Borderline personality disorder therapies

Borderline personality disorder (BPD) is a psychiatric condition associated with fear of abandonment, unstable interpersonal relationships, and intense mood swings. When left untreated, BPD can lead to complications such as job loss, relationship problems, and suicide attempts, but BPD therapies are available to make the condition more manageable ^[1].

How is borderline personality usually treated?

Borderline personality disorder is most often treated with psychotherapy, or “talk therapy.” There are several different therapeutic modalities that are beneficial for patients with BPD. Each different therapy modality will involve a licensed mental health professional, such as a clinical social worker, psychologist, or mental health counselor. Talk therapy includes talking through problems with the person struggling with BPD and helping them to arrive at solutions and develop stronger coping skills ^[1].

While talk therapy is the most common form of BPD treatment, some people may benefit from medications to treat specific symptoms, such as anxiety, sleep problems, and depression. Medications can be beneficial, but there are no FDA-approved medications used specifically for the treatment of BPD ^[1].

Patients who do take medications often have the best outcomes when medication is taken alongside participation in talk therapy. Furthermore, medications for BPD are not intended to treat global symptoms, but rather to address one specific symptom, such as anxiety. Patients with BPD may benefit from taking antidepressants, antipsychotics, or mood stabilizers to help with symptom management ^[2].

What types of therapy are used to treat BPD?

There are numerous different therapeutic modalities that have been found to be beneficial for patients with BPD. These include ^[3]:

• Dialectical behavior therapy (DBT): DBT was created to treat BPD. It is a well-studied treatment option that helps patients develop skills for emotional regulation, managing relationships, and tolerating distress. It also includes components of mindfulness training. DBT involves individual therapy and group sessions.
• Mentalization-based therapy (MBT): MBT helps patients with BPD to more effectively engage in mentalizing, which is the process of thinking about their own and others’ thoughts. According to this therapeutic approach, problems arise when patients stop mentalizing and begin disconnecting from reality. MBT uses both individual and group therapy sessions to help patients strengthen their mentalization skills.
• Transference-Focused Psychotherapy (TFP): TFP has roots in psychoanalytic theory, which states that people are driven by unconscious motives and that they use defense mechanisms to protect themselves from addressing painful or uncomfortable emotions. In TFP the therapist identifies ineffective relationship patterns through a process called transfere Transference isthe patient projects onto the therapist feelings the patient has toward people in the patient’s life.
• Schema Therapy: This therapeutic model focuses on altering dysfunctional patterns of thinking, behaving, and feeling, and replacing them with healthier patterns. This is achieved by the therapist developing a strong therapeutic relationship with the patient and engaging in “re-parenting” to help the patient correct maladaptive patterns.

The BPD therapies discussed here are just some of the treatment modalities used for BPD. They are the most effective and well-studied BPD treatments. However, additional BPD therapies are available and can be effective for some patients.

For instance, some patients benefit from generalized psychiatric management (GPM), which uses a case management model to help individuals with BPD to improve their social functioning and develop vocational skills. GPM typically involves one weekly individual appointment, during which patients learn about BPD symptoms and are linked to other helpful services, such as medication management and family counseling ^[3].

How successful is therapy in treating borderline personality disorder?

The effectiveness of therapy for BPD depends upon the specific type of modality used, as well as the needs of the individual patient being treated. However, researchers have carried out numerous studies to assess the effectiveness of DBT therapies, and the results are promising. Studies have found that DBT and psychodynamic therapies, such as TFP, are the most effective for treating BPD symptoms ^[4].

Additional research shows that there is a good prognosis for patients with BPD. After two years, 35% of patients achieve remission, and over ten years, the remission rate jumps to 91%. Once patients achieve remission, 75% stay in remission for over eight years. In order to achieve remission, it is important for patients with BPD to adhere to treatment. Without treatment, patients are more likely to experience poor outcomes, including legal and social problems ^[1].