Borderline Personality Disorder - Treatment Overview

Treatment Overview

Borderline personality disorder is difficult to treat. Relapse, which is a return of your symptoms, is a common problem, and many people with the disorder have difficult relationships with their counselors or other health professionals. But it is possible to recover from the damaging behaviors associated with borderline personality disorder.

Many people find relief from destructive symptoms within the first year of treatment.⁴ About half of those treated for this condition find that they no longer have most of the behaviors after about 10 years of treatment.⁴

Consistent, long-term treatment of borderline personality disorder is important in improving your symptoms and the quality of your life.

Successful treatment for borderline personality disorder can be more difficult if you have:⁹

• Been abused as a child.
• Experienced symptoms early in life.
• Had continuous symptoms over a long period of time.
• Continued to be unable to control your emotions.
• Experienced problems with aggression, substance abuse, or other mental health conditions, such as depression.

Initial treatment

Initial treatment depends on how bad your condition is. When borderline personality disorder is diagnosed, you most likely will begin treatment with professional counseling (psychotherapy). The first goal of therapy is to help you control destructive behaviors, especially if you are feeling suicidal or self-destructive. When you are less likely to harm yourself and you are able to function more normally, treatment will focus on managing your emotions, such as controlling feelings of anger or unhappiness.⁵

Types of counseling commonly used to treat the disorder include:¹⁰

• Cognitive-behavioral therapy (CBT), which focuses on changing certain thoughts and behavior patterns to control the symptoms of a condition.
• Dialectical behavior therapy, which helps reduce destructive behaviors by teaching healthy ways to adapt to and cope with challenges and feelings of frustration or lack of power.
• Psychodynamic therapy, which focuses on uncovering or understanding your past to gain insight into your actions and current behavior. This technique assumes that problems with behavior are caused by internal conflicts that you are not consciously aware of.
• Family therapy, which can help educate your family about your condition and provide support to you and to those who care about you and are affected by your condition. For example, it is sometimes difficult for a parent with borderline personality disorder to be nurturing, even to his or her own child.
• Support groups, where you and people you care about are able to meet others who share similar challenges.

Techniques that may help you manage symptoms of borderline personality disorder, such as stress and anxiety, include:

• Getting enough sleep and going to bed around the same time every night.
• Eating a balanced diet.
• Getting regular exercise, such as walking or swimming.
• Avoiding alcohol, illegal drugs, and medicines that have not been prescribed to you. These may make your symptoms of borderline personality disorder worse and also may interfere with your prescribed medicines.
• Avoiding any major life decisions (like changing jobs, moving, or getting married or divorced) when you are feeling irritable, anxious, angry, or depressed.
• Building a strong social support system by developing positive relationships with other people, such as family members, friends, and health professionals.

You many need to stay in the hospital if you show warning signs of suicide, such as thoughts or plans of harming yourself or another person, detachment from reality (psychosis), or excessive use of alcohol or drugs.

Any other medical conditions you have may also need to be treated. It is common for other conditions to occur with borderline personality disorder. These may include depression, eating disorders, substance abuse problems, attention deficit hyperactivity disorder (ADHD), or another personality disorder.

Your health professional may prescribe medicines to treat symptoms that can occur with borderline personality disorder, such as impulsive or reckless behavior, uncontrolled anger, thoughts of self-injury, depression, anxiety, and psychosis. Medicines to treat such symptoms include:²

• Antidepressants, which may help to reduce anger, irritability, impulsive behaviors, and depression. Those often used include selective serotonin reuptake inhibitors (SSRIs) or other similar medicines.
• Mood stabilizers, which may help control impulsive behaviors and anger.
• Atypical antipsychotics, which are sometimes used to help reduce impulsive and reckless behavior.

Ongoing treatment

Ongoing treatment for borderline personality disorder includes:

• Long-term professional counseling such as:
  • Cognitive-behavioral therapy (CBT), which focuses on changing certain thoughts and behavior patterns to control the symptoms of a condition.
  • Dialectical behavior therapy, which helps reduce destructive behaviors by teaching healthy ways to adapt to and cope with challenges and feelings of frustration or lack of power.
  • Psychodynamic therapy, which focuses on uncovering or understanding your past to gain insight into your actions and current behavior. This technique assumes that problems with behavior are caused by internal conflicts that you are not consciously aware of.
  • Family therapy, which can help educate your family about your condition and provide support to you and to those who care about you and who are affected by your condition. For example, it is sometimes difficult for a parent with borderline personality disorder to be nurturing, even to his or her own child.
  • Support groups, where you and people you care about are able to meet others who share similar challenges.
• Medicines, which may be used to reduce symptoms that can occur with borderline personality disorder, such as impulsive or reckless behavior, uncontrolled anger, thoughts of self-injury, depression, anxiety, and psychosis. You may have to try several medicines before you find the one(s) that work best for you. Medicines to treat such symptoms include:²
  • Antidepressants, which may help to reduce anger, irritability, impulsive behaviors, and depression. Those often used include selective serotonin reuptake inhibitors (SSRIs) and other similar medicines.
  • Mood stabilizers, which may help control impulsive behaviors and anger.
  • Atypical antipsychotics, which are sometimes used to help reduce impulsive and reckless behavior.

Techniques that may help you manage features of borderline personality disorder include:

• Getting enough sleep and going to bed around the same time every night.
• Eating a balanced diet that is low in saturated fat and contains lots of fresh fruits and vegetables.
• Getting regular exercise, such as walking or swimming.
• Avoiding alcohol, illegal drugs, and medicines that have not been prescribed to you. These may make your symptoms of borderline personality disorder worse and also may interfere with your prescribed medicines.
• Avoiding any major life decisions (like changing jobs, moving, or getting married or divorced) when you are feeling irritable, anxious, angry, or depressed.
• Keeping scheduled counseling appointments and taking your medicines as prescribed.

Treatment if the condition gets worse

If your symptoms associated with borderline personality disorder get worse while you are being treated with professional counseling and medicines, you may need to be hospitalized briefly until serious symptoms (such as intense thoughts of suicide) are reduced.

Your doctor may also prescribe medicines, such as selective serotonin reuptake inhibitors (SSRIs), to help reduce symptoms and prevent relapse (a return of your symptoms). It may take several weeks for these medicines to become effective.

You can help manage symptoms by getting enough sleep regularly, eating a balanced diet, getting regular exercise, avoiding alcohol and medicines not prescribed for you, avoiding big decisions when you are feeling low, keeping scheduled counseling appointments, and taking all medicines as prescribed.

Successful treatment for borderline personality disorder is more difficult if you have:⁹

• Been abused as a child.
• Experienced symptoms early in life.
• Had symptoms over a long period of time.
• Continued to be unable to control your emotions.
• Experienced problems with aggression, substance abuse, or other mental health conditions, such as depression.