Treatment for Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental health illness characterized by intense mood swings, problems maintaining interpersonal relationships, and an unstable sense of self. BPD can be difficult to diagnose because the symptoms are varied and often mimic other mental health disorders. But once BPD is identified, it is very treatable. With proper treatment, many people who suffer from borderline personality disorder have an improved prognosis and can lead healthy, productive lives.

Treatment for borderline personality disorder (BPD) is much like treatment for other mental health disorders—a combination of psychotherapy and medication can result in improved outcomes for people who suffer from BPD.

A variety of psychotherapy methods have been used to effectively treat BPD, reduce symptoms, and improve prognosis.

The most common types of psychotherapy treatments include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), psychodynamic psychotherapy, and mentalization based treatment (MBT).

Cognitive Behavioral Therapy

Cognitive behavioral therapy is a type of talk therapy used to treat a wide variety of mental health issues. It is based on the notion that many mental health conditions are partly grounded in faulty, unhelpful thinking and learned, unhelpful behaviors, and that sound, healthy coping mechanisms can help reduce symptoms and, thus, disruptions in life. CBT can be helpful treating people with borderline personality disorder because it focuses on identifying how and what a person is feeling and thinking, and how each affects life function. Generally, CBT seeks to do the following:

  • Identify stressors
  • Help individuals develop awareness of their thoughts and feelings about those stressors
  • Identify negative thoughts and feelings
  • Teach coping skills to modify or change negative thoughts and feelings into positive thoughts and feelings and improve self-confidence

Dialectical Behavior Therapy

Dialectical behavior therapy was designed specifically as a treatment for borderline personality disorder. The key to DBT is the ability to hold on to two opposing ideas at the same time, and then to balance acceptance and change. For example, dialectical behavior therapy, in part, attempts to teach people with borderline personality disorder that even though they have a negative self-image, they can still accomplish positive things in life. They are then taught to accept how they see themselves and change the negative sense of self into a positive sense of self. DBT appears to be particularly effective at reducing suicidal behaviors.

Dialectical behavior therapy uses many of the same concepts as cognitive behavioral therapy, but borrows from Eastern medicine to achieve its goals. DBT focuses on four specific areas to help regulate emotions, manage relationships, and change self-image:

  1. Mindfulness teaches techniques to learn how to accept the current situation and be fully present in it. The goal is for people to be aware of, and learn to positively manage, stress without using negative coping mechanisms associated with borderline personality disorder.
  2. Distress Tolerance is focused on increasing tolerance for negative emotions. With increased tolerance, a person suffering from BPD can more appropriately deal with the emotion rather than try to escape it.
  3. Emotion Regulation teaches skills geared at managing and changing the intensity of emotions people with BPD feel. With better control of intense emotions, people with borderline personality disorder can reduce disruptions in interpersonal relationships and other aspects of life.
  4. Interpersonal Effectiveness helps people with borderline personality disorder develop communication skills aimed at improving relationships. The goal is to teach people with BPD to communicate “in a way that is assertive, maintains self-respect, and strengthens relationships.”

Psychodynamic Psychotherapy

Psychodynamic psychotherapy is an intensive, in-depth form of psychotherapy that focuses on the relationship between a person suffering from a mental health disorder, his or her previous, often repressed experiences and emotions, and his or her external world.

Like cognitive behavioral therapy and dialectical behavior therapy, psychodynamic psychotherapy centers on trying to help people with borderline personality disorder identify, acknowledge and accept, then change, contradictory negative thoughts and emotions. It also addresses how repressed emotions can affect current emotions, thoughts, beliefs, decision making, and relationships. Psychodynamic psychotherapy can also be helpful for people who are already aware of the way their thoughts and emotions are affecting them, but who are unable to overcome their difficulties on their own. With psychodynamic psychotherapy, people with BPD can learn to identify, analyze, and resolve conflicts and change their behavior to improve self-image, interpersonal relationships, and life function.

Mentalization Based Treatment

Mentalization based treatment focuses on improving the process by which a person suffering from borderline personality disorder makes sense of him or herself, others, and the external world. Mentalization is basically the mind’s ability to make sense of social situations and respond appropriately to them. This ability is largely learned and becomes innate over time. Often, people who suffer from BPD have a reduced ability to mentalize. A reduction in mentalization can lead to problems regulating emotions, managing impulsivity and disruptions in relationships and life functions. Mentalization based treatment is designed to improve development of the mentalization process and thus improve the prognosis for people with borderline personality disorder.

People with BPD have instability in sense of self and difficulty controlling emotions and impulses. A focal point of MBT treatment for borderline personality disorder is on stabilizing sense of self—one of the core issues in BPD. Mentalization based treatment also seeks to teach people to become comfortable with uneasiness, to be patient, to take time to understand varying perspectives, and think of experiences in terms of “what” rather than “why.” All of these methods work together to help develop better mentalization overall and, particularly when under stress, to decrease symptoms, improve interpersonal relationships and quality of life.

Medication for BPD

Treatment for borderline personality disorder can also include medication when therapy alone is insufficient to alleviate symptoms. Medication is generally not used to treat BPD specifically, because the symptoms vary widely, and the effectiveness is not clear. But when used to treat specific symptoms, use of prescription medication can be very effective in alleviating symptoms associated with BPD.

Usually, medications are prescribed to address specific symptoms or treat other co-occurring mental health disorders. For instance, antidepressants might be used to treat depression, mood stabilizers to address instability in mood, and antianxiety medications prescribed to deal with symptoms of anxiety. Common medications used to treat symptoms associated with borderline personality disorder include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Benzodiazepines
  • Mood stabilizers (such as lithium, carbamazepine, or valproate)

Common mental health disorders that co-occur with BPD include depression, anxiety, bipolar disorder, and substance abuse.

Inpatient Treatment for BPD

It is important to get treatment for borderline personality disorder once it is diagnosed. While it has been difficult to treat in the past, current trends show improved prognosis for people with BPD who receive treatment from trained, licensed mental health professionals.

Whether symptoms are moderate or severe, residential treatment can be beneficial for people suffering for borderline personality disorder. Many times, even if symptoms are moderate, if they are long-term and chronic, or co-occurring mental health disorders are present, inpatient treatment can be a more effective option. Development of long-term, chronic symptoms can create deeply ingrained maladaptive behaviors that are difficult to change in a short period of time. Often, outpatient care or short residential stays prove less effective in long-term prognosis. It took a long time to develop symptoms, and behaviors and will similarly take time to reduce, modify, or change.

In situations where symptoms are severe, inpatient treatment can be very helpful. It allows for in-depth, intensive, individualized therapy programs that are provided in a safe, controlled, and comfortable setting. In general, residential treatment can lead to reduced self-harm and impulsivity, improved self-image and relationships, and overall improved prognosis. Residential treatment is often indicated when self-harm or suicidal behaviors are present.

Studies have indicated that inpatient treatment for BPD has been highly effective, particularly when combined with dialectical behavior therapy. In fact, one study showed inpatient DBT is far superior to outpatient non-specific therapy for borderline personality disorder. There were significant improvements at the three-month period for people in inpatient DBT therapy for BPD. Those in outpatient, non-specific therapy saw no significant improvement at the four-month mark.

Longer-term residential stays combined with specific psychotherapy treatments can provide more concentrated individualized programs, with full integration of skills, provided within a controlled and therapeutic setting alongside mental health professionals and a community of others who may have had similar experiences.

People who suffer from borderline personality disorder can also learn and practice new skills that improve interpersonal interaction, emotional regulation, and other functional instabilities or disruptions brought on by the disorder.