From the Guidelines
The most effective treatment for borderline personality disorder is Dialectical Behavior Therapy (DBT), which has been shown to reduce suicidality and improve emotional regulation, interpersonal effectiveness, and distress tolerance. DBT typically involves weekly individual therapy sessions, group skills training, phone coaching, and therapist consultation teams over a 6-12 month period 1. This approach combines elements of cognitive-behavioral therapy, skills training, and mindfulness techniques to help patients develop skills in emotion regulation, interpersonal effectiveness, and distress tolerance.
Some key components of DBT include:
- Core Mindfulness Skills module to diminish identity confusion and self-dysregulation
- Interpersonal Effectiveness Skills module to enable interpersonal problem-solving through assertiveness training
- Distress Tolerance module to reduce impulsivity by teaching acceptance and tolerance of painful situations
- Emotion Regulation Skills module to identify emotions, reduce emotional vulnerability, and increase positive events 2
Other effective therapies include Mentalization-Based Therapy (MBT), Schema-Focused Therapy, and Transference-Focused Psychotherapy. Medications may be prescribed to target specific symptoms, though no medication is FDA-approved specifically for BPD. Antidepressants like SSRIs and mood stabilizers such as lamotrigine or low-dose antipsychotics like quetiapine may help with emotional dysregulation and impulsivity 1. Treatment often requires long-term commitment, with improvements typically seen over months to years. Developing a strong therapeutic relationship, learning emotional regulation skills, and addressing co-occurring conditions like depression or substance use disorders are essential components of effective treatment.
It's worth noting that DBT has been found to reduce nonsuicidal and suicidal self-directed violence among patients with borderline personality disorder and recent self-directed violence, as shown in a systematic review by Hawton and colleagues 1. Additionally, a systematic review by Leavey and Hawkins found that CBT reduced suicidal ideation and behavior by more than 50% among a heterogeneous population including patients who had recently attempted suicide 1.
From the Research
Borderline Personality Disorder Treatment
The treatment for borderline personality disorder (BPD) primarily involves psychotherapy, with various approaches having empirical support in randomized controlled trials, including:
- Dialectical behavior therapy
- Mentalization-based therapy
- Transference-focused therapy
- Schema therapy No single approach has been proven superior to others, with effect sizes between 0.50 and 0.65 regarding core BPD symptom severity 3.
Pharmacotherapy
Pharmacotherapy may be useful for discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, but there is no evidence that any psychoactive medication is efficacious for the core features of BPD 3, 4.
Implementation of Evidence-Based Interventions
Research has shifted focus to the evaluation of dialectical behavior therapy (DBT) implementation in routine clinical settings, with consideration of implementation facilitators and barriers 5.
Key Considerations
Early diagnosis and treatment of BPD can reduce individual suffering and societal costs, but more high-quality studies are required, in both adolescents and adults 3. Additionally, the effectiveness of psychotherapeutic approaches, such as DBT, has been evaluated alongside the role of pharmacological interventions 6, 7.