From the Guidelines
The primary treatment for borderline personality disorder (BPD) is dialectical behavior therapy (DBT), which has been shown to reduce suicidality and improve emotional regulation, interpersonal effectiveness, and distress tolerance 1.
Key Components of DBT
- Weekly individual therapy sessions
- Group skills training sessions
- Focus on developing problem-oriented strategies to increase distress tolerance, emotion regulation, interpersonal effectiveness, and the use of both rational and emotional input to make more balanced decisions
- Four components or modules: Core Mindfulness Skills, Interpersonal Effectiveness Skills, Distress Tolerance, and Emotion Regulation Skills
Evidence Supporting DBT
- A systematic review found that DBT reduces nonsuicidal and suicidal self-directed violence among patients with borderline personality disorder and recent self-directed violence 1
- Another systematic review found that DBT reduces posttreatment suicidal ideation and repetition of self-directed violence among patients with borderline personality disorder 1
- A randomized trial found evidence that DBT reduces nonsuicidal and suicidal self-directed violence among patients with borderline personality disorder and recent self-directed violence 1
Additional Considerations
- Medication may be prescribed to manage specific symptoms, such as selective serotonin reuptake inhibitors (SSRIs) for mood regulation, and low-dose antipsychotics for impulsivity and aggression
- Treatment should be long-term and involve a multidisciplinary team, including a psychiatrist and psychotherapist
- Patient commitment to therapy and a strong therapeutic alliance are crucial for success
- Alongside professional treatment, patients should focus on self-care, stress management, and building a support network
- Treatment aims to improve emotional regulation, interpersonal relationships, and overall functioning, rather than completely eliminating the disorder
From the Research
Treatment Options for Borderline Personality Disorder (BPD)
The treatment for BPD primarily involves psychotherapy, with several approaches showing clinical benefits. Some of the effective treatments include:
- Dialectical behavioral therapy (DBT) 2, 3, 4, 5
- Mentalization-based treatment (MBT) 3, 4
- Transference-focused psychotherapy (TFP) 3, 4
- Schema-focused therapy 2, 4
- Cognitive behavioral therapy (CBT) 2, 5
- Good psychiatric management (GPM) 6
Efficacy of Treatments
These treatments have been shown to reduce the severity and frequency of self-harm behaviors, improve social and interpersonal adjustment, and decrease the overall psychopathology associated with BPD 2, 4. Dialectical behavioral therapy and schema-focused therapy have demonstrated high remission rates of diagnostic BPD criteria, with 57% and 94% respectively 2.
Pharmacological Interventions
While psychotherapy is the primary treatment for BPD, pharmacological interventions may be useful in managing discrete and severe comorbid symptoms such as anxiety, depression, or psychotic-like features 4. However, there is no evidence to suggest that any psychoactive medication is efficacious for the core features of BPD.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of BPD can reduce individual suffering and societal costs 4. It is essential to provide the right dose of the right therapy at the right time to avert an escalating trajectory that may lead to a diagnosis of BPD 5.