Common BPD Treatments (Borderline Personality Disorder)
Borderline personality disorder (BPD) is a commonly misunderstood mental health condition. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), BPD is a psychological disorder characterized by impulsive behaviors and unstable relationships, emotions, and self-image. People with this condition experience considerable distress and dysfunction in many areas of life, particularly in relationships.
In this article, we review common psychotherapies and pharmacological BPD treatments (i.e. medications).
Though psychological therapies remain the cornerstone of BPD treatments, medications are also used to manage certain symptoms of this condition, such as aggression, anxiety, depression, and impulsiveness.
Commonly prescribed medications for treating the depressive symptoms of BPD include antidepressants, especially selective serotonin reuptake inhibitors (SSRIs).
Some examples are Zoloft, Prozac, and Luvox. These medications work by reducing the reabsorption of serotonin (a neurotransmitter involved in mood regulation), thus increasing the amount of serotonin available to neurons.
SSRIs improve depressive symptoms and other mood disturbances. They may also reduce aggression and suicidal tendencies, both of which are BPD symptoms potentially linked to low levels of serotonin.
Aside from SSRIs, a variety of medications are sometimes prescribed for BPD, including:
- Non-SSRI antidepressants (e.g., atypical antidepressants, like Wellbutrin)
- Atypical antipsychotics (e.g., Zyprexa, Seroquel)
- Mood stabilizers (e.g., Lamictal)
- Anti-anxiety medications (e.g., Klonopin)
It is important to note medications alone are not an effective treatment for BPD; they are helpful mainly for managing specific symptoms or for treating co-occurring conditions (e.g., anxiety, depression).
In addition, some patients do not take their medications—for instance, due to side effects (e.g., weight gain with certain antipsychotics). Or they misuse their medications (e.g., abusing anti-anxiety medications).
Therefore, as useful as pharmaceutical PBD treatments might be in specific circumstances, they are often used in combination with psychological treatments.
Psychological BPD treatments
Examples of psychological interventions for BPD include cognitive behavioral therapy, transference-focused psychotherapy, mentalization-based treatments, and schema therapy. Perhaps the best-known and most effective psychological treatment for borderline personality disorder is dialectical behavior therapy (DBT). DBT incorporates different types of techniques, including those borrowed from cognitive therapy, behavioral therapy, and mindfulness.
A critical component of DBT is skills training. For instance, patients are taught how to behave more effectively in personal relationships and how to become better problem solvers.
The focus on behavior change is balanced with a focus on helping patients feel validated. This is important because according to a common theory of how BPD develops, a combination of sensitive temperaments and invalidating childhood environments give rise to this disorder.
Indeed, many BPD patients have trouble with self-validation and emotion regulation.
To address emotion-regulation deficiencies, therapists teach patients skills they can use to regulate their emotions in stressful situations or invalidating environments. Other essential skills taught in therapy are listed below.
- Mindfulness: To regulate one’s attention; to stay in the present moment.
- Interpersonal effectiveness: To communicate more effectively and assertively in interpersonal situations.
- Distress tolerance: To improve coping with negative emotions and not making a stressful situation worse (e.g., through self-harm).
Since many patients with BPD who present for treatment are struggling with a variety of issues (from minor to very serious issues), DBT’s approach is always to stabilize the patient first (e.g., address suicidal behaviors). Next, the therapist deals with treatment-interfering behaviors (e.g., non-compliance). Subsequently, the therapist addresses major traumas and mental health symptoms (e.g., depression, drug abuse), employment or school concerns, and other problems that decrease one’s quality of life.
The goal of therapy is to help patients improve their quality of life and, as Linehan (the developer of DBT) frequently notes, create a life worth living.
What is Treatment-Resistant Depression?
Treatment-resistant depression is depression that has failed to respond to at least 3 antidepressant medications from different drug classes.
What is Spravato?
Spravato Nasal Spray is a new FDA approved medication for treatment of chronic depression in adults. Please fill out the form to download our patient guide to get more information on this medication, who is the right candidate, treatment options, and potential side effects.
Talk to your doctor to see if Spravato is right for you.
Please note that Spravato can only be administered in a medically supervised healthcare setting that has been recognized as a certified treatment center.
Download your copy of:
Spravato Patient Guide
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