Borderline Personality Disorder (BPD) treatments

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is the most common Personality Disorder affecting approximately 7 in every 1000 people. Called ‘Borderline’ by psychoanalyst Adolph Stern in 1938 to describe patients who did not fit neatly into a diagnosis of psychosis or neurosis, but stood on the ‘borderline’ of other conditions. Patients will typically present impulsive, unstable behaviour and emotions, have difficulties in interpersonal relationships and have a chronic fear of abandonment. Often sufferers will behave in a manner that others deem inappropriate and can be impulsive, seeing things in very black and white terms. Please see our section on What is Borderline Personality Disorder for more information on BPD.

Borderline Personality Disorder management

Everyone with BPD should be individually assessed and the treatment options will depend on a range of factors including symptoms, medical history and whether any other (comorbid) conditions are present.

Psychotherapy

Psychotherapy should underpin the treatment for BPD. There are a range of psychological treatments available, some prove to be more effective than others. Management of Borderline Personality Disorder techniques are constantly adapting and evolving as more is understood about the condition. A number of therapeutic techniques have shown to be helpful in the treatment of BPD, these commonly include:

Dialectical Behavioural Therapy (DBT)

DBT is a psychological treatment that has been specifically designed for those with BPD. Developed by Marsha M. Linehan, DBT has a combination approach that involves different methods of therapy. It’s principles are based on different practices including Behavioural science and mindfulness (which roots can be found in Zen Budhism). It is goal-oriented and focuses on helping the individual build a life that they are happy with. Individual therapy, skills training, situational skills training (using skills outside a therapy setting – for example a therapist may call at home/outside therapy hours to help you assess the learned skills in a real life environment) and lastly group therapy will be used. DBT has been proven an effective treatment for BPD and is shown to significantly reduce suicidal behaviour, self-harm, destructive and impulsive behaviour.

Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that isgoal-oriented. This means it focuses upon a pre-determined outcome that is systematically worked towards. It is a procedure that aims to solve dysfunctional emotions, behaviours and cognitions.

CBT includes a variety of approaches but commonly it will involve challenging problematic or unrealistic beliefs and behaviours by gradually facing activities, objects or situations that may have been avoided. CBT aims to teach the patient new ways of thinking and reacting, reduce fear and enforce positive, healthy ways of behaving.

CBT has been adapted for treatment of BPD and instead of being focused on the present and future, it also takes into consideration elements of the BPD sufferer’s past that may have contributed to these dysfunctional beliefs.

Mentalization-based therapy (MBT)

This form of therapy was developed by Peter Fonagy and Antony Bateman, it rests on the assumption that during childhood a BPD sufferer was unable to correctly develop the recognition of what other peoples thoughts and intentions, and how this related to their own. This is usually put down to dysfunctional parental relationships. The therapy looks to adjust and control this by helping the patient develop this ability. This is also a multi formatted therapy that incorporates individual and group therapy, usual within a day hospital environment. This form of therapy is usually given over a period of around 18months. The results of this form of therapy seem positive, especially when followed up with longer term care for example group therapy.

Individual Psychological Therapies

Psychodynamic Psychotherapy – this is a one-to-one therapy that helps the patient work through unhealthy emotions, any traumatic past experiences and helps them find unconscious sources of conflict in order to work through these to a positive outcome. For BPD sufferers the therapist will often be more active and structured than for those without the condition.

Psychodynamic Counselling is similar to psychodynamic psychotherapy with similar approaches, however this may be less intensive and may last for a shorter period of time.

Other forms of psychotherapy that your GP or psychiatrist may decide to recommend to you could include: Problem-solving therapy (PST) this is similar to CBT and usually used in a crisis situation. Manual-assisted cognitive therapy (MACT)found to be very effective for those who self-harm, again this is a problem-focused therapy, this time a manual will be used as a structure to the treatment. Cognitive analytic therapy (CAT) uses lots of the CBT methods but focuses largely on the relationship between patient and counsellor to explore the development of relationships. Interpersonal therapy (IPT)looks at different aspects of interpersonal relationships. Usually used in those with depression it has been adapted with good effect, to treat people with BPD.

How long will treatment for BPD last?

Psychological treatments for BPD are often seen to be more effective if used over a longer period of time, usually a period of one year or more. Unfortunately due to a high drop out rate by the patient and unavailability of longer term ‘Brief Psychological intervention Therapies’ such as CBT and IPT (please see above) the effectiveness of ‘talking therapies’ on BPD suffers is not as high as in some other psychological disorders.

Medication

There is no specific medication that is recommended for BPD. Some medicines can help relieve certain symptoms of BPD for example anxiety or depression. The National Institute for Health and Clinical Excellence recommends medication should only be considered for comorbid conditions, not for BPD itself.

Medicines that may be considered depending on your personal circumstance, medical history and any comorbid disorders include:

Antidepressants
Antipsychotics
Mood Stabilisers (including Lithium)
Omega-3 Fatty Acids

Antidepressants could be prescribed if depression (or other conditions which may benefit from this class of drug) is also present alongside BPD.

Antipsychoticsare known as ‘major tranquillisers’ these may be considered in patients that are experiencing ‘psychosis’ symptoms such as; hallucinations (visual or audible), delusions and/or disturbed thought patterns.

Mood Stabilisersare a group of drugs that are designed to ‘stabilise mood’ these include anticonvulsants and lithium. These may be considered for patients who have severe mood disturbance.

Omega-3 Fatty Acids,studies have found Omega Fatty acids to be very beneficial to the mind. Research also suggests that long-chain n-3 fatty acids may help delay or prevent the progression of certain psychotic disorders in adolescence. It may be considered that a patient suffering BPD would benefit from supplemented omega 3.