What Is High-Functioning BPD? Signs and How to Get Help

High-functioning BPD is a form of borderline personality disorder where symptoms are masked by outward stability. Learn how to recognize the signs and explore treatment options.

Borderline personality disorder (BPD) is a complex mental health condition that’s often misunderstood. While it affects approximately 1.6% of the general population, it accounts for 20% of psychiatric hospitalizations.

BPD is typically recognized by dramatic mood swings and unstable relationships. However, some people with BPD can mask their symptoms, which is often referred to as high-functioning BPD. High-functioning BPD can be harder to identify, but it can still severely affect relationships, career stability, and overall well-being. Read on to learn more about what high-functioning BPD looks like, its common symptoms, and how effective treatment can help manage this condition.

What is high-functioning BPD?

High-functioning BPD refers to individuals who meet the criteria for BPD but are able to maintain the appearance of stability in areas like work, school, or social life. They may excel professionally, keep up with responsibilities, and appear socially engaged, all while privately struggling with intense emotions, fear of abandonment, unstable relationships, and a chronic sense of emptiness. Because their symptoms are more hidden, high-functioning individuals are often misdiagnosed or overlooked, leading to untreated distress and difficulties beneath the surface.

What are the subtypes of BPD?

BPD symptoms can show up in a variety of ways and are often categorized into subtypes. Many of these symptoms also overlap with other mental health conditions, like bipolar disorder or histrionic personality disorder, which can make the diagnosis more complex. 

It’s also important to remember that any BPD subtype can be high-functioning, meaning someone may appear outwardly successful or emotionally stable while still experiencing intense internal struggles.

1. Petulant BPD

Often driven by a need for control, Petulant BPD is marked by emotional volatility and relationship struggles. Common traits include: 

• Sudden mood swings and emotional outbursts
• Passive-aggressive behavior and manipulation
• Feelings of worthlessness or unlovability

2. Impulsive BPD

This subtype may appear confident and charismatic, but impulsivity often leads to risky behaviors. Typical behaviors include:

• Thrill-seeking or reckless activity, including substance use, alcohol abuse, or risky sexual behavior
• Self-harm and suicidal gestures
• Difficulty considering long-term consequences

3. Self-destructive BPD

Often inwardly directed, this subtype struggles with self-loathing and destructive behaviors that may be masked from others. Signs include:

• Self-sabotaging behavior
• Crippling self-criticism
• Risk-taking without regard for safety

4. Quiet or discouraged BPD

High-functioning BPD, sometimes called “quiet borderline personality disorder,” involves internalizing emotions rather than expressing them outwardly. People with quiet BPD may appear calm and in control while struggling silently. Key characteristics include:

• Perfectionism and people-pleasing
• Fear of rejection or abandonment
• Emotional numbness or chronic emptiness

What is BPD splitting, and how does it show up in high-functioning BPD?

“Splitting” is a defense mechanism often seen in BPD, where people or situations are viewed as either all good or all bad, with no gray area. This black-and-white thinking can make relationships volatile and unpredictable. For example, a partner may be idolized one day and vilified the next based on perceived slights. Splitting can fuel emotional instability, codependent behaviors, and difficulty trusting others.

In high-functioning BPD, splitting may be more internalized—someone might not lash out outwardly, but instead silently withdraw or ruminate, cycling through intense feelings of admiration and resentment without expressing them.

Causes and risk factors of high-functioning BPD

Even in high-functioning cases of BPD, the underlying causes and risk factors remain the same. Here are some common causes and risk factors for the condition: 

• Genetics 
• Abnormalities in brain function 
• Environmental factors like stress and trauma 
• Childhood abuse (physical, sexual, verbal)

Impact of untreated high-functioning BPD

Because high-functioning individuals often hide their struggles, the symptoms of BPD can go unnoticed by others—and even by the person themselves. However, when left untreated, BPD can lead to serious consequences over time, including career instability or job loss, high-conflict or unhealthy relationships, divorce and family disruption, substance use or addiction, and even legal issues or unsafe behaviors. Many people also experience worsening anxiety or depression, and in some cases, may struggle with suicidal thoughts or attempts.

How is high-functioning BPD diagnosed?

There’s no single test for BPD (let alone high-functioning BPD). Mental health professionals use clinical interviews and DSM-5 criteria to diagnose personality disorders. Most diagnoses occur in late adolescence or early adulthood after a thorough evaluation of long-standing patterns.

To be diagnosed with BPD, a person must meet five out of nine diagnostic criteria related to:

• Abandonment fears
• Unstable relationships
• Identity disturbance
• Impulsivity
• Self-harming behavior
• Emotional instability
• Chronic emptiness
• Intense emotions (especially anger)
• Dissociative symptoms

Treatment for borderline personality disorder

While a BPD diagnosis can feel overwhelming, many find that the condition is treatable with the right approach. Here are common treatments for BPD:

Therapy 

Therapy is the foundation of effective treatment. Specifically, dialectical behavior therapy is known as the gold standard for BPD treatment. DBT focuses on emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness. In one study, 77% of participants no longer met criteria for BPD after one year of DBT.

Also, cognitive behavioral therapy (CBT) helps patients recognize and reframe distorted thinking patterns. It’s goal-oriented and focuses on building healthy coping strategies. Studies show it is beneficial as it is goal-oriented, meaning it aims to achieve specific, measurable changes in thoughts, emotions, and behaviors. CBT empowers patients to develop healthier coping strategies by restructuring their thinking and modifying their actions.

Medication

There’s no specific medication for BPD, but antidepressants, mood stabilizers, or antipsychotics may be prescribed to manage co-occurring conditions like depression or anxiety.

Healthy coping strategies

Outside of therapy, lifestyle changes and self-help tools can make a significant difference. Helpful strategies include:

• Identifying and managing emotional triggers
• Setting clear boundaries in relationships
• Joining a support group or peer community
• Practicing mindfulness and meditation
• Maintaining a regular exercise routine
• Seeking treatment for co-occurring conditions
• Avoiding assumptions about others’ intentions

How Charlie Health can help

If you or a loved one is struggling with high-functioning BPD, Charlie Health is here to help. Charlie Health’s Virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions, including high-functioning BPD, childhood trauma, and more. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing high-functioning BPD and other mental health concerns is possible. Fill out the form below or give us a call to start healing today.