Borderline Personality Disorder (BPD)

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What is the treatment for borderline personality disorder?

Different forms of psychotherapy have been found to effectively treat BPD. Dialectical behavior therapy (DBT) is a method of 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, treatment with 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 or CBT) has also been found to be effective treatment for BPD. Schema therapy, also called schema-focused cognitive therapy, is based on a theory that many maladaptive ways of thinking (cognitions) are the result of past experiences. This approach to psychotherapy has also been found to alleviate the symptoms of BPD.

Other psychotherapy approaches that have been used to address BPD include interpersonal psychotherapy (IPT) and psychoanalytic therapy. IPT is a type of psychotherapy that addresses 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 when this approach is used in the context of current rather than past relationships. Considered a form of psychodynamic psychotherapy, transference-focused psychotherapy involves the therapist clarifying, confronting, and interpreting the evolving reactions that the person with BPD has toward the therapist that are thought to be a repetition of the person's previous relationships (transference). Some BPD sufferers are found to benefit from this form of therapy, as well.

The use of psychiatric medications, like antidepressants (for example, fluoxetine [Prozac], sertraline [Zoloft], paroxetine [Paxil], citalopram [Celexa], escitalopram [Lexapro], vortioxetine (Brintellix) venlafaxine [Effexor], duloxetine [Cymbalta], vilazodone (Viibryd) 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], paliperidone [Invega], iloperidone [Fanapt], asenapine [Saphris]), lurasidone (Latuda), or brexpiprazole (Rexulti) may be useful in addressing some of the symptoms of BPD but do not manage the illness in its entirety. On a positive note, 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 medication like Depakote. On the other hand, the use of medications in the treatment 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 if taken in overdose.

Partial hospitalization is an intervention that involves the individual with mental illness being in a hospital-like treatment center during the day but returning home each evening. In addition to providing a safe environment, support and frequent monitoring by mental-health professionals, partial hospitalization programs allow for more frequent mental-health interventions like professional assessments, psychotherapy, medication treatment, as well as development of a treatment plan for after discharge from the facility. While funding a long-term stay in a partial hospitalization facility may be difficult, studies show that when it is provided using a psychoanalytic or psychodynamic approach, it may help the person with BPD enjoy a decrease in the severity of general discontent, anxiety, depression, and inability to feel pleasure, as well as decreasing the frequency of suicide attempts and full hospitalizations, as well as developing improved relationships with others such that the BPD sufferer may be less likely to engage in social isolation. Contrary to earlier beliefs, BPD has been found to significantly improve in response to treatment with appropriate inpatient hospitalization. Loved ones of individuals with BPD might benefit from participation in a support group.

Medically Reviewed by a Doctor on 3/7/2016

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