There is much hope regarding the treatment for BPD thanks to the development of dialectical behavioral therapy (DBT) and medications used to manage some of the symptoms. While DBT is the frontline therapy type for those with BPD, there are lots of treatment options available, as well as self-help strategies that people can use to help manage symptoms.
Borderline Personality Disorder impacts roughly 1.5% of people worldwide.2 This disorder is frequently associated with trauma in childhood and a family history of personality disorders. BPD symptoms can be chronic and pervasive, and may vary in severity depending on what type of BPD someone has. Due to the lifelong nature of this disorder, finding and utilizing effective treatment is paramount to meaningful life outcomes. There are several treatment approaches that show success in treating and managing BPD.
The Importance of Treatment for BPD
Untreated borderline personality disorder leads to a lack of reliable, supportive relationships because most BPD friends or family members cannot tolerate their emotional chaos long term. Social and family connections are fundamental to everyone; without them, physical and mental health outcomes are reduced and can have long-term effects.
Untreated BPD also leads to higher rates of eating disorders, addiction, incarceration and suicide. For individuals with BPD, effective treatment and support systems are imperative.
BPD Therapy
Psychotherapy is the most effective form of treatment for BPD and has been refined and studied for several years. Long-term therapy, in conjunction with medication to manage symptoms, appears to be the most effective approach to the treatment of BPD.
While DBT is often seen as the most effective treatment approach, there are several types of therapy that can result in positive outcomes and individual growth for those with BPD:
Dialectical Behavior Therapy (DBT)
Developed by Marsha Linehan in the 1970s, DBT is often the treatment of choice for individuals diagnosed with BPD.10 DBT is a multi-dimensional treatment approach originally created to intervene in suicidal ideation in those with BPD. DBT is now used successfully to treat a myriad of mental health concerns and contains elements of individual and group therapy, crisis phone sessions, and therapy worksheets, allowing for many avenues of support.
In general, people report improvement after six months of treatment, with significant and lasting change occurring at around two years. DBT focuses on building skills in four areas:8
- Mindfulness
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness
This approach to the treatment of BPD blends behaviorism, humanism, and mindfulness to allow for holistic and sustainable progress.
Cognitive Behavioral Therapy (CBT)
The treatment of BPD has involved elements of CBT for more than a half a century. CBT 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 negative and maladaptive thinking, then challenges the individual to change distorted thoughts and beliefs.
Schema-Focused Therapy
Schema-focused therapy helps someone understand maladaptive schema developed in childhood. This approach can assist people in identifying how unmet needs can lead to unproductive patterns in relationships and general living.
What was helpful to us as children for our survival or success may be unproductive and facilitate negative social interactions with others in our adulthood. Schema-focused therapy helps someone identify these unhealthy interaction patterns and ways of being in the world to help facilitate meaningful changes. People with BPD who are participating in schema therapy report improved self-understanding and increased emotional awareness and regulation.9
Schema-focused therapy is showing promising lasting results but more research is needed to confirm the effectiveness of this approach.
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. MBT 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 own feelings and thoughts, and create an alternative, healthier perspective.
MBT allows for a more stabilized sense of self and emotional regulation, which aids in developing socially-appropriate means of meeting needs. It has demonstrated improved individual outcomes with sustained gains when applied specifically to people with BPD.1
Transference-Focused Psychotherapy
A form of psychodynamic psychotherapy, this approach centers around the idea that BPD develops from “identity diffusion,” or a splitting (black and white thinking) that starts in childhood and develops into difficult 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, including childhood, with an emphasis placed on current reactions in the moment.
The goal of transference-focused psychotherapy is to help people integrate views of self and others in a more effective manner through the therapist identifying interaction patterns and helping the individual to create more satisfying relationships in their present environment.6 This approach to the treatment of BPD has shown to increase people’s ability to reflect, in turn impacting the way they view themselves.3 A transference-focused therapist will likely not provide their advice or opinions, but rather assist the individual in understanding reactions and social interactions.
STEPPS
STEPPS, or “Systems Training for Emotional Predictability and Problem Solving,” is another approach to therapy which lasts 20 weeks and has been known to reduce the severity of BPD symptoms. This approach combines psychoeducation, group therapy, and CBT to learn 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 also learn techniques to help de-escalate BPD flare-ups.12
Arts Therapies
Channeling emotions into art can be really rewarding. Whether that art involves paint, music or dance, creative and art therapies remind us that there is beauty in the unique nature of all our stories, and can help us reframe our experiences. These therapies help us express emotions in healthy ways with supportive therapists that can help us cultivate self love and hold ourselves up in the face of inner adversity.11
Other Types of Therapy You May Encounter
In addition to the evidence-based and best-practice treatment approaches for the treatment of BPD, other theories and methodologies may be helpful in managing symptoms and developing a better sense of self. These approaches may help patients with BPD live more meaningful and productive lives and increase relational satisfaction.
- Logotherapy: Logotherapy assists people in making meaning of life, which is negatively correlated with BPD symptomology and success in counseling with patients with BPD is linked to finding purpose.7
- Gestalt Psychotherapy: Gestalt therapy works to increase awareness of self and others, and helps someone learn how to maintain meaningful contact with others.
- Systems Approach or Family Therapy: Due to the heritability of BPD and the difficulty in social and family interaction inherent to this disorder, family systems therapy is often an approach that can yield lasting and significant outcomes. Incorporating the entire family system into the treatment of BPD allows for new ways of coping while maintaining support for a new approach to life.
What to Ask a New Therapist Before Your First Session
Before beginning therapy with someone new, it can be helpful to have a phone call or initial conversation first.
Here are some questions you may want 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 for?
- 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?
Can Therapy Cure BPD?
While there is no known cure for BPD, there is still a lot of hope for living a long, fulfilling life. Managing BPD is possible with the right support and therapy, and many who stay in therapy long-term have great results. In a recent study, it was found that 35% of those with BPD had managed BPD with few symptoms after 2 years, and 91% of those with BPD had the same result after 10 years.13
Medication for Borderline Personality Disorder
Psychotherapy is the first line of treatment for BPD due to the social and relational components of the disorder. Also, all personality disorders are not easily treated with pharmaceuticals. While talk therapy is the treatment of choice for BPD, medication is often used to assist in regulating mood quickly and managing difficult symptoms.
Medications used to treat BPD should be prescribed by a psychiatrist or psychiatric nurse practitioner. While there are no medications approved by the FDA solely for the treatment of BPD, practitioners are able to prescribe medication for symptoms related to co-occurring disorders of BPD like depression, impulsiveness, anger, and anxiety.
All medications come with a risk of side effects. Some medication can be habit forming. Talk with your prescriber or pharmacist to learn about side effects and find the appropriate medication for you.
- Antidepressants: 80 to 90% of individuals diagnosed with BPD have a co-occurring mood disorder, so for these people, antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Norepinephrine Reuptake Inhibitors (SNRIs) can be helpful for managing depression.2
- Anxiolytics: Anxiety is a common experience for individuals diagnosed with BPD, with up to 88% of people with BPD reporting co-occurring anxiety diagnoses.2 For people who struggle to manage anxiety, an anti-anxiety medication may be helpful. Caution must be taken as many of the medications in this classification can be habit forming and must be prescribed by a general practitioner, psychiatrist, or psychiatric nurse practitioner.
- Mood Stabilizers: Unstable mood and difficulty with emotional regulation is a primary symptom of BPD and 15% of people diagnosed with BPD also have a co-occurring bipolar diagnosis that may be effectively treated with a mood stabilizer.2 Mood stabilizers are the most commonly prescribed medication for individuals with a BPD diagnosis.4
Here are some questions you might want to ask your prescriber before starting any new medications:
- What is the success rate of this medication in treating my issue?
- How quickly can I expect relief from this medication?
- Is this medication controlled or habit-forming?
- What are the most commonly reported side effects of this medication?
- How long do people report this medication working before needing to find something else?
- Does this medication interact with any other medications or supplements I am taking?
- What do I need to know about taking this medication?
Self-Help Strategies for Coping With BPD
People with BPD can benefit from using coping skills, learning about the disorder, and incorporating self-help strategies into their daily living. Being aware of symptoms, triggers, and coping skills allows people with BPD to be more intentional in social interactions and increase positive relationships.
Some of the best coping skills and self-help strategies practiced by people with BPD include:
1. Develop Coping Strategies to Reduce Self-Harm
People with BPD have a high likelihood of self-harming behaviors, and identifying coping skills that will decrease the harm associated with these behaviors is essential in treating BPD.
2. Learn All You Can About BPD
Gaining a better understanding of the etiology, symptoms, and outcomes associated with BPD can increase an individual’s ability to identify ways of coping with BPD. Reading books like, I Hate You, Don’t Leave Me, can allow an individual with BPD to feel less isolated and gain a stronger sense of what they want to change.
3. Work to Improve Your Social Skills
Joining a therapy group, taking a course on social skills, or identifying a plan to increase social communication skills is a positive step towards improved functioning for people with BPD. Learning nuances involved in communication, identifying social cues, and gaining awareness of personal communication styles can greatly improve daily life for individuals diagnosed with BPD.
4. Practice Mindfulness
Participating in mindfulness activities, such as meditations and groups, can have a lasting beneficial impact on individuals diagnosed with BPD. Increased intentionality and awareness of the moment can help you increase your quality of life and overall ability to cope with challenges as they arise.
5. Develop a Stronger Relationship With Yourself
Intentionally focusing on learning about yourself can help to decrease symptoms, especially those related to not having a strong sense of self and lack of self-understanding.
6. Find Healthy Ways to Process Your Emotions
Whether through psychotherapy or talking to a good friend, finding tools and people to assist in emotional processing is essential for healthy living for people diagnosed with BPD. Identifying emotional coping skills and support during times of emotional dysregulation helps to avoid the negative consequences of difficult emotions.
7. Journaling
Writing things down gets them out of your head. This can help us identify negative thought patterns and explore where they come from and why. Once we’re able to sort through the negative emotions and the background behind them, we can start to do the work to heal.
8. Meditation
Finding a special and sacred place to meditate may also be beneficial in helping you reflect and be with yourself. Meditating can help us process emotions differently so we can respond appropriately instead of being overly reactive to difficult situations. This can also help you be more mindful with yourself and remember to speak to yourself with kindness and offer grace on the hard days.14
9. Yoga
Yoga allows people to express emotions through their body. There are a lot of benefits to moving your body and exercising, however yoga takes that one step further with the goal of finding balance, both physically and mentally. When finding balance and an emotional equilibrium is at the center of your mind, it becomes that much easier to learn more about yourself.
Here are some questions to consider before starting a new self-care strategy:
- Is this practice sustainable and helping my overall well-being?
- Does this change/approach help me feel like I am making progress towards more peaceful and positive living?
- What will I have to give up to make this change? What will I gain?
- What support do I need to allow this change/approach to be effective and lasting?
- What needs are being met through this change/approach?
Hospitalization for Borderline Personality Disorder
BPD is a chronic disorder that can be severe enough at times to warrant hospitalization to help the patient stabilize from thoughts of self-harm or harming others. The majority of hospitalizations for BPD result from suicide attempts, heightened suicidality, and self-injurious behaviors. People diagnosed with BPD make up about 1.6% of our society, yet account for 20% of psychiatric hospitalizations.2
Inpatient hospitalization for BPD may be voluntary or involuntary, meaning the individual may seek to be hospitalized or may require hospitalization against their will. Either way, the stay may be anywhere from a few days to a few months. BPD patients willfully seeking treatment may participate in intensive outpatient treatment programs after stabilizing during a short-term inpatient stay.
Facilities differ in approach to treatment, but in general, patients can expect to receive individual and group psychotherapy, medication management, and case management services. Inpatient services can be very expensive and may be covered by insurance providers.
Research suggests long-term hospitalizations are not helpful for people with BPD, and care should be taken to get the patient stabilized and back in the community as soon as possible.5
What to Do in an Emergency
If you or someone you love is having a BPD emergency, such as having suicidal thoughts, are self harming or engaging in dangerous and risky behaviors, there are a number of emergency lines you can contact:
- Suicide Prevention Lifeline: 1-800-273-8255
- Crisis text line: Text HOME to 741741
- Veterans Crisis Line: 1-800-273-8255 (Press 1) or text 838255
