions, such as anxiety and depression. That can seem like being distracted or daydreamy, but it can also look like being stressed, disorganized, and unmotivated.

In addition, women with inattentive ADHD may be more likely to internalize their traits, which can make them less obvious to others.

How Does Inattentive ADHD Impact Daily Life?

There are both benefits and challenges that inattentive ADHD presents. Some of the benefits of inattentive ADHD (as well as other types of ADHD) include:

  • Being adventurous: When ADHD is managed effectively, impulsivity can make life exciting and inspiring. People with ADHD may use this trait adaptively to explore their curiosities and interests in life.
  • Creative thinking: People with ADHD are often naturally creative, seeing the world in unique ways and coming up with inventive solutions to problems.
  • Increased energy: There are times when increased energy is beneficial. People with ADHD may thrive while performing certain tasks or engaging in certain activities that require a lot of energy.
  • Self-awareness: People with inattentive ADHD may find that they are tuned in to how they’re feeling at any given moment, which can help them fulfill their needs—whether it’s time away from a task when they’re feeling distracted or learning a new skill when they’re feeling energetic.

There are also challenges that people with inattentive ADHD may face. These challenges may be made more difficult because schools, jobs, and social norms often don’t account for people who are neurodivergent. It can feel frustrating to constantly have to advocate for yourself if you have inattentive ADHD.

Women with inattentive ADHD may also struggle with anxiety, depression, or other mental health issues.

Below is a list of the potential challenges:

  • School: The traits of inattentive ADHD may make it harder to focus during long lectures and/or complete assignments on a deadline. People with inattentive ADHD may benefit from taking breaks during the day, getting help outside school, and/or receiving other academic accommodations.
  • Work: Inattentive ADHD may make it challenging to complete work tasks or adjust to the social norms of an office setting. But people with inattentive ADHD can still thrive at work. They may benefit from speaking with their manager about ways that will help them complete their work the most efficiently, perhaps by eliminating unnecessary distractions.
  • Personal relationships: Maybe you tend to forget plans with friends, or your family feels that you’re not fully present. Communicate honestly with loved ones. Let them know how you’re doing your best to show up for them; you may offer ways they can help support you, too.
  • Anxiety: Women with inattentive ADHD may be at risk for anxiety disorders. The traits of inattentive ADHD can contribute to feelings of anxiety and worry. In addition, women with inattentive ADHD may be more likely to internalize their traits, which can lead to increased anxiety.
  • Depression: Women with inattentive ADHD may also be at risk for depression. The traits of inattentive ADHD can contribute to feelings of sadness and isolation. Internalizing your traits can lead to increased depression.

If you are feeling anxious or depressed, try speaking to a mental health professional who can help you address uncomfortable feelings and reframe negative thoughts.

Inattentive ADHD Treatment

There is no one approach to treating inattentive ADHD. The best course of treatment will vary from person to person. Some people with inattentive ADHD may benefit from medication, while others may benefit from therapy or a combination of both.

There are many different options you might want to consider if you have ADHD, such as:

Medication

Medication can be used to treat some of the challenging traits of inattentive ADHD. Commonly prescribed medications include stimulants, such as methylphenidate (Ritalin) and amphetamines (Adderall). Non-stimulant medications, such as atomoxetine (Strattera), may also be effective.

Therapy

Therapy can be used to help people with inattentive ADHD manage some of the traits that may be disruptive to their daily life. While there are a multitude of therapy options helpful for ADHD, the relationship you have with your therapist/professional plays a significant role in therapeutic change versus the model of therapy itself.

Coaching

ADHD coaching is another support option that is helpful for managing ADHD. Getting involved and being around other ADHD folks (and just neurodivergent folks in general) is critical. Having a sense of community is incredibly important when the world isn’t designed for your brain.

Self-Help

There are also many self-help resources available for people with inattentive ADHD. Books, websites, YouTube channels, and support groups can provide information and support. In addition, many apps are available that can help with task management, organization, and time management.


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I Tried Drinking 13 Cups of Water a Day for My Mental Health


Key Takeaways

  • I enjoyed drinking so much water—more than I thought I would.
  • In practice, 13 cups wasn’t quite as daunting as it looks, and once I got into a bit of a habit of opting for water, I was in a good position.
  • I feel better, both mentally and physically, for it too.

I’ll be honest. I don’t drink enough water. I drink water when I’m working out, and sometimes have a glass at home, but I really should be drinking more. According to the Academy of Nutrition and Dietetics, the average man should be drinking 13 cups of water a day, which is about a liter more water than you’d drink following the previous popular advice to drink eight 8-ounce glasses of water a day.

Why Do We Need So Much Water?

“Thirteen cups a day is a good target for getting the benefits of regular hydration,” says Christy Swaid, a wellness mentor, nutrition expert, and former athlete.

“But 13 cups may not be enough in the context of exercise, heat, sun exposure, sickness, fever, or air travel. Many people forget to drink enough water or choose not to with the intention to avoid going to the bathroom.”

Jennifer Pallian, BSc RD, registered dietitian and food scientist at Foodess, adds that hydration is more important than hitting a target, as it can differ from person to person. “Maintaining adequate hydration levels, rather than simply meeting a numeric intake goal, may play a protective role in preserving cognitive function as people age,” she explains.

Jennifer Pallian, BSc RD

Maintaining adequate hydration levels, rather than simply meeting a numeric intake goal, may play a protective role in preserving cognitive function as people age.

— Jennifer Pallian, BSc RD

Drinking 13 Cups of Water Every Day

Curious to see how feasible this goal was, I decided to give it a try for a week.

Day 1

This was a Saturday, and I woke up with a slight hangover after enjoying a few drinks the night before. It was the perfect opportunity to begin the experiment, and I was eager to quench my thirst with a glass of cold water.

  • Before I touched any coffee, I had my first 2 cups of the day. 
  • I had to run a couple of errands, so I drank another 2 cups while getting ready.
  • I then bought a bottle of water at the store while I was out, and when my girlfriend wanted to sit down somewhere for a while, I ordered a glass of water rather than a hot drink or a soda. 

Once we got back home, I was almost halfway through my daily quota. I figured that being at home for the rest of the day would make things easier, and I was right.

I had a relaxing evening, and decided that every time I went into the kitchen, I’d pour another glass of water. I had my last glass of water at 11 p.m., about an hour before I went to sleep.

While I didn’t notice any effects after just one day, I definitely felt a sense of achievement in actually drinking 13 cups. 

Day 2

I woke up earlier than I usually do on a Sunday, and let myself have a coffee before switching up and having a cup of water.

  • I had another cup of water before going grocery shopping.
  • It was warm outside, so I bought a bottle of water (roughly 2 cups) from the supermarket and sat down to enjoy it before heading back home. 
  • I drank another cup before going to the gym, where I drank about 2 cups.
  • I had a protein shake followed by another cup of water when I returned, and then followed a similar pattern to the previous day.

I didn’t have anything else to do for the rest of the day, so I tried to make myself a cup of water whenever I went to the kitchen, if I didn’t already have one on the go. I made sure I had a glass of water with my dinner, too. 

Day 3-4

I didn’t feel as grumpy as I usually do on a Monday morning.

Working from home, I found it relatively easy to keep on top of my water intake—I went for a haircut over lunchtime and went for a run in the afternoon, but other than that, I was at my desk with a glass of water by my side almost at all times. 

This was the first day I thought to check my urine color, too. I thought that after a couple of days of drinking water, it might be quite pale, and I was right. While I don’t exactly make a habit of checking the color from day to day, it has definitely been a darker yellow in the past.

Tuesday was more of the same. I was drinking water throughout while at work, and felt as though I was getting into the habit of refilling my glass on a regular basis, particularly after meals.

I was going to the toilet more regularly, but by the same token, I was beginning to feel mentally and physically fresher, not as sluggish.

Because I work at my computer and then I’ll also be scrolling social media and messaging friends on my phone, my screen time statistics don’t look the best. I sometimes feel a headache coming on toward the end of the workday as a result, but I realized on Tuesday that I hadn’t had a headache so far that week. 

Day 5-6

Well into the experiment on Wednesday, I had quite a busy weekday, so I had to be mindful to meet my water consumption goals.

I kept things up regularly in the morning before heading to the gym at lunchtime, where I refilled my water bottle twice, and then had to walk into the city center to run a couple of errands before I saw my therapist mid-afternoon.

Between the gym and therapy, I didn’t fit any water in, and, with it being one of the warmest days in the UK for some time, I could feel a headache brewing when I left my therapist’s office—even though I had a glass there. 

I went to see a movie with some friends in the evening, and we grabbed food beforehand. I’d usually get a beer or a soda, but I opted for water with my meal, and I finished the last of my cups at home before bed. Needing to go to the toilet more often than usual in the movie was slightly annoying, but didn’t bother me too much. 

I remarked to my therapist that I’d been having the best week, mentally, that I’d had in some time. At the time, I didn’t connect this to my increased water intake, but reflecting afterward, I realized that there might be a connection.

Thursday was no different from the start of the week, really. I noticed that I was instinctively drinking more water with the weather being warm, and I enjoyed having a glass by me at my desk. 

It also struck me that I was snacking on unhealthy foods less frequently. Particularly in the evening, I notice myself snacking on junk food, but drinking water stopped me from feeling tempted to run to the store.

Day 7

I couldn’t believe it was Friday—and the final day of the experiment—already. I was used to enjoying my 13 cups of water, even if it sometimes felt like a lot of fluid to get through.

Throughout the week, it had made me feel fresher and, by and large, put me in a better mindset. I kept up the habit throughout the day, and, to be honest, if not for writing up this article, I’d have forgotten it was an experiment. It became a new normal quite quickly. 

The experiment is also more practical than other experiments I’ve tried. You don’t need anything fancy: just a faucet and a glass or bottle.

All this made me think that I might not need as much water as the average man. But that said, I also go to the gym or run about five or six times a week, so it might all even out. 

How Do I Know How Much to Drink?

Per the Academy’s advice, men need about 13 cups and women need about 11. This is on top of the fluids we already get from our regular food and drink—we tend to get about 20% of the water we need from our diet without actively drinking more water itself. 

Of course, this is just a guide. Age, activity level, and overall health can all impact the amount of water you need. Adults usually need more than children, as do people who live more active lifestyles. And people who are pregnant or breastfeeding need more water. As Swaid says, “There is no cookie-cutter quantity that is ideal for every person.”

Christy Swaid, wellness mentor and nutrition expert,

Severe or chronic dehydration can lead to kidney complications, heatstroke, electrolyte imbalances, shock, coma, or even death.

— Christy Swaid, wellness mentor and nutrition expert,

People with certain health conditions may also need more or less water, too. Someone with congestive heart failure might need to restrict their intake, while someone with diarrhea or vomiting will probably need more water. 

Serious health conditions aside, if you’d like to know whether you’re getting enough water, take a look at the color of your urine. If it’s a pale yellow, you’re likely consuming enough. If it’s darker, you might need more.

Can You Drink Too Much Water?

Water intoxication is a thing. It creates a chemical imbalance in your body, and in some cases, it can be fatal. Symptoms include headache, confusion, drowsiness, nausea, and muscle weakness.

Fortunately, you’d need to drink a lot to be at risk. For the average person, drinking over 8 liters a day is probably too much, or more than about 1 liter per hour—any more than that, and the kidneys can struggle to process it. “Listen to your body and stop drinking water when you feel satisfied,” says Swaid. 

How to Drink So Much Water in a Day

Drinking 13 cups sounds slightly daunting. but there are things you can try:

  • I made it into a routine, making sure I had a cup of water with each meal, as well as one once I got back from the gym.
  • I tried to alternate, too, so rather than having two glasses of diet soda one after the other, I’d have a soda and then a water. 
  • It became a habit that when I went into the kitchen, I’d also get a glass of water. 

If you aren’t a big fan of regular water, Swaid recommends infusing it with natural fruits or herbs. “Squeeze fresh lemon, limes, or oranges,” she suggests. “Add mint and strawberries or make your own favorite concoction.”


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