How Is Borderline Personality Disorder Treated?
Borderline personalty disorder (BPD) is a disease that can severely affect a person’s relationships, their ability to stay employed, and their physical and mental health. But many patients can manage the condition—and live meaningful and happy lives—by working with their doctors to develop a BPD treatment plan that works for them.
There are several treatments that have shown to be effective for BPD, all of which involve psychotherapy, also known as talk therapy. These treatments involve meeting with a doctor or therapist, either one-on-one or in a group setting, and learning strategies for managing symptoms of BPD. Here is an overview of a few of these treatments, and other things that may be helpful.
Dialectical behavior therapy
Dialectical behavior therapy (DBT) is the most widely used treatment for BPD, and it has been around for about 30 years. It is a yearlong program that involves group sessions, individual meetings, and phone coaching with a therapist. Patients learn strategies for coping with stressful situations, learning to accept what they can’t change, and working to improve what they can.
These strategies can include mindfulness and being present in the moment, practicing effective communication with people around them, and using the five senses (think soft music, a warm bath, or a delicious meal) to self-soothe and de-stress.
“A lot of times, people who come to DBT don’t have a lot of ways to regulate their emotions,” Adam Carmel, PhD, clinical assistant professor of psychology at the University of Washington, previously told Health. “If you teach them crisis survival skills, they learn better ways to cope, and they can get through that crisis without making things worse.”
In mentalization-based therapy, a mental-health professional helps patients identify and modify how they are feeling at any given moment. “The theory behind this treatment is that borderline patients are not very good at understanding their own internal states—and not very good at understanding the internal space of others—especially when they’re feeling anxious or threatened,” D. Bradford Reich, MD, an attending psychiatrist at the Harvard-affiliated McLean Hospital in Belmont, Mass., tells Health.
This may sound vague, but mentaliztion-based therapy (along with the other types of psychotherapy used to treat BPD), involves very structured exercises and strategies patients can turn to when they become emotional or when their lives become stressful.
Schema-focused therapy is another type of psychotherapy used to treat BPD. The goal of schema-focused therapy is to help patients reframe harmful world views, also known as schemas, that were developed in childhood.
For example, if a BPD patient grew up in an abusive situation, they may have developed coping skills that helped them survive at the time but that are now harmful to them—and to their relationships—as adults. This type of therapy, which involves guided imagery, role playing, and other psychotherapy techniques, can help patients develop new behaviors and views.
Schema-focused therapy usually involves at least a two-year commitment from a patient. After this period is over, patients can continue to refer back to the coping strategies they learned during their sessions.
Good psychiatric management
It can sometimes be hard to find therapists who are certified in specialized treatments for BPD, like those listed above. These therapies can also be costly and time-intensive, Brandon Unruh, MD, assistant medical director at McLean Hospital’s Gunderson Residence, a program for women with severe personality disorders, tells Health. For those reasons, they may not be the best option for all patients.
Instead, some BPD patients may decide, with their doctors, that an approach called good psychiatric management is a better treatment plan for them. In this type of therapy, doctors and patients establish clear goals about what they want to achieve during their sessions.
“An early goal might be developing a better understanding of how one’s own mind works, which can be a very confusing and fearful thing for borderline patients,” says Dr. Unruh. Another goal might be for patients to understand how their emotional reactions correlate with things or people going on around them, so they can be better prepared to deal with these situations.
Even though this type of treatment isn’t as lengthy or specialized as other BPD therapies, studies show that it can still be effective in helping patients keep symptoms under control. “We now know that the vast majority of patients don’t need something so long-term or intensive, and instead can make do with some of these more pared down treatments,” says Dr. Unruh.
Is there medication for BPD?
There is no medication approved for the treatment of borderline personality disorder, and no drugs can be a stand-alone strategy for managing the condition. But because BPD patients often have related issues—including depression, anxiety, substance abuse, or self-harming or suicidal behaviors—medications may sometimes be prescribed to treat these specific symptoms.
“Medications are, at best, a secondary treatment for BPD,” says Dr. Unruh. “They may defray some of the emotional turbulence that a patient is going through, but they never constitute a cure.”
Dr. Reich agrees. “If a patient develops a major depression and they can’t get out of bed, you’re going to treat them with an antidepressant,” he says. “But the fact is that medications don’t generally work that well for borderline patients, so a truly successful treatment plan would probably lead to that patient being on fewer medication in the long run.”
What is the prognosis for BPD patients?
These therapies have all been used for the treatment of borderline personality disorder, and all have been shown to be effective. “Most patients show most of their progress in the first three months,” says Dr. Reich.
Most BPD patients are diagnosed in late adolescence or early adulthood. “And some people have more mild forms and will actually grow out of it by the time they’re in their early to late 20s, even without any treatment,” says Dr. Reich. “Others are going to be challenged for life and, in fact, may be disabled because of their disease.”
Still, says Dr. Reich, treatment for BPD has come a long way in recent years. “It was thought, 30 or 40 years ago, that giving someone a borderline personality diagnosis basically meant their condition was hopeless,” he says. “And that’s hardly the case today: If you look at studies of borderline patients, you’ll see that at least 50% achieve pretty full recoveries in the sense that they are able to work, have intimate relationships, and live a fairly normal life."
“The take-home point is that they can get better,” says Dr. Reich. “And even though their emotional lives may be more complicated than those of the average person, they can still lead lives that are quite enriched.”
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter