Borderline Personality Disorder - Treatment

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What types of treatment, including medication, have you received for borderline personality disorder?

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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.

Return to Borderline Personality Disorder (BPD)

See what others are saying

Comment from: pkt, 55-64 Female (Patient) Published: March 30

I was just diagnosed last week with borderline personality disorder which came as quite a shock to me but after reading the causes and symptoms of the disorder everything became very clear to me regarding my behaviors over the last 40 years. In addition to therapy, I am being treated with the medications Vistaril and Remeron. I have not yet noticed any improvement or changes in myself but hope that they will help. The more I read about this disorder, the more it scares me.

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Comment from: bpd sufferer, 45-54 Male (Patient) Published: June 14

I was recently diagnosed with borderline personality disorder. At first I was angry, but now, feel a sense of relief knowing that something identifiable is wrong with me. I hit all nine markers for the disorder and see the self-destructive patterns I have developed and the problems I have caused. I feel horrible to know how many people I have hurt and am starting dialectical behavior therapy in a week. I hope it is not too late to feel some sense of worth and to be a kinder person.

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