Borderline Personality Disorder (cont.)
How is borderline personality disorder treated?
Different forms of psychotherapy have been found to effectively treat BPD. Dialectical
behavior therapy (DBT) is an approach to psychotherapy in which the therapist
specifically addresses four areas that tend to be particularly problematic for
individuals with BPD: self-image, impulsive behaviors, mood instability, and
problems in relating to others. To address those areas, DBT tries to build four
major behavioral skill areas: mindfulness, distress tolerance, emotional
regulation, and interpersonal effectiveness. Talk therapy
that focuses on helping the person understand how their thoughts and behaviors
affect each other (cognitive behavioral therapy) has also been found to be
effective treatment for BPD. Other psychotherapy approaches that have been used
to address BPD include interpersonal psychotherapy (IPT) and psychoanalytic
therapy. ITP is an approach that focuses on how the person's symptoms are
related to the problems that person has in relating to others. Psychoanalytic
therapy, which seeks to help the individual understand and better manage
his or her ways of defending against negative emotions, has been found to be
effective in addressing BPD, especially when the therapist is more active or
vocal than in traditional psychoanalytic treatment and is used in the context of
current rather than past relationships.
The use of psychiatric medications, like antidepressants (for example, fluoxetine [Prozac], sertraline [Zoloft], citalopram [Celexa], escitalopram [Lexapro],
or trazodone [Desyrel]), mood stabilizers (for
example, divalproex sodium [Depakote], carbamazepine [Tegretol], or lamotrigine [Lamictal]) or antipsychotics (for example, olanzapine [Zyprexa], risperidone [Risperdal], aripiprazole [Abilify],
or paliperidone [Invega]) may be useful in addressing some of the symptoms of BPD but do not manage the illness in its entirety. On the positive
side, some women who suffer from both BPD and bipolar disorder may experience a
decrease in how irritable and angry they feel, as well as a decrease in how
often and severely they become aggressive when treated with a mood stabilizer
like Depakote. On the other hand, the use of medications in
the treatment of symptoms in individuals with BPD may sometimes cause more harm
than good. For example, while people with BPD may experience suicidal behaviors
no more often than other individuals with a severe mental illness, they often
receive more medications and therefore suffer from more side effects. Also, given how frequently many sufferers of BPD experience suicidal feelings, great care is taken to avoid the medications that can be dangerous in overdose.
Partial hospitalization is an intervention that involves the individual with
mental illness being in a hospital-like environment during the day but returning
home each evening. In addition to providing a safe environment and frequent
monitoring by mental-health professionals, partial hospitalization programs
allow for more frequent mental-health interventions like professional
assessments, psychotherapy, and medication treatment. While funding for a long-term
stay in a partial hospitalization may be difficult, research shows that when it
is provided using a psychoanalytic approach it may help the person with BPD
enjoy a decrease in the severity of anxiety and depression, the frequency of
suicide attempts and full hospitalizations, as well as developing improved
relationships with others. Contrary to earlier beliefs, BPD has been found to
significantly improve in response to treatment with appropriate inpatient
hospitalization.
Next: What are the complications of borderline personality disorder? »
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