Medications borderline personality disorder

Contents

Pharmacologic treatment of borderline personality disorder

As psychiatry’s understanding of borderline personality disorder (BPD) grows, the literature clearly describes the seriousness of BPD, as well as these patients’ high utilization of treatment. Pharmacotherapy for BPD remains controversial. The most recent American Psychiatric Association practice guidelines focus on using symptom domains of this heterogeneous illness to guide medication selection, yet when these guidelines were published, there was a lack of data to support this recommendation.1

This article evaluates medications for BPD and emerging data supporting matching medications to BPD symptom domains, with an emphasis on making choices that advance clinical practice. We conclude by reviewing studies of combined pharmacotherapy and dialectical behavior therapy (DBT) and describing how a multidisciplinary team approach can enhance BPD treatment.

Early research

Early studies of pharmacotherapy for BPD began after the development of the Diagnostic Interview for Borderlines2,3 and DSM-III criteria for BPD.4 Researchers recruited patients who fulfilled the diagnostic criteria; however, these participants’ symptom profiles were highly heterogeneous. Although such studies can be useful when starting to test new treatments—especially if they are able to show efficacy over placebo or explore safety—they are less helpful in guiding clinical practice.

During the 1980s, low doses of first-generation antipsychotics were evaluated based on hypotheses that BPD was related to schizophrenia. Case series5 and placebo-controlled trials6,7 pointed to symptom reduction over time and greater than placebo for BPD patients. Interestingly, in a small study of BPD inpatients, Soloff et al8 compared the first-generation antipsychotic haloperidol to amitriptyline and found amitriptyline led to symptom worsening in some patients. Cowdry and Gardner9 compared alprazolam, carbamazepine, trifluoperazine, and tranylcypromine in a double-blind, placebo-controlled crossover trial of 16 female BPD outpatients. They found antipsychotics were not useful. Further, the study found behavioral disinhibition when a benzodiazepine (alprazolam) was used alone in impulsive patients.

These studies provided a basis for the idea that medications could help reduce BPD symptoms. However, some early investigators noted that antipsychotics’ side effects led some patients to discontinue treatment.6

Next-generation studies

Antidepressants. Interest in exploring pharmacologic treatments for BPD diminished after the early efficacy trials. Several events led to a reemergence of this interest, including the FDA’s approval of the selective serotonin reuptake inhibitor fluoxetine for depression in 1987. Some investigators hypothesized fluoxetine’s antidepressant properties could help treat BPD symptoms and perhaps the serotonin reuptake action could diminish impulsivity.10 Case series and a double-blind, placebo-controlled trial11 demonstrated fluoxetine’s efficacy in BPD. In 1 study, Salzman et al12 found fluoxetine’s greatest impact was on “anger,” a major affective dimension of BPD.

Mood stabilizers. When valproic acid emerged as a successful treatment for bipolar disorder, researchers turned their attention to mood-stabilizing anticonvulsants for BPD. Numerous case series and controlled trials provided evidence of its efficacy.13,14 This was the first time subtypes of BPD patients were tested prospectively—with the hypothesis that the mood-stabilizing anticonvulsants would diminish impulsivity and aggression. The positive results of Hollander et al13 and Frankenburg and Zanarini14 in assessing divalproex in BPD patients with bipolar II disorder has implications for targeted treatment (discussed below).

Newer antipsychotics. The introduction of second-generation antipsychotics (SGA) led some researchers to explore whether these agents could decrease BPD symptoms. Case series15 and some (but not all) placebo-controlled trials have demonstrated benefit from SGAs such as olanzapine,16-18 aripiprazole,19 and quetiapine.20,21 Initial research on risperidone22 and ziprasidone also suggested efficacy for BPD. Two placebo-controlled studies of olanzapine examined which symptom groups were most helped; each reported a broad effect.16,17 However, not all studies of SGAs for BPD patients have been positive.18 Further, metabolic side effects have been noted for several SGAs, including olanzapine.18

Omega-3 fatty acids. Some studies examining omega-3 fatty acids have sparked an ongoing interest in this compound. In an 8-week, double-blind, pilot study of 30 women with BPD, Zanarini23 found omega-3 fatty acids demonstrated efficacy over placebo.

Targeted treatment

Most studies of BPD pharmacotherapy have used a classic clinical trial design, which does not easily translate into recommendations regarding medication selection for individual patients, especially those with BPD and comorbid illnesses. Also, existing trials have not fully explored starting doses, and no maintenance studies have been published. Therefore, many clinical application questions remain unresolved. However, some early treatment recommendations are supported by recent meta-analyses that demonstrate effects of medication classes for specific symptom domains.

Related Posts

Borderline personality disorder (BPD) is a mental health disorder that affects mood, emotions, and the ability to sustain relationships. Researchers believe that brain chemistry is likely affected in those suffering from BPD, with certain areas being more active and others being underdeveloped. So what BPD medications are available for treating borderline personality disorder?

Most medications for mental health disorders work to stimulate certain areas of the brain, suppressing others, and can be helpful in treating these mental health issues. Due to the range of symptoms for borderline personality disorder, there is no “magic pill” or type of medication that is specifically approved to treat all who suffer from BPD.

There are, however, different types of medications that have been effective for some. Those suffering primarily from issues with perception and thought can benefit from an antipsychotic medication that helps deter feelings of paranoia and hallucinations. Mood stabilizers are likely to work best for the symptoms of unstable moods and mood swings.

How Medication Works to Treat BPD

While the FDA has not approved any specific medication to treat BPD as a whole, some medications can be helpful in managing specific bpd symptoms. According to Psych Central, serotonin reuptake inhibitors, or SSRIs, are typically the go-to for treating borderline personality disorder. SSRIs work to alleviate symptoms of anxiety, depression, suicidal behavior, anger and impulsivity. One of the most common SSRIs is Prozac which is an antidepressant.

The Mayo Clinic explains that SSRIs work to prevent the reuptake or reabsorption of serotonin in the brain. By changing the balance of the neurotransmitter serotonin in the brain, mood is boosted.

NAMI suggests that medications like valproate may help to control impulsive actions, naltrexone is likely to deter self-injurious behavior, while omega-3 fatty acids can work to stabilize moods. Olanzapine, which is not a typical antipsychotic, has also worked in some cases to minimize symptoms of borderline personality disorder.

Many who suffer from BPD are also diagnosed with an additional mental health disorder, making treatment that much more delicate. What works for one disorder may be counterproductive in another. Here are some of the common co-occurring disorders, and their percentage of frequency, that are comorbid with borderline personality disorder in their lifetime, as reported by the Psychiatric Times:

  • Mood disorders: 96 percent
  • Anxiety disorder: 88 percent
  • Depression: 71 – 83 percent
  • Alcohol and substance abuse: 50 – 65 percent
  • Post-Traumatic Stress Disorder (PTSD): 47 – 56 percent
  • Panic disorder: 34 – 48 percent
  • Eating disorders: 7 – 26 percent

It is important to have the correct diagnosis so that treatment can be tailored to fit the specific needs of each individual.

Biological Reasons for Medication Treatment

Magnetic resonance imaging (MRIs) done on people diagnosed with BPD show that certain areas of the brain seem to be affected similarly on different patients as reported by NHS. For example, the amygdala, which is responsible for emotional responses, seems to be overactive while the prefrontal cortex, which works to help regulate emotions, is likely underdeveloped. Brain chemicals like specific neurotransmitters that assist in regulating mood, sleep, and learning may also be affected in someone who suffers from BPD.

Those suffering from BPD symptoms may experience intense mood swings, anxiety, feelings of emptiness, impulsivity, and inappropriate bouts of anger. Feelings and emotions are largely regulated by the brain, which can be enhanced by medication. Some of the different types of medications used to treat BPD are:

  • Antipsychotics
  • Mood stabilizers
  • Anti-anxiety medications
  • Antidepressants
  • MAOIs
  • Sedatives
  • SSRIs
  • Omega-3 fatty acids

These medications are specific to treating certain symptoms of BPD, such as trouble sleeping or anxiety, and are usually coupled with psychotherapy in order for treatment to truly be effective.

Effective Medications

Medication can be a useful tool to help someone suffering from BPD to manage his or her symptoms. Since borderline personality disorder can present differently in each individual, symptoms may vary person to person. A medical health professional will need to evaluate which symptoms are present and research the individual’s personal biology to determine which medication is best for each separate case and set of symptoms.

Sufferers of BPD are prone to psychotic episodes and paranoid thinking or behavior. Antipsychotic medications can work to stabilize these feelings by affecting chemicals in the brain responsible for mood and emotions, like dopamine and serotonin. Mood stabilizers work in similar ways to regulate moods by enhancing the brain’s neurotransmitters. Anti-anxiety and antidepressant medications work on brain chemicals to help control specific symptoms of the disorder, including overwhelming loneliness and self-harming thoughts or behavior. Omega-3 fatty acids – like those found in fish oil – have shown some success in helping to manage the mood fluctuations indicative of BPD.

Some of the names of medications that may be used to treat different symptoms of BPD include:

  • Haldol
  • Zyprexa
  • Seroquel
  • Risperdal
  • Depakote
  • Tegretol
  • Lithobid
  • Lamictal
  • Xanax
  • Klonopin
  • Buspar
  • Ativan
  • Valium

How Effective are BPD Medications?

No one medication has proved to work all of the time on every case of BPD. In fact, RC Psych College publishes that 75 percent of those diagnosed with BPD also received poly-pharmacy or the use of multiple medications. Antipsychotic medications seem to be the ones used most commonly to treat symptoms of BPD, and they seem to be most effective in higher doses.

Each case of borderline personality disorder is unique, however, and while the use of medication can be an effective intervention or treatment tool, it isn’t a cure. Studies that have been performed on the efficiency of medication on BPD are inconclusive and highly variable.

Medication can be a useful tool for stabilizing mood, preventing suicidal behavior, dampening impulsivity and anxiety, treating depression, and managing many other symptoms of borderline personality disorder. Some cases of BPD are more likely to benefit from different forms of treatment.

Alternatives to BPD Medication

Dialectical behavior therapy, or DBT, is a form of therapy that seems to be very effective in the treatment of BPD. It was developed by Marsha Linehan and is a hybrid of traditional cognitive behavioral therapy and skills-based training that works to teach validation and mindfulness.

DBT usually works as an outpatient treatment in which sufferers of BPD are taught life skills and how to cope with their raging emotions. Individual and group therapy play a role, and therapists are typically available by phone as needed. Families are encouraged to participate also since family support is vital to recovery. This form of treatment is not necessarily used instead of medication, however, but often used in addition to it.

BPD Medication in Conjunction With Treatment

A combination of medication and proper treatment is likely the best option in most cases of borderline personality disorder. While medication can work to soothe the intense symptoms as they occur, they address symptoms on a short-term basis and are not intended for long-term use. Medications alone will not work to treat borderline personality disorder; instead, it must be coupled with treatment.

Treatments, programs and therapies that work to teach those who suffer from BPD how to manage their symptoms in a healthy way are essential. Some will benefit from inpatient care, while others will be better served on an outpatient basis. All who learn what their triggers are, or the events, memories or situations that lead to BPD episodes, will be more successful in managing their disorder. Treatment for borderline personality disorder is very individualized, and a mental health professional is best suited to decide on the right course of treatment for the individual.

Borderline personality disorder often co-occurs with other disorders. If it does coexist with another condition, it is important to treat both issues simultaneously. In fact, F1000 Prime reports that sufferers of BPD also suffer from an anxiety disorder as much as 90 percent of the time. Medication is not a cure for BPD but can be a useful tool when used along with psychotherapy and other forms of BPD treatment.

Here at OPI, we can help develop a plan that treats the entire person and not just the BPD. Contact us today for more information on how we can help you or your loved one get on the path to a healthier, more balanced life.

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Drugs can help symptoms of borderline personality

NEW YORK (Reuters Health) – While there are no drugs that specifically treat borderline personality disorder, some medications can improve certain symptoms of the psychiatric condition, a new research review finds.

Borderline personality disorder, or BPD, is a serious mental illness marked by intense mood swings and difficulty with emotional control, impulsive behavior, problems maintaining personal relationships, and high rates of self-injury and suicidal behavior.

Right now, “talk therapy” is the cornerstone of managing BPD, and no drug is specifically approved for treating the disorder. But in a new analysis of 27 clinical trials, researchers found that certain psychiatric drugs do seem to ease some of the major symptoms of BPD.

Specifically, certain newer antipsychotic drugs used for schizophrenia appeared to improve BPD patients’ emotional instability and impulsive behavior. Two drugs — aripiprazole (Abilify) and olanzapine (Zyprexa) — showed benefits.

In addition, the review found, medications known as mood stabilizers, often used for bipolar disorder, seemed to aid patients’ emotional control and rein in impulsivity. Benefits were seen with the drugs topiramate (Topamax), divalproex sodium (Depakote) and lamotrigine (Lamictal), which are all anti-seizure medications that have mood-stabilizing effects.

“Drugs may be effective in treating certain symptoms of BPD, such as impulsivity and difficulties to control anger,” Dr. Klaus Lieb, the lead researcher on the review, noted in an email to Reuters Health.

But medications, if they are used, should be given to target specific symptoms, and not as a treatment for the overall disorder, added Lieb, of the University Medical Center Mainz, in Germany.

The findings, published in the British Journal of Psychiatry, are based on the results of 27 clinical trials, most of which were done in the past decade.

On average, patients randomly assigned to take second-generation antipsychotics or mood stabilizers saw improvements in certain symptoms, compared with patients who were given a placebo.

There was also some promising evidence on omega-3 fatty acid supplements, which in one study were shown to reduce BPD patients’ depression symptoms and suicidal behavior by about half.

Some other studies have suggested that omega-3 fats — found largely in fish oil — have antidepressant effects, and supplements are being investigated as a treatment for depression and bipolar disorder. The jury is still out on their effectiveness.

For people with borderline personality disorder, talk therapy remains the “first-line” treatment, according to Lieb. What this review suggests, he said, is that certain patients may benefit from drugs that target their particular symptoms.

He added that if a patient does begin a drug, his or her symptoms should be continually monitored, and if there is no improvement after three months, the medication should be stopped.

While antipsychotics and mood stabilizers can be effective, they also carry the risk of side effects — including, drug dependence, weight gain or weight loss, fatigue, high cholesterol and difficulty with memory and concentration.

SOURCE: British Journal of Psychiatry, January 2010.

Our Standards:The Thomson Reuters Trust Principles.

Treating borderline personality disorder

Published: June, 2010

Psychotherapy options have increased and appear equally effective.

Borderline personality disorder (BPD) is a challenge to treat not only because it is complicated and stigmatized, but also because its symptoms reflect ingrained patterns of thinking and behavior. Although it is heterogeneous in nature, causing different clusters of symptoms in different people, the disorder has three major clinical components: a fragile sense of self that impairs relationships with other people, impulsiveness, and emotional volatility. Many patients with BPD also have other mental health problems, such as a mood disorder or post-traumatic stress disorder.

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Borderline personality disorder treatment and medications

What is borderline personality disorder? | Borderline personality disorder diagnosis | Borderline personality disorder treatment options | Borderline personality disorder medications | Best borderline personality disorder medications | Side effects of borderline personality disorder | Borderline personality disorder home remedies | FAQ | Resources

What is borderline personality disorder

Living with impulsive behaviors, unstable moods, distorted self-image, and suicidal behavior can be extremely difficult to deal with. These are just some of the symptoms that characterize borderline personality disorder (BPD), which affects up to 1.4% of people living in the United States. People with BPD have difficulty regulating their emotions and are easily triggered into intense emotional episodes. They also have great difficulty stabilizing themselves after a flare-up or emotional episode.

People with borderline personality disorder are easily triggered by anything that makes them feel abandoned, rejected, or criticized. This could be anything from a fight with a spouse to a friend not returning a phone call. The triggering event then causes the person to experience a drastic shift in mood which could result in anger, impulsivity, substance abuse, self-harm, or other self-destructive behaviors.

Borderline personality disorder is often treated with a combination of psychotherapy and medication. Hospitalization may be necessary in extreme situations if someone is attempting self-injury or making suicide attempts.

BPD can sometimes be underdiagnosed or misdiagnosed as bipolar disorder. Doctors and researchers are always searching for new ways to ensure that people are properly diagnosed, because this means that treatment will be accurate and successful.

Beyond proper diagnosis, doctors and researchers are also searching for new treatment options for borderline personality disorder. The principal investigator on a National Institute of Mental Health study, Dr. Mary Zanarini, is looking into a new treatment called psychoeducation. New treatment options will hopefully bring new relief to those living with the intense emotions and symptoms of BPD.

It takes proper diagnosis and a good treatment program to bring relief to people living with BPD. This guide gives an overview of borderline personality disorder medications that a health-care provider may prescribe or recommend to treat BPD.

Borderline personality disorder diagnosis

Anyone can experience borderline personality disorder, though people who’ve had traumatic childhoods, women, or people who have a family member with BPD have a higher risk of developing the disorder.

Borderline personality disorder is similar to bipolar disorder in many ways, and can therefore be difficult to diagnose. This article in Psychiatric Times explains the importance of correctly diagnosing BPD separately from bipolar disorder. A psychiatrist or other mental health professional will conduct a comprehensive clinical interview to diagnose BPD, and then determine the best treatment option from there.

A mental health professional may ask the following questions to help confirm a diagnosis:

  • Is there a history of mental illness in your family?
  • Do you have thoughts of suicide?
  • How would you describe your childhood?
  • Are your symptoms continuous or sporadic?
  • Do you use any drugs or alcohol?

Borderline personality disorder treatment options

Borderline personality disorder symptoms are most effectively and commonly treated with a combination of psychotherapy and medication. This combination of therapy and medication doesn’t treat borderline personality disorder itself, but treats the symptoms associated with it. Some people with BPD may supplement psychotherapy and medication with natural remedies to help manage the emotional symptoms of BPD. The right course of treatment depends on the individual and that person’s specific symptoms.

Psychotherapy can include individual therapy, mentalization-based therapy (MBT), cognitive behavioral therapy (CBT), and dialectical behavior therapy (DBT), to name a few. The objective with psychotherapy is to teach people how to understand and manage their behavioral symptoms and improve their distress tolerance. Therapy tends to be very effective at preventing flare-ups and episodes that come with BPD. A counselor or therapist can help someone learn what triggers them and how to move through a triggering situation. Different types of psychotherapy focus on different things, and may have varying results.

Medications are often prescribed along with psychotherapy to help alleviate emotional symptoms. Anticonvulsants, antidepressants, and antipsychotics are all classes of drugs commonly used (off label, as no medications have FDA indications specifically for any personality disorder) to treat BPD. There is not one single drug that can cure borderline personality disorder, but a mental health professional can determine which drug will best treat someone’s symptoms.

Some natural and home remedies such as meditating and getting enough sleep may help people reduce symptoms associated with BPD such as anger, mood swings, and impulsivity. It’s important to talk with a therapist or counselor to determine the right type of therapy for you.

Borderline personality disorder medications

There is not one single medication approved by the FDA for BPD treatment. Anticonvulsants, antidepressants, and antipsychotics are typically prescribed to help treat and manage borderline personality disorder symptoms. A health-care professional can determine the proper dosage and form of medication on a case-by-case basis.

Anticonvulsants

Anticonvulsants work by helping to stabilize moods and impulsive behavior. Common side effects of anticonvulsants include changes in vision, unusual behavior, and allergic reaction. Some commonly prescribed anticonvulsants include:

  • Carbamazepine
  • Lamictal
  • Topamax

Antidepressants/Anxiolytics

Antidepressants can help people with borderline personality disorder experience relief from symptoms such as emotional reactivity, depression, and anxiety. Taking an antidepressant may come with certain side effects, allergic reaction, or unusual bleeding. Here’s a list of antidepressants sometimes used to treat BPD:

  • Fluvoxamine
  • Prozac
  • Zoloft
  • Lexapro

Antipsychotics

Antipsychotics are used to treat borderline personality disorder because they help reduce impulsive behavior, anger, anxiety, and other similar emotions that result from BPD. Common side effects associated with antipsychotics include unusual behavior, seizures, uncontrollable muscle movements, and blurred vision. Here are some popular antipsychotic drug brand names:

  • Abilify
  • Haloperidol
  • Zyprexa
  • Risperdal

What are the best medications for borderline personality disorder?

There is no one universal borderline personality disorder medication that’s best for everyone. Individual symptoms and responses to treatment vary. A doctor can determine the best medication for BPD based on an individual’s symptoms, medical history, and response to treatments. Here’s an overview of popular medications that a doctor may prescribe.

Drug name Drug class Administration route Standard dosage Adverse effects
Abilify (aripiprazole) Antipsychotic Oral

Intramuscular, and long acting injectable

5 – 30 mg taken orally once per day Allergic reaction, compulsive behavior, unusual behavior, or seizures
Carbatrol

(carbamazepine ER)

Anticonvulsant Oral 200 mg taken twice daily Blurred or double vision, behavioral changes, allergic reaction, or unusual bleeding
Fluvoxamine Maleate Antidepressant Oral 100 mg tablet taken as directed by a healthcare professional Seizures, unusual behavior, allergic reaction, or uneven heartbeat
Haloperidol Antipsychotic Oral

Intramuscular, and long-acting injectable

0.5 – 5 mg tablet taken 2 – 3 times daily as directed by a healthcare professional Seizures, uncontrollable muscle movements, and blurred vision
Lamictal (lamotrigine) Anticonvulsant Oral 25 mg taken orally once per day to start Nausea, skin rash, unusual behavior, and blurred vision
Zyprexa (olanzapine) Antipsychotic Oral 10 or 15 mg taken once per day as directed by a healthcare professional Unusual behavior, uncontrollable muscle movements, or confusion
Topamax (topiramate) Anticonvulsant Oral 25 mg taken twice daily to start Changes in vision, confusion, and behavioral changes

A prescribing mental health professional determines the best dosage based on medical conditions, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are some common side effects of borderline personality disorder medications?

As with any medication, there are always potential side effects, and adverse effects. Common side effects associated with borderline personality disorder medications include changes to behavior, confusion, involuntary and uncontrollable muscle movements, vision problems, and seizures. Contact your doctor or pharmacist if your side effects persist or worsen.

Borderline personality disorder medications may cause allergic reactions that result in hives or difficulty breathing. Allergic reactions can be life-threatening. You should seek immediate medical care if you believe you are experiencing an allergic reaction.

This list of side effects is not comprehensive. Ask a healthcare professional for more details regarding the possible side effects of a particular medication.

Home remedies for borderline personality disorder

Many people rely on home remedies and natural treatments to help treat their borderline personality disorder. Certain lifestyle changes may help prevent BPD from worsening. Home remedies, natural treatments options, and lifestyle changes are all ways that people who have BPD can try to reduce their symptoms. Many natural supplements are not approved by the FDA. Here are some popular home and natural remedies for borderline personality disorder:

  • Going to therapy or counseling. Seeking talk therapy or counseling is one way people learn important coping skills to address their borderline personality disorder. A therapist can help someone manage destructive thoughts and behavior. Even talking with a loved one can help with feelings of emptiness and other symptoms of borderline personality disorder.
  • Taking a bath with Epsom salts. Taking a bath can help with symptoms of anxiety and sleeplessness that may make BPD symptoms worse, which could help alleviate things like migraines and depression that are associated with BPD.
  • Getting enough sleep. Getting enough quality sleep has been shown to help with symptoms of anxiety and depression that people with borderline personality disorder experience. Things to help get a good night’s sleep include making your bedroom dark and slightly cool, having a set bedtime each night, taking a relaxing bath or journaling before bed.
  • Managing depression and anxiety. Depression and anxiety are commonly associated with borderline personality disorder. Working to reduce stress, anxiety, and symptoms of depression can be really beneficial. Exercising regularly, eating a healthy diet, seeking counseling, and meditating are all really good ways to help manage depression and anxiety.

Frequently asked questions about borderline personality disorder

What medication is usually prescribed for borderline personality disorder?

Borderline personality disorder is often treated with anticonvulsants, antidepressants, or antipsychotics. There is no medication that is best for treating BPD. The type and amount of medication prescribed will depend on the individual’s symptoms The following medications are commonly used to treat distressing symptoms of BPD:

  • Abilify (aripiprazole)
  • Carbatrol (carbamazepine ER)
  • Fluvoxamine Maleate
  • Haloperidol
  • Lamictal (lamotrigine)
  • Zyprexa (olanzapine)
  • Topamax (topiramate)

What triggers a person with borderline personality disorder?

There are many things that can potentially trigger someone with borderline personality disorder into an episode. Interpersonal relationship problems (such as perceived abandonment) are a common trigger. Getting into an argument with a spouse, relative, friend, or coworker can be highly stressful for someone with BPD. Other common triggers include rejection, losing a job, ending a relationship, or reliving negative memories.

Can BPD be cured?

Borderline personality disorder is a complex disorder to live with and treat. It is among the most treatable personality disorders, and symptoms can be greatly reduced with consistent therapy. It can’t be cured entirely, but can be well managed and treated. According to the National Alliance on Mental Illness, most people respond well to comprehensive treatment that includes medication and psychotherapy. Natural and home remedies are also used in conjunction with more traditional treatment options to help manage symptoms.

Do mood stabilizers work for BPD?

Mood stabilizers can help manage common symptoms like mood shifts, irregular emotional responses, and impulsivity. Mood stabilizers can’t fix BPD alone and are often used as part of a comprehensive treatment plan that includes psychotherapy.

Is BPD worse than bipolar?

Borderline personality disorder and bipolar disorder (BPAD) are sometimes confused, or thought of as being the same condition. Borderline personality disorder is a personality disorder, and bipolar disorder is a type of mood disorder. People with BPD experience ongoing, varying moods and behaviors. It’s possible for people who have bipolar disorder to go long periods of time without symptoms with proper treatment. Borderline personality disorder could potentially be considered worse than bipolar disorder because those with BPD don’t experience as much stability between episodes. Both disorders are serious conditions and require appropriate medical attention.

Related resources for borderline personality disorder

  • Harvard Health Publishing on treating borderline personality disorder
  • Diagnosing and treating borderline personality disorder
  • Psychiatric Times on patients with bipolar and borderline personality disorder
  • American Psychiatric Association on personality disorders
  • National Alliance on Mental Illness on borderline personality disorder

World-Class Treatment for Borderline Personality Disorder

McLean Hospital combines the highest quality care, research, and clinical training to provide unparalleled specialty services for adolescents and adults living with borderline personality disorder (BPD).

Offering individual and family services that have proven results, McLean has specialized residential and partial hospital programs and outpatient care—as well as an array of treatments for coexisting diagnoses and symptoms such as depression, anxiety, addiction, and trauma. Our specialized therapeutic approaches, including dialectical behavior therapy (DBT) and mentalization-based treatment, help patients with the goal of improving interpersonal and relationships skills and reducing self-destructive behaviors. Services include individual and group therapy, family therapy, comprehensive psychiatric and medical assessments, customized treatment plans and aftercare planning, medication evaluation and management, and patient education and support.

“McLean’s expertise in the treatment of borderline personality disorder was born out of John Gunderson’s pioneering work that integrated BPD into the Diagnostic Statistical Manual,” said Lois W. Choi-Kain, MEd, MD, medical and program director of the Gunderson Residence and director of the Borderline Personality Disorder Training Institute. “As a result, a massive swell of progress in research and treatment development for BPD occurred and transformed the diagnosis from one of stigma and futility to one of hope. Our services represent the expanse of that progress, ranging from shorter-term to longer-term services, many types of reimbursement, and many different evidence-based treatment approaches. There is no other hospital in the world with this degree of diversity in treatment approaches and focused dedication to advancing the cutting edge in terms of BPD’s treatment, training of professionals about the disorder, and scientific discovery to further improve our knowledge base.”

McLean provides unparalleled specialty services for adolescents and adults living with borderline personality disorder

Below is an overview of the BPD treatment program options at McLean. For further information or to refer a patient, please contact any of the programs directly.

3East

McLean’s adolescent DBT programs, collectively known as 3East, provide specialized care for teens and young adults who require treatment for depression, anxiety, post-traumatic stress disorder (PTSD), and emerging BPD. The programs in the 3East continuum are specifically designed to accommodate patients in different phases of the treatment and recovery process, from highly focused residential treatment to outpatient care. We have intensive treatment tracks for both boys and girls, and our day program (partial hospital) and outpatient program are coed. The length of treatment is 20 days for the day program, a minimum of 20 weeks for the outpatient program, and a minimum of three months for the residential program.

Gunderson

The Gunderson programs—Gunderson Residence and Gunderson Outpatient Program—offer highly specialized therapeutic approaches for individuals with BPD and other severe personality disorders, including those who experience co-occurring psychiatric conditions such as substance use, eating disorders, depression, or anxiety. These self-pay programs are best suited for those who have BPD and other complex personality disorders; who are seeking treatment for core issues related to personality disorders such as emotion dysregulation, self-harm, suicidality, and relationship difficulties; and who struggle with self-image problems, feelings of self-doubt, intense fear of abandonment, and low self-worth. The average length of stay for the residential program is approximately four months, and the outpatient program requires a commitment of six months.

Hill Center for Women

The Hill Center for Women is an insurance-based program that offers psychiatric and psychological services for women with histories of trauma and related disorders such as PTSD, dissociative disorders, BPD, and mood and anxiety disorders. Empathy, compassion, collaboration, and empowerment are emphasized to help women build strength and regain control of their lives. The program provides intensive DBT with a specialized emphasis on the treatment of self-destructive or impulsive behavior and emotional dysregulation as they present in survivors of early, repeated traumatic experiences. The center offers two-week residential and two-week partial hospital care options.

Behavioral Health Partial Hospital Program

The Behavioral Health Partial Hospital Program is a day treatment program that helps individuals to develop skills that improve their mood and ability to function in hopes of allowing them to better cope with life circumstances. To achieve this mission, the Behavioral Health Program (BHP) utilizes cognitive behavior therapy approaches (including DBT skills) for a wide range of conditions such as mood and anxiety disorders, depression, personality disorders, bipolar disorder, and substance use disorders. BHP is useful as a step-down transition from acute inpatient care or as an alternative to inpatient treatment. The length of treatment at this program typically lasts 3 to 10 days.

Medications

* – Placebo-controlled studies; + – open-label studies; – no published studies; FGAs – First generation antipsychotic agents; SGAs – second generation antipsychotic agents

Antipsychotic Agents

This is one of most useful classes of medications for the treatment of patients with borderline disorder.27 They are most commonly used to treat other mental illnesses, especially bipolar disorder and schizophrenia. However, when prescribed at lower doses than used for these two disorders, these agents also have been found to be quite useful in the treatment of many patients with borderline disorder. This class of medications is the most rational starting point for pharmacotherapy in patients with borderline disorder who have cognitive-perceptual symptoms such as a suspiciousness, paranoia, split (all-or-nothing) thinking, and dissociative episodes. The size of these therapeutic effects are often moderate to large. Studies suggest that Abilify has the largest effect size in this class, and that the effects are sustained over an extended period of time.29

If one or more cognitive-perceptual symptoms are present and respond well to an antipsychotic agent, but other symptoms such as impulsivity and poor emotional control persist, the addition of another medication from the class of mood stabilizers discussed below is indicated.

Special Notes: Some patients are concerned about taking a medication that is typically used for people with severe mental illnesses. Also, some physicians are reluctant to prescribe this class of medications because of a specific side effect that they may produce called tardive dyskinesia. This is an abnormal, involuntary movement disorder that occurs in patients typically receiving average to large doses of these agents.

To my knowledge, there is no scientific evidence that indicates these medications, as typically used in patients with borderline disorder, cause tardive dyskinesia. Nonetheless, although the risk appears to be minimal, it should be noted. The new agents in this class appear to carry a lower risk of causing tardive dyskinesia when prescribed at the usual doses for patients with other mental illnesses. Therefore, these newer medications are now more commonly prescribed for patients with borderline disorder than are the ones originally used.

Both older and newer subtypes of medications in this class may produce other side effects. These vary with the medication being used, and include weight gain, nausea and other GI symptoms, headache, drowsiness, insomnia, breast engorgement and discomfort, lactation, and restlessness. Some of these, and other side effects, are temporary, and others may be persistent, requiring a change in medication. Because Latuda appears to produce less side effects such as weight gain and high lipid levels, I will often begin treatment with this medication. Although its effectiveness for borderline disorder has not yet been reported in the scientific literature, I have found it to be effective for the same symptoms as the other SGA’s mentioned. In addition, because it’s side effect profile is more tolerable for many patients, I have observed that acceptance of the medication appears to be higher. Before you start on any antipsychotic agent, or any medication for borderline disorder, you should review its side effect profile with your psychiatrist.

Mood Stabilizers

Another class of medications, referred to as mood stabilizers, has been shown to significantly reduce certain symptoms in patients with borderline disorder.27 These symptoms include impulsivity, anger, anxiety, depressed mood, and general level of functioning. The size of these therapeutic effects range from moderate to large.

Mood stabilizers do not reduce suspiciousness, split-thinking, dissociative episodes and paranoia in borderline disorder. When these symptoms persist after others improve with mood stabilizers, the addition of, or replacement with, an antipsychotic agent is indicated. if the symptoms responsive to antipsychotic agents are controlled, but other symptoms of the disorder persist, I will add a mood stabilizer to the antipsychotic agent in use.

The most commonly used and effective mood stabilizers for borderline disorder are topiramate (Topamax) and lamotrigine (Lamictal). These medications are also referred to as antiepileptic drugs because they are commonly used for people suffering from partial complex seizure disorder. Partial complex seizure disorder has its origin in the medial temporal lobes of the brain, a brain region important in the generation of emotions and theMike control of impulsive behavior.

Weight gain does not appear to present a problem with Topamax, which may acutally normalize weight in some patients, or with Lamictal. The latter medication rarely may result in a serious dermatological problem, especially if the dose is raised too quickly.

Other Medications

SSRIs

Although recommended in the the Guideline for the Treatment of Borderline Personality Disorder published by the American Psychiatric Association in 2001,30 research since then has failed to demonstrate the effectiveness of SSRIs in treating the core symptoms of the disorder.27 Their primary use now in borderline disorder is in the treatment of co-occurring major depressive disorder, if present.

MAOIs

Another class of antidepressants, the monoamine oxidase inhibitors (MAOIs), may be useful in patients with borderline disorder who are resistant to antipsychotics and mood stabilizers. Two studies of the MAOI phenelzine (Nardil) have suggested that it may be effective in some patients.27 However, orally administered MAOIs have the potential to produce very serious, even life-threatening side effects if used improperly. Therefore, some physicians use an MAOI for patients with borderline disorder only after other medications have been tried, and the physician feels confident that the patient will follow the necessary rules that have been clearly outlined to him or her. A new skin patch delivery form of an MAOI (ENSAM) given at its lowest dose appears to eliminate the usual dietary concerns involved in orally administered MAOIs.

Tricyclic Antidepressants

The tricyclic antidepressants amitriptyline (Elavil, Amitril, Endep) and nortriptyline (Pamelor, Aventyl) may worsen the condition of people with borderline disorder. These and other tricyclic antidepressants should be used with caution in patients with borderline disorder.

Antianxiety Agents and Sedatives

Anxiety, irritability, agitation and poor sleep are common symptoms of borderline disorder. In other disorders, the benzodiazepines are frequently used for these symptoms. These include diazipam (Valium), alprazolam (Xanax), temazepam (Restoril), flurazepam (Dalmane), and triazolam (Halcion). These medications should be used with caution in patients with borderline disorder because of their high addictive potential and a reported capacity to increase impulsive behavior in patients with the disorder.

However, it has now been observed that in patients with borderline disorder who continue to have symptoms of anxiety, irritability and difficulty sleeping, buspirone (BuSpar) is effective in reducing these symptoms when they do not respond to SGA’s and Mood Stabilizers.

Some patients with borderline disorder also experience adverse responses, such as impaired perceptions and greater sleep deterioration, to the non-benzodiazepine sedatives such as zolpidem (Ambien). Therefore, if these medications are prescribed for you, be aware of this possible problem.

Drug treatment for borderline personality disorder

Many people with borderline personality disorder (BPD) receive medical treatment. However, there are no drugs available for BPD treatment specifically. A certain drug is most often chosen because of its known properties in the treatment of associated disorders, or BPD symptoms that are also known to be present in other conditions, such as depressive, psychotic, or anxious disorders. BPD itself is characterised by a pervasive pattern of instability in affect regulation (with symptoms such as inappropriate anger, chronic feelings of emptiness, and affective instability), impulse control (symptoms: self-mutilating or suicidal behaviour, ideation, or suicidal threats to others), interpersonal problems (symptoms: frantic efforts to avoid abandonment, patterns of unstable relationships with idealization and depreciation of others), and cognitive-perceptual problems (symptoms: identity disturbance in terms of self perception, transient paranoid thoughts or feelings of dissociation in stressful situations). This review aimed to summarise the current evidence of drug treatment effects in BPD from high-quality randomised trials.

Available studies tested the effects of antipsychotic, antidepressant and mood stabiliser treatment in BPD. In addition, the dietary supplement omega-3 fatty acid (commonly derived from fish) which is supposed to have mood stabilising effects was tested. Twenty-eight studies covering 1742 study participants were included.

The findings tended to suggest a benefit from using second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but most effect estimates were based on single study effects so repeat studies would be useful. Moreover, the long-term use of these drugs has not been assessed. The small amount of available information for individual comparisons indicated marginal effects for first-generation antipsychotics and antidepressants.

The data also indicated that there may be an increase in self-harming behaviour in patients treated with olanzapine. In general, attention must be paid to adverse effects. Most trials did not provide detailed data of adverse effects and thus could not be considered within this review. We assumed their effects were similar to those experienced by patients with other conditions. Available data of the studies included here suggested adverse effects included weight gain, sedation and change of haemogram parameters with olanzapine treatment, and weight loss with topiramate. Very few beneficial effects were identified for first-generation antipsychotics and antidepressants. However, they may be helpful in the presence of comorbid problems that are not part of BPD core pathology, but can often be found in BPD patients.

There are only few study results per drug comparison, with small numbers of included participants. Thus, current findings of trials and this review are not robust and can easily be changed by future research endeavours. In addition, the studies may not adequately reflect several characteristics of clinical settings (among others, patients’ characteristics and duration of interventions and observation periods).

Counseling

The goal of counseling, also called psychotherapy or talk therapy, is to help you learn how to manage your emotions. For example, you can observe your feelings (“I feel very angry right now”) instead of acting on them. It helps you function in your daily life and relationships. Counseling can happen in a one-on-one setting with a therapist or in a group.

Depending on your symptoms and situation, your counselor may use one of these types of psychotherapy:

  • Dialectical Behavior Therapy (DBT) began as a way to help manage crisis behavior, such as suicidal behavior or self-harm. It is the most commonly recommended therapy for BPD. It works with the concept of mindfulness, or being present in the moment. This helps you be aware of your emotions, moods, and behavior. You learn skills like how to tolerate negative emotions and how to communicate effectively.
  • Cognitive Behavioral Therapy (CBT) focuses on changing the basics of what you believe about yourself and others.
  • Schema-Focused Therapy is similar to CBT in how it reframes negative thoughts about yourself into positive ones.

What Are the Best Treatments and Therapies for Borderline Personality Disorder (BPD)?

Using Psychotherapy to Help Treat Borderline Personality Disorder

BPD can be treated with a number of different types of therapies.

Psychotherapy, or talk therapy, is usually the first line of treatment for people with mental health issues, including BPD.

Therapy is usually conducted one-on-one with a therapist, but it may also be conducted in a group. It can help people with BPD better manage their emotions, reduce impulsiveness, and improve their relationships, among other things.

There are a number of different types of psychotherapy, including the following:

Dialectical Behavioral Therapy (DBT)

This therapy was developed specifically to treat BPD and is a form of cognitive behavioral therapy, or CBT. (More on that next.)

In DBT, patients are usually seen individually and in groups, multiple times a week, meaning it’s a fairly intensive experience, Ochoa says. Sessions may focus on building skills, like managing anger, reducing self-harm, or discouraging substance use, or they may focus on interpersonal relations, like increasing awareness of oneself and others, she explains. Ultimately, Ochoa says the goal is to help people manage difficult feelings without engaging in self-destructive behaviors, and to manage their relationships effectively.

Using a skills-based approach, this type of psychotherapy can help people to: (6,7)

  • Better manage emotions
  • Build tolerance to distress
  • Improve interpersonal abilities
  • Practice mindfulness, or being attentive to (and aware of) current situations and emotions

“DBT is unique in its focus on balancing acceptance and change,” Lazarus adds.

Cognitive Behavioral Therapy (CBT)

Another common type of therapy for BPD is general cognitive behavioral therapy, or CBT, which is also used to treat numerous other mental health issues, including post-traumatic stress disorder (PTSD).

For people with BPD, CBT treatment can help them identify and change core beliefs about themselves, others, and the world, ultimately leading to a reduction in negative thoughts and behaviors.

CBT generally is anchored in the present, rather than focused on exploring the past, Ochoa says, noting that CBT focuses on examining links between thoughts, feelings, and behaviors.

“In general, CBT focuses on the development of new and more adaptive core beliefs about oneself, the world, and the future,” Lazarus says.

Still, Lazarus points out, “the research examining mechanisms of change in these treatments is far behind that which establishes their efficacy.” Some research indicates some of the key mechanisms behind that efficacy. Lazarus cites one review that looked at both DBT and CBT in treatment of BPD. The review found that three themes were important drivers in changing symptoms: emotional regulation and self-control, skills use, and investment in treatment. (8)

Other types of therapy for BPD include: (9)

Schema-Focused Therapy (SFT) While not commonly used for BPD, this treatment combines aspects of various other types of psychotherapy to help people recognize and change maladaptive schemas, or negative patterns of thoughts, feelings, and behaviors toward themselves and others.

Typically, SFT involves two weekly individual therapy sessions, Lazarus says. It encourages an attachment between patient and therapist, a process called “limited reparenting,” she explains. Lazarus notes that the treatment aims to help patients alter negative patterns of thinking, feeling, and behaving to reduce the control of more dysfunctional patterns.

Mentalization-Based Therapy (MBT) Also uncommon in BPD treatment, MBT aims to help patients with BPD stabilize their symptoms by increasing the patient’s capacity to imagine thoughts and feelings in their own and others’ minds — especially under stress, Lazarus says.

Outpatient MBT generally involves 50 minutes of individual weekly therapy, 75 minutes of group therapy, and a team meeting for therapists, Lazarus explains. She notes that the therapy aims to help improve mentalization abilities (the imagination of thoughts and feelings) under duress.

Transference-Focused Therapy (TFT) A type of psychodynamic psychotherapy, this treatment uses the developing relationship between the patient and therapist to help patients understand their emotions and interpersonal problems.

TFT generally involves two weekly individual therapy sessions but no group therapy, and allows clinicians to work individually (though supervision is encouraged), Lazarus says. She notes that TFT aims to help patients by having them develop a more balanced and coherent view of themselves and others.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) This 20-week, group-based treatment aims to involve family members, caregivers, friends, or significant others.

Lazarus emphasizes that STEPPS is designed to supplement other treatments, and that some of its benefits include its cost-effectiveness and its relative brevity.

Dialectical Behavior Therapy Family Skills Training This form of DBT treatment incorporates family members into DBT sessions.

DBT generally includes things like one hour of weekly individual therapy, two hours of group skills training, and a consultation team for the therapist, Lazarus says. She notes that the full DBT model can be resource-intensive, given its intensity and structure.

DBT aims to treat patients by helping them develop skills that improve emotional regulation, mindfulness, and effectiveness within interpersonal relationships, Lazarus says.

General Psychiatric Management This is a structured treatment that includes case management, symptom-targeted medication, and psychodynamic psychotherapy to target mood instability, impulsivity, and aggressiveness.

This treatment is designed to be less intensive, and it is more easily accessible to the generalist clinician, Lazarus says. General psychiatric management focuses on the patient’s life outside of therapy and typically involves one session per week, along with group and family therapy and medication management, she explains. Lazarus notes that this treatment aims to help patients by facilitating the natural course of BPD’s improvement.

Understanding the Pros and Cons of Psychotherapy for BPD

For all of the above treatments, people with BPD can benefit from having a person to go to when they feel hopeless or desperate, building strong relationships with their therapist and treatment team, and educating themselves about their condition, Ochoa says.

But cons include the length of treatment, sometimes requiring multiple visits a week, the cost of these longer-term treatments, and the demanding nature of therapy, especially if it requires the patient to face uncomfortable feelings, Ochoa notes.

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