From the Guidelines
Borderline Personality Disorder (BPD) is a complex mental health condition characterized by emotional instability, impulsivity, unstable relationships, and distorted self-image, and the most effective treatment is Dialectical Behavior Therapy (DBT), which has been shown to reduce suicidal ideation and behavior by more than 50% in patients with BPD 1.
Key Characteristics of BPD
- Emotional instability
- Impulsivity
- Unstable relationships
- Distorted self-image
Treatment of BPD
- Dialectical Behavior Therapy (DBT) is the gold standard therapy for BPD, which teaches skills for emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness 1
- Other effective therapies include Mentalization-Based Therapy (MBT) and Schema Therapy
- Medication may include SSRIs, low-dose antipsychotics, or mood stabilizers to target specific symptoms, but none are FDA-approved specifically for BPD
Development of BPD
- Combination of genetic vulnerability and environmental factors, particularly childhood trauma or invalidating environments
- Affects brain regions involved in emotion regulation and impulse control
Outcome with Treatment
- With appropriate treatment, many people with BPD experience significant improvement in symptoms and quality of life
- Treatment typically requires long-term commitment, often 1-2 years of therapy, with gradual improvement 1
From the Research
Definition and Characteristics of Borderline Personality Disorder (BPD)
- Borderline Personality Disorder (BPD) is a mental health disorder characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms 2.
- BPD affects approximately 0.7% to 2.7% of adults in the US and is associated with considerable social and vocational impairments and greater use of medical services 2.
- The disorder is typically diagnosed by a mental health specialist using semistructured interviews 2.
Symptoms and Co-occurring Disorders
- Individuals with BPD often experience co-occurring mental disorders, such as mood disorders (83%), anxiety disorders (85%), or substance use disorders (78%) 2.
- Symptoms of BPD include suicidal ideation, self-injurious behaviors, depression, anxiety, anger, and violent behaviors 3, 2, 4.
- The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse 2.
Treatment Options
- Psychotherapy is the treatment of choice for BPD, with dialectical behavior therapy (DBT) and psychodynamic therapy being effective in reducing symptom severity 2, 4, 5.
- DBT has been shown to be effective in reducing parasuicide, medical risk of parasuicides, number of hospital days, dropout from treatment, and anger, while improving social adjustment 4.
- Mentalization-based treatment (MBT) may be used in combination with DBT to improve social cognitive skills and attachment security 6.
- There is no evidence that any psychoactive medication consistently improves core symptoms of BPD, although medications may be prescribed for discrete and severe comorbid mental disorders or for short-term treatment of acute crisis 2.