High Functioning, Low Functioning Borderline Personality Disorder

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People with Borderline Personality Disorder (BPD) vary a great deal in their functionality: that is, in their ability to live a normal lifestyle, work inside or outside the home, cope with everyday problems, interact with others, and so on.

Some people with BPD are so incapacitated by their illness that they are unable to work. They may spend a great deal of time in the hospital because of self-mutilation, severe eating disorders, substance abuse, or suicide attempts. BPD makes it very hard for them to form relationships, so they may have a weak support system. They may be so incapable of dealing with money that they have no cash for food or a place to live.

People who are close to low-functioning borderlines often find themselves living from crisis to crisis. They often feel manipulated by self-mutilation and suicide attempts. However, because the borderline is obviously ill, non-BPs usually receive understanding and support from family and friends.

High-functioning borderlines act perfectly normal most of the time. Successful, outgoing, and well-liked, they may show their other side only to people they know very well. Although these borderlines may feel the same way inside as their less-functional counterparts, they have covered it up very well-so well, in fact, that they may be strangers unto themselves.

Non-borderlines involved with this type of BPD need to have their perceptions and feelings confirmed. Friends and family members who don't know the borderline as well may not believe stories of rage and verbal abuse. Many non-BPs told us that even their therapists refused to believe them when they described the BP's out-of-control behavior.

Of course, there's a lot of room in between high-functioning (sometimes referred to as the "borderline" borderline) and low- functioning BPs. Stressful life events are most likely to trigger dysfunctional coping mechanisms.

Acting In, Acting Out

Most borderline behavior is about one thing: trying to cope with internal anguish. However, people with Borderline Personality Disorder may do this in different ways. In our experience, the behavior of people with BPD tends to fall into two general categories: "acting out" and "acting in." These are not official, empirically researched categories. Rather, they are a convenient, real-world way of looking at differences.

Acting-out behaviors are attempts to alleviate pain by dumping it onto someone else-for example, by raging, blaming, criticizing, making accusations, becoming physically violent, and engaging in verbal abuse. Acting-out behaviors cause direct anguish for friends, family members, and partners. For example, one borderline woman, Kiesha, became very angry when she felt that her husband was ignoring her at an office Christmas party. So she went up to him, threw her drink in his face, and stalked out.

Acting-in behaviors mostly hurt the person with BPD, although non-BPs are also affected. Someone with BPD who mostly acts in may feel extremely guilty over-imagined transgressions. They may mutilate themselves, try to hold in their anger, and blame themselves for problems that are not their fault. Suicide is also a possibility.

Some Borderlines seem to mainly act in. Some mainly act out. And some both act in and act out. Take Kiesha, for example; after she embarrassed her husband at the Christmas party, she felt very guilty. She walked home from the party, a distance of several miles. When she arrived home, she grabbed several ornaments from the tree and crushed them with her hands, causing a great deal of bleeding.

continue: Additional Traits Common to People with BPD

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Reviewed: 04/2006