Borderline Personality Disorder Treatment

There are a variety of effective treatments for borderline personality disorder (BPD). What treatments seem to work best, and what should I know about the options available?

Overview

Usually, BPD is treated with a combination of medication and psychotherapy, although during times of crisis, individuals with BPD may require brief periods of hospitalization to remain safe. More recently, self-help tools have been developed to supplement traditional treatments for BPD.

Psychotherapy

Long-term outpatient psychotherapy, or "talk therapy," is an important part of any treatment for BPD. Research has shown that several types of psychotherapy are effective in reducing the symptoms of BPD, including:

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) was the first form of psychotherapy found to be effective for people with borderline personality disorder (BPD). DBT is a form of cognitive behavior therapy (CBT), which focuses on how thoughts and beliefs can lead to actions and behaviors. In this therapy, people learn how to manage distress and learn skills to help them cope with strong emotions. Mindfulness is a component of this approach.

Schema-Focused Therapy

Schema-focused therapy is an integrative psychotherapy incorporating aspects from cognitive behavior therapy and psychoanalytic theories. Schema-focused therapy operates with the thought that unmet needs from childhood can lead to unhealthy ways of thinking about the world. This therapy focuses on challenging these maladaptive beliefs and behaviors and focusing on healthier ways of thinking and coping.

Mentalization-Based Therapy

Mentalization-based therapy has been studied for BPD and may help with anxiety and depression as well as social functioning. This therapy focuses on helping the client to recognize mental states—their own thoughts and feelings, as well as the thoughts and feelings of others they communicate with. Through recognition, they are then able to see how these thoughts contribute to their behavior or the behavior of others.

Transference-Focused Psychotherapy

Transference-focused psychotherapy has been studied for BPD and may be as good or better than dialectical behavior therapy according to these studies. This therapy uses the concept of transference—transferring feelings and expectations from early relationships on to a person in the present, which is a key concept in psychodynamic therapies. Transference-focused psychotherapy utilizes the relationship between the client and the therapist so that the therapist can see how a client relates to others. The therapist can then use this awareness to help a person respond more effectively in their other relationships.

Medications

Although there are currently no medications approved by the FDA specifically to treat borderline personality disorder, research has shown that some medications do reduce certain symptoms of the disorder. Medication may be particularly effective for BPD when it is used in conjunction with psychotherapy. In addition to helping with BPD symptoms, medications may help with co-existing mental health conditions such as anxiety or depression.

Some of the most commonly prescribed medications for BPD include:

• Antidepressants: Antidepressants may help with feelings of depression and anxiety.
• Antipsychotics: Antipsychotics were some of the first medications used to treat BPD and may be particularly helpful for some of the more problematic symptoms of BPD such as anger, impulsivity, and paranoid thinking.
• Anxiolytics (anti-anxiety medications): Anxiety can go hand in hand with BPD making some of these medications helpful, yet some of these are a double-edged sword due to their addictive potential.
• Mood stabilizers/anticonvulsants: Mood stabilizers may help with impulsivity and emotional reactivity.

Other potential treatments, such as omega-3-fatty acids, are also being explored. The best evidence for medication benefit in BPD involve second-generation antipsychotics and mood stabilizers.

The best way to see which, if any, medication options are right for you is to speak with your doctor or psychiatrist. They can help iron out a plan of action for getting symptoms under control.

Borderline Personality Disorder Discussion Guide

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Hospitalization

Borderline personality disorder is associated with very intense emotional experiences. Sometimes people with BPD are admitted to a psychiatric hospital to maintain safety. Inpatient treatment requires you to stay overnight in the hospital.

Another treatment option is partial hospitalization or day treatment. These are programs that are more intensive than traditional outpatient psychotherapy but do not require you to stay overnight. You may be enrolled in a partial hospital or day program if you may be headed toward a crisis, or if you have just been discharged from inpatient hospitalization and need a period of more intensive treatment to make sure the crisis does not reemerge.

Self-Help

Self-help strategies for BPD are an essential part of any treatment program. Of course, these should be used to supplement care from a qualified therapist and not alone. An ideal plan includes learning as much as you can about your disorder through self-help education, learning healthy coping skills for BPD, and finding ways to help you express and manage your emotions.

There are valuable self-help resources available for BPD that can be used in conjunction with more traditional forms of treatment. Books and online resources offer information about BPD and suggest ways to cope with the symptoms.

What to Do in an Emergency

If you or someone you love is experiencing a mental health emergency, it is critical that you get help immediately. Call 911 or go to your nearest emergency room. If there is evidence that you (or your loved one) are a danger to yourself or others, you may be admitted for a brief hospital stay on an inpatient psychiatric unit until the crisis has passed. It's recommended that anyone living with BPD put together a safety plan for BPD. In this plan, you can anticipate a crisis and make a plan for exactly how you will address your feelings before they become an emergency.