From the Guidelines
The primary treatment for Borderline Personality Disorder (BPD) is psychotherapy, with Dialectical Behavior Therapy (DBT) being the most effective approach, as evidenced by the 2019 study published in the Annals of Internal Medicine 1.
Key Components of DBT
- Weekly individual therapy sessions
- Group skills training
- Phone coaching
- Therapist consultation teams DBT typically involves a 6-12 month period of treatment, focusing on developing emotional regulation skills, improving interpersonal effectiveness, and building distress tolerance.
Other Effective Therapies
Other effective psychotherapies for BPD include:
- Mentalization-Based Therapy
- Schema-Focused Therapy
- Transference-Focused Psychotherapy These therapies may be used in conjunction with DBT or as alternative treatments.
Medications
Medications may be prescribed to target specific symptoms, such as:
- SSRIs like fluoxetine (20-80mg daily) or sertraline (50-200mg daily) for mood symptoms
- Low-dose antipsychotics like quetiapine (25-300mg daily) for impulsivity or anger
- Mood stabilizers like lamotrigine (25-200mg daily) for emotional instability However, medications are not considered first-line treatment for BPD, and therapy should be the primary focus.
Importance of Comprehensive Treatment
Treatment for BPD should be comprehensive, addressing both immediate crisis management and long-term skill development, as highlighted in the 2001 study published in the Journal of the American Academy of Child and Adolescent Psychiatry 1. With consistent engagement in therapy, recovery is possible, although treatment may need to continue for several years.
From the Research
Treatment Options for Borderline Personality Disorder
- Dialectical behavior therapy (DBT) is a structured outpatient treatment developed by Dr. Marsha Linehan for the treatment of borderline personality disorder (BPD) 2.
- DBT is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD 2.
- Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders 2.
Components of Dialectical Behavior Therapy
- Traditional DBT is structured into 4 components, including skills training group, individual psychotherapy, telephone consultation, and therapist consultation team 2.
- These components work together to teach behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors 2.
- The skills include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance 2.
Efficacy of Dialectical Behavior Therapy
- Findings from randomized controlled trials and meta-analyses suggest that there are several efficacious treatments for borderline personality disorder, including those based on cognitive behavior theories and psychodynamic theories 3.
- DBT has been shown to reduce self-harming behaviors and alleviate depression in patients with BPD, but has a negligible effect on suicidal ideation and anger 4.
- Standard DBT and DBT skills training lasting beyond 4 months have been shown to be beneficial in reducing self-harming behaviors and improving depression in patients with BPD 4.
Role of Pharmacotherapy in Treatment
- Psychopharmacologic interventions are oftentimes considered appropriate adjunctive care for patients with BPD participating in DBT 2.
- However, adding fluoxetine to an efficacious psychosocial treatment such as DBT does not provide any additional benefits 5.
- Further studies with larger sample sizes are warranted to fully understand the role of pharmacotherapy in the treatment of BPD 5.