From the Research
Borderline personality disorder (BPD) is a complex condition that requires a comprehensive treatment approach, and dialectical behavior therapy (DBT) is currently the most empirically supported treatment for BPD, as evidenced by the most recent and highest quality study 1.
Key Characteristics of BPD
The primary symptoms of BPD include:
- Intense fear of abandonment
- Unstable relationships that alternate between idealization and devaluation
- Rapidly shifting self-image
- Impulsive behaviors, such as spending, substance abuse, reckless driving, or binge eating
- Recurrent suicidal thoughts or self-harming behaviors
- Intense mood swings lasting hours to days
- Chronic feelings of emptiness
- Inappropriate intense anger or difficulty controlling anger
- Stress-related paranoid thoughts or severe dissociative symptoms For diagnosis, at least five of these symptoms must be present in various contexts and begin by early adulthood.
Treatment Options
While DBT is the most effective treatment for BPD, other approaches, such as mentalization-based therapy, transference-focused psychotherapy, and schema-focused psychotherapy, may also be beneficial 2.
- DBT is a structured outpatient treatment that teaches behavioral skills to target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity.
- Mentalization-based therapy focuses on helping patients develop a better understanding of their own thoughts, feelings, and behaviors, as well as those of others.
- Transference-focused psychotherapy aims to help patients understand and manage their relationships with others, including their therapist.
- Schema-focused psychotherapy targets specific cognitive patterns and behaviors that contribute to BPD symptoms.
Importance of Early Recognition and Treatment
Early recognition and treatment of BPD are crucial to reduce individual suffering and societal costs, as BPD is associated with considerable functional impairment, intensive treatment utilization, and high societal costs 1.
- BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews.
- The disorder is associated with a high risk of self-mutilation and suicide.
- BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders.
Limitations and Future Directions
While significant progress has been made in understanding and treating BPD, further research is needed to clarify the neurobiological underpinnings of the disorder and to develop more effective treatments 1.
- The interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD.
- No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD.
- Further research is warranted to identify the most effective treatment approaches for individual patients and to develop personalized treatment plans.