From the Guidelines
Dialectical Behavior Therapy (DBT) is the best evidenced treatment for impulsivity in borderline personality disorder (BPD). The typical treatment approach involves individual and group sessions over the course of a year, focusing 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 1. DBT has been shown to reduce suicidality in adults with BPD and has been modified for use in adolescents with BPD, with promising results 1. While pharmacotherapy, such as mood stabilizers, may be used as an adjunct to treatment, DBT is the gold standard psychological treatment for BPD and should be prioritized. The treatment comprises four components or modules: Core Mindfulness Skills, Interpersonal Effectiveness Skills, Distress Tolerance, and Emotion Regulation Skills, which help reduce impulsivity by teaching acceptance and tolerance of painful situations with self-soothing and distraction from pain 1.
Some key points to consider when implementing DBT include:
- The importance of individual therapy sessions to review a weekly diary documenting suicidal and self-destructive behavior, behaviors that interfere with treatment and quality of life, and use of new skills 1
- The use of telephone consultations with the therapist to discuss skills that may be useful to decrease suicidal behaviors, report positive behaviors and events, and resolve conflicts with the therapist 1
- The benefits of patient consultation groups, where adolescents help each other to utilize skills to cope with life circumstances 1
- The need for a comprehensive treatment approach that includes psychotherapy, particularly DBT, as the primary treatment for BPD, with pharmacotherapy used as an adjunct when necessary 1
It's essential to note that while other treatments, such as mood stabilizers, may have some evidence for treating impulsivity in BPD, DBT has demonstrated the most consistent benefits specifically for impulsivity with a favorable side effect profile compared to alternatives 1.
From the Research
Mood Stabilizers for Impulsivity in Borderline Personality Disorder
- The use of mood stabilizers, such as lamotrigine, has been explored in the treatment of borderline personality disorder (BPD) to manage impulsivity and other core symptoms 2, 3, 4.
- A study from 1998 found that lamotrigine was effective in reducing impulsivity and improving symptoms in patients with BPD, with 50% of patients achieving sustained remission from their personality disorder 2.
- However, a randomized controlled trial from 2018 found that lamotrigine was not effective in reducing symptoms of BPD, including impulsivity, compared to placebo 5.
- A systematic review from 2020 found that mood stabilizers, including lamotrigine, may be effective in reducing impulsivity in BPD, but noted that the evidence is limited and more research is needed 6.
- Another review from 2024 found that lamotrigine has shown promise in managing BPD symptoms, particularly in stabilizing mood and reducing emotional dysregulation and impulsivity, and suggested that it may be a useful adjunctive treatment for BPD 4.
Comparison of Mood Stabilizers
- The effectiveness of different mood stabilizers, such as lithium, carbamazepine, and divalproex sodium, has also been explored in the treatment of BPD 3.
- However, the evidence for these medications is limited, and more research is needed to determine their effectiveness in reducing impulsivity and other symptoms of BPD.
Limitations and Future Directions
- The current evidence for the use of mood stabilizers in BPD is limited by the small number of studies and the variability in study design and outcome measures 6, 5, 3.
- Further research is needed to determine the effectiveness of mood stabilizers, including lamotrigine, in reducing impulsivity and other symptoms of BPD, and to explore their potential as adjunctive treatments 6, 4.