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Borderline Personality Disorder: Treatment

BPD has historically been viewed as difficult to treat. However, with newer and proper treatment, many people with BPD experience fewer or less severe symptoms and an improved quality of life. Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with BPD and their loved ones to be patient and to receive appropriate support during treatment. People with BPD can recover. If you think you have BPD, it is important to seek treatment.

Studies indicate that BPD patients who never recover may be more likely to develop other chronic medical conditions and are less likely to make healthy lifestyle choices. BPD is also associated with a high rate of self-harm and suicidal behavior.

If you are thinking about harming yourself or attempting suicide, tell someone who can help right away. Call your licensed mental health professional if you are already working with one. If you are not already working with a licensed mental health professional, call your personal physician or go to the nearest hospital emergency room.

If a loved one is considering suicide, do not leave him or her alone. Try to get your loved one to seek immediate help from his or her doctor or the nearest hospital emergency room, or call emergency services. Remove any access he or she may have to firearms or other potential tools for suicide, including medications, sharp edges such as knives, ropes or belts. If you or a loved one are in crisis, call a reputable national suicide prevention hotline. Most of these are available 24 hours a day, seven days a week. The service is available to anyone, and all calls are confidential.

Treatments and Therapies

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More research is needed to determine the effectiveness of these treatments, who may benefit the most and how best to deliver treatments.

Psychotherapy

Psychotherapy (or "talk therapy") is the main treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

Psychotherapy can be provided one-on-one between the therapist and the patient, or it can be in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively. It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain a comfortable and trusting bond with their therapist.

Types of psychotherapy used to treat BPD include the following:

• Cognitive behavioural therapy (CBT): CBT can help people with BPD identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
• Dialectical behaviour therapy (DBT): This type of therapy utilizes the concept of mindfulness, or being aware of and attentive to the current situation and moods. DBT also teaches skills to control intense emotions, reduce self-destructive behaviors and improve relationships. DBT differs from CBT in that it integrates traditional CBT elements with mindfulness, acceptance, and techniques to improve a person's ability to tolerate stress and control his or her emotions. DBT recognizes the dialectical tension between the need for acceptance and the need for change.
• Schema-focused therapy: This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image — possibly brought on by negative childhood experiences — that affects how people react to their environment, interact with others, and cope with problems or stress.
• Systems Training for Emotional Predictability and Problem-Solving (STEPPS) is a type of group therapy that aims to educate family members, significant others and health care professionals about BPD and gives them guidance on how to interact consistently with the person with the disorder using the STEPPS approach and terminology. STEPPS is designed to supplement other treatments the patient may be receiving, such as medication or individual psychotherapy.

Families of people with BPD may also benefit from therapy. The challenges of dealing with a loved one with BPD on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms. Some therapies include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies focus on the needs of family members and help them understand the obstacles and strategies for caring for a loved one with BPD. Although more research is needed to determine the effectiveness of family therapy in BPD, studies on other mental disorders suggest that including family members can help in a person's treatment.

Other types of psychotherapy may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may also switch from one type of psychotherapy to another, mix techniques from different therapies or use a combination of psychotherapies.

Medications

Medications should not be used as the primary treatment for BPD, as the benefits are unclear. However, in some cases, a mental health professional may recommend medications to treat specific symptoms, such as mood swings, depression or other disorders that may occur with BPD. Treatment with medications may require care from more than one medical professional.

Because of the high risk of suicide among people with BPD, health care providers should exercise caution when prescribing medications that may be lethal in the event of an overdose. Certain medications can cause different side effects in different people. Talk to your doctor about what to expect from a particular medication.

Other Treatments

Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Although in rare cases, some people who develop this disorder may improve without any treatment, most people benefit from and improve their quality of life by seeking treatment.