Borderline Personality Disorder Treatments: Therapies, Medication, & Lifestyle Changes

Borderline personality disorder (BPD) treatment typically includes a heavy emphasis on psychotherapy, such as dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT). While therapy is the frontline approach for those with BPD, providers may prescribe medications to treat co-occurring conditions. Along with traditional treatment, self-help strategies can help individuals manage their symptoms of BPD.

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) results in emotional instability, impulsivity, and relationship difficulties. The signs and symptoms of BPD are chronic and pervasive, often varying in severity depending on age and the type of BPD one experiences.¹ Unfortunately, untreated borderline personality disorder can lead to a lack of reliable, supportive relationships as most people cannot tolerate this emotional chaos long term.

How Is BPD Diagnosed?

Symptoms of BPD are often evident in adolescence or early adulthood and affect numerous areas of life. For those exhibiting signs of BPD, reaching out to a licensed professional experienced in diagnosing and treating BPD is recommended. This expert can arrive at a valid diagnosis by conducting a thorough psychological evaluation.² 

A diagnostic assessment for borderline personality disorder may include:^{1, 2}

• A detailed, structured interview to discuss symptoms
• Questionnaires and screening tools
• Reviewing previous medical and mental health history
• A medical exam to discard other possible reasons or co-occurring conditions that may account for symptoms

Treatments for Borderline Personality Disorder

BPD is a treatable disorder, and symptoms can improve within the first year of treatment. Borderline personality disorder treatment usually includes therapy, but medications can help address problems related to other conditions, anxiety, or depression. After seeking treatment, those with BPD can benefit from making lifestyle changes and developing self-coping strategies.

Therapy For Borderline Personality Disorder

Psychotherapy for BPD has been refined and studied for years and is considered the most effective treatment option. While DBT is often seen as the most successful therapy method, several other forms, including BPD support groups online, can result in positive outcomes and individual growth for those with BPD.

Although therapy cannot cure borderline personality disorder, it can still provide hope for a long and fulfilling life. Managing BPD is possible with the proper support and treatment, and many who stay in therapy long-term report positive results. For example, a recent study found that 35% of those with BPD had fewer symptoms after two years of treatment, with 91% reporting similar results after ten years.¹

Common borderline personality disorder therapies include:

Dialectical Behavior Therapy (DBT)

Developed by Marsha Linehan in the 1970s, many consider DBT the “best” treatment for borderline personality disorder.³ DBT for BPD is a multi-dimensional therapy approach designed to address suicidal ideation in those with BPD. However, DBT is now used successfully to treat numerous mental health concerns with elements of individual and group therapy, crisis phone sessions, and therapy worksheets.

A DBT approach to BPD treatment blends behaviorism, humanism, and mindfulness to allow for holistic and sustainable progress. By teaching clients mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness skills, DBT can begin improving their symptoms in six months, with significant and lasting change occurring at around two years.⁴

Cognitive Behavioral Therapy (CBT)

The treatment of BPD has involved elements of CBT for more than half a century. CBT for BPD allows the individual to evaluate, monitor, and change thoughts and beliefs that impact feelings, experiences, and social relationships. This talk-therapy-based approach assists people in gaining awareness of harmful and maladaptive thinking patterns, then challenges the individual to replace these distorted thoughts and beliefs.

Schema-Focused Therapy

Schema-focused therapy helps someone understand maladaptive schema developed in childhood. This approach for borderline personality disorder treatment can assist people in identifying how unmet needs can lead to unproductive relationship and behavioral patterns. For example, what was helpful to us as children for our survival or success may facilitate negative social interactions in adulthood. Schema-focused therapy focuses on identifying these unhealthy patterns to promote meaningful changes.

People with BPD who participate in schema therapy report improved self-understanding and increased emotional awareness and regulation.⁵ While schema-focused therapy is showing promising lasting results, more research is needed to confirm its effectiveness in the treatment of BPD.

Mentalization-Based Therapy (MBT)

This approach for BPD treatment incorporates the process of mentalizing, which is how we make sense of ourselves and each other in our subjective daily experiences. Mentalization-based therapy is a highly structured and time-limited approach that incorporates several interventions to promote the development of mentalizing. Its goal is to allow people to understand their feelings and thoughts to create an alternative, healthier perspective. MBT supports a more stabilized sense of self and emotional regulation, allowing those with BPD to develop socially-appropriate means of meeting needs.⁶

Transference-Focused Psychotherapy

Transference-focused psychotherapy is a form of psychodynamic therapy centering around the idea that BPD develops from “identity diffusion,” or BPD splitting (black-and-white thinking). These elements of BPD often start in childhood and contribute to problematic adult relationships and a lack of self-identity. This approach relies on individuals working closely with a psychotherapist to identify and understand dynamics in past relationships and current reactions.

Transference-focused psychotherapy aims to help people integrate views of self and others more effectively. The therapist identifies interaction patterns, which can help the individual create more satisfying relationships in their present environment.⁷ This approach to BPD treatment has been shown to increase the ability to reflect, positively impacting self-image.⁸ A transference-focused therapist will likely not provide their advice or opinions but rather assist the individual in understanding reactions and social interactions.

Systems Training for Emotional Predictability and Problem Solving (STEPPS)

Another borderline personality disorder treatment includes STEPPS. This therapy lasts 20 weeks and can reduce the severity of BPD symptoms. STEPPS combines psychoeducation, group therapy, and CBT to educate clients about negative thought patterns and how to challenge them. STEPPS also has a component for family and friends to participate and support the person with BPD. These supporters learn techniques to help de-escalate BPD flare-ups.⁹

Art Therapies

Channeling emotions into art can be rewarding. Whether that art involves painting, music, or dance, expressive arts therapies remind us that there is beauty in our unique nature and can help us reframe our experiences. These therapies allow individuals to express emotions in healthy ways with supportive therapists to cultivate self-love in the face of inner adversity.¹⁰

Other Types of Therapy You May Encounter

In addition to evidence-based and best-practice treatment approaches for BPD, other theories and methodologies may help individuals manage symptoms and develop a better sense of self. These approaches may promote more meaningful and productive lives and increase relational satisfaction.

Other borderline personality disorder therapies may include:

• Logotherapy: Logotherapy assists people in making meaning of life, which is negatively correlated with BPD symptomology. Success in counseling patients with BPD is linked to finding purpose.¹¹
• Gestalt psychotherapy: Gestalt therapy increases awareness of self and others, helping those with BPD learn how to maintain meaningful contact with others.
• Systems approach or family therapy: Due to the heritability inherent to this disorder, family systems therapy is often a BPD treatment approach that can yield lasting and significant outcomes.

What to Ask a Therapist Before Your First Session

A phone call or initial conversation with a therapist before your first session can be helpful. Therapists expect you to ask questions, and having a list of inquiries and questions ahead of time can help you feel less anxious about the discussion.

Here are questions to ask a new therapist before you work with them:

• What approach do you take with treating BPD, and how long have you been treating this population?
• How often do you meet with individuals, and how long are appointments scheduled?
• Do you have a crisis line or resources available? Do you offer contact between sessions?
• What specialized training do you have in treating BPD?
• On average, how long do you see individuals with BPD before they report improvements?
• Do you give therapy homework, and what might that look like?
• What struggles do individuals run into when receiving this form of treatment?
• What support do you offer outside of the traditional weekly therapy hour?

For Further Reading

• How to Help Someone With BPD: 20 Ways to Offer Support
• Can Borderline Personality Disorder (BPD) Be Cured?
• Mental Health America
• National Alliance on Mental Health
• MentalHealth.gov

Borderline Personality Disorder Treatments Infographics