The onset of borderline personality disorder (BPD) is primarily linked to childhood abuse and neglect. There can be genetic and biological factors, but those occurrences are not as common. If you are living with BPD, you may be wondering what the best treatment for BPD is. Mental health professionals who study BPD describe the associated symptoms as often, but not always, being adaptations to traumatic events and chaotic environments during early childhood. For this reason, the most successful BPD treatment centers focus on processing traumatic events and learning to gain control of emotions.
The Importance of Accurate Diagnosis
Many people with BPD ask themselves questions such as “Can BPD be cured?”, “What are the cures for BPD?” or “Do BPD treatment options really work?”
Personality disorders are notably more difficult to treat than mood disorders, as they pertain to the individual’s actual personality or character rather than their transient state. Personality is defined at the “trait” level and is generally thought to be enduring and stable over time. This contrasts with moods at the “state” level, which are more transient and malleable.
However, research into the management of borderline personality disorder has shown that there are viable treatment options available. If a person receives an accurate diagnosis, they can be put on a treatment path that is likely to be effective for them.
The 10 personality disorders can be categorized into three clusters: Cluster A (eccentric or odd), Cluster B (erratic or dramatic) or Cluster C (fearful or anxious). Personality disorders in each cluster share certain similarities. For this reason, it can sometimes be tricky to distinguish between them, and for therapists to pinpoint which one their patient has.
The current way of diagnosing personality disorders involves the use of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR). It offers the most widely accepted criteria for diagnosis and should be used by any psychological professional administering a diagnosis.
BPD treatment options typically involve some form of cognitive behavioral therapy, with dialectical behavior therapy (DBT) being a common choice. Dialectical behavior therapy has four components:
- Skills training
- Individual therapy
- Phone coaching
- Consultation team
In addition to DBT, a treatment plan for a person living with BPD often includes medication, lifestyle changes and other forms of therapy.
Levels of Care for BPD Treatment
Depending on the severity of the symptoms and the stage of treatment an individual is at, the treatment options for BPD may span the full continuum of care from residential care through to outpatient mental health care.
This range of treatment options ensures each individual is given the right level of support based on their needs. In addition, it helps fit treatment options around individual lifestyles, enabling those who are further along in their treatment to stay in touch with care providers and receive ongoing support on an outpatient basis.
BPD and Co-Occurring Substance Use
It’s common for individuals living with BPD to have a co-occurring substance use disorder. According to a meta-analysis published in the São Paulo Medical Journal, the prevalence of alcohol use disorder among those living with BPD was 55.28%, compared with 8.6% for men and 1.7% for women within the general population.
Drug or alcohol abuse can complicate treatment for mental health disorders. The co-occurring disorders program at FHE Health aims to address both the mental health challenges and the substance abuse, providing patients with the tools they need to live a healthier lifestyle in the long term.
Counseling to Treat Borderline Personality Disorder
Psychotherapy is a fundamental treatment option for those who are diagnosed with BPD. A therapist who is experienced with the treatment of BPD will set the following goals:
- Learn about BPD, including how and why it presents
- Prioritize your ability to function on a daily basis
- Reduce impulsiveness by managing your feelings
- Improve relationships by being more self-aware
- Develop coping skills for BPD
Family Therapy and Involvement
Family therapy can be an important part of treating BPD. It helps create a more stable home environment, helping the patient and their loved ones establish healthy boundaries and communicate more effectively. It also teaches people how to reduce emotional reactivity and manage conflict in a healthier fashion.
Types of Effective Methods of Psychotherapy
Good Psychiatric Management. Dr. John Gunderson at Harvard Medical School developed this protocol, which aims to be a relatively light-touch option that provides patients with the skills they need for long-term healing.
Mentalization-based therapy. MBT is a talk therapy method that reinforces thinking before reacting.
Schema-focused therapy. Conducted individually or in a group therapy setting, schema-focused therapy looks at your hierarchy of needs and identifies healthy ways to get your needs met.
Transference-focused psychotherapy. TFP focuses on developing healthy relationships as a way to better understand your emotions and struggles with interpersonal relationships.
Dialectical behavior therapy. DBT can be implemented either individually or in a group setting. The therapy is a skills-based approach designed to teach you to handle distress in healthy ways and improve relationships.
Eye Movement Desensitization and Reprocessing Therapy (EMDR). This treatment method is designed to assist with trauma processing and healing. During EMDR sessions, a therapist asks their patient to remember details about traumatic memories while they are presented with a visual or auditory signal. The goal is to ‘rewire’ the associations with those memories, helping heal trauma.
The Importance of Medical Integration to Treat BPD
If you suspect that your symptoms and behaviors are consistent with BPD, it is important to schedule a full medical workup with your primary care doctor. Many times, BPD symptoms can occur as a result of other undiagnosed medical ailments. Responsible healthcare providers will rule out other health issues and evaluate for co-occurring conditions before diagnosing you with BPD and developing a treatment plan tailored to your needs and circumstances.
Medication to Treat Borderline Personality Disorder
Personality disorders, such as BPD, typically develop by the end of adolescence or early adulthood. Early childhood experiences can increase the risk of an individual developing BPD symptoms. Individuals may subconsciously hold on to these experiences, resulting in changes to their behavior and self-identification. Because BPD is oftentimes the result of severe trauma, therapy is most effective and using medications to treat BPD is less common.
Healthcare providers will carefully evaluate you before prescribing medication. One reason is that BPD patients have an increased likelihood of self-harm, which makes prescribing medications that could be used to overdose a viable concern. Historically, clinicians believed that BPD was nearly impossible to treat and ruled out pharmacotherapy as an option. Modern-day treatments include interventions using medications and have proven successful.
