April 25, 2014

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Treating BPD

Treatments for Borderline Personality Disorder

Current research shows that treatment can decrease the symptoms and suffering of people with BPD.

Talk therapy is usually the first choice of treatment (unlike some other illnesses where medication is often first.) Generally, treatment involves one to two sessions a week with a mental health counselor.  For therapy to be effective, people must feel comfortable with and trust their therapist.

Some BPD symptoms are easier to treat than others.  Fears that others might leave, intense, unstable relationships or feelings of emptiness are often hardest to change.   Research shows that treatment is more effective in decreasing anger, suicide attempts and self- harm, as well as helping to improve over-all functioning and social adjustment

People whose symptoms improve may still have issues related to co-occurring disorders, such as depression, substance abuse, eating disorders, or post-traumatic stress disorder. However, research suggests that full-blown symptoms rarely coming back after remission.

There are several treatments that are most often used to manage BPD:

1. Dialectical behavior therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships.  It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed.  DBT is the most studied treatment for BPD and the one shown to be most effective.

2. Cognitive Behavior Therapy (CBT) can help people with BPD recognize and change both their beliefs and the ways they act that reflect inaccurate or negative opinions of themselves and others. This therapy can help people see difficult situations and relationships more clearly and find better ways to deal with them. CBT has been shown to be effective in lessening mood and anxiety symptoms and self-harm.

3.   Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.

4.   Transference-focused therapy (TFP) is designed to help patients understand their emotions and interpersonal problems through the relationship between the patient and therapist.  Patients then apply the insights they learn to other situations.

5.  Medications cannot cure BPD but can help treat other conditions that often accompany BPD such as depression, impulsivity, and anxiety.  Often patients are treated with several medications, but there is little evidence that this approach is necessary or effective.  People with BPD are encouraged to talk with their prescribing doctor about what to expect from each medication and its side effects. Omega-3 Fatty Acids, often called fish oils, have efficacy in relieving symptoms for certain mental illnesses, but their effectiveness in BPD is less clear. One study of 30 women with BPD showed that omega-3 fatty acids might help reduce symptoms of depression and aggression. 1

6.  Self-Care activities include: regular exercise, good sleep habits, a nutritious diet, taking medications as prescribed, and healthy stress management.   Good self-care can help to reduce common symptoms of BPD such as mood changes, impulsive behavior, and irritability.


1 Zanarini MC, Frankenburg FR. omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 2003 Jan;160(1):167–9.