Borderline personality disorder (BPD) can be treated in a number of different ways. Unlike some mental health conditions, the most effective treatments are generally different forms of talk therapy.
Treatments for BPD
The following are some of the most common, evidence-based treatments used to treat borderline personality disorder:
Dialectical Behavior Therapy (DBT)
Dialectical behavioral therapy (DBT) is the most well-understood and widely available treatment for BPD. It combines dialectics, a complex concept that essentially explores the interconnectivity of ideas and the necessity of change, and methods to help a patient feel valid and valuable.
This treatment can be somewhat time- and resource-intensive, but it has the potential to result in some of the most positive changes of all available options.
Mentalization-Based Therapy (MBT)
Mentalization-based therapy (MBT) focuses on helping a patient better understand their thoughts and feelings as well as those of others. Through this understanding, a client can feel more connected with those around them and develop healthier and more realistic understandings of how others perceive them. As a result, they can feel safer overall and more secure in their interactions with people.
Transference-Focused Psychotherapy (TFP)
Transference-focused psychotherapy (TFP) shares some similarities with MBT, with a focus on interpersonal dynamics in a patient’s life and how they can bring out disproportionately intense emotional states in those with BPD.
It is a psychoanalytically oriented psychotherapy, developed from ideas of the psychoanalyst Otto Kernberg in the 1960s and evolving since then. Whereas other BPD therapies can often benefit from clinicians working in groups, TFP has a greater emphasis on individual clinicians working with their clients.
Structured Clinical Management (SCM)
Structured clinical management (SCM) is a generalist form of treatment that is designed to help clients better manage various negative aspects of their lives. Its generalist nature means it can help a client address a number of diverse issues, including these:
- Emotions and moods that negatively impact their life
- A person’s triggers for distress
- The urge to rush through feelings and thoughts rather than confront them
- Frequent feelings of vulnerability and powerlessness
- Urges to self-harm or engage in suicidal actions
- Struggles to develop healthy, long-lasting relationships
Despite the generalist nature of this treatment, it can still offer significant help to patients with BPD specifically.
Schema-Focused Therapy (SFT)
Schema-focused therapy (SFT) has a focus on helping a patient work to change their personality in a way that improves their overall quality of life and ability to function interpersonally.
It has an unusual facet in that a therapist and client are generally intended to develop a closer, more attached relationship than in other forms of therapy. In part, the intention is to help the patient form a stable, healthy interpersonal relationship and otherwise develop various alternatives to the more dysfunctional relationships and behavioral patterns many people with BPD struggle with.
General Psychiatric Management (GPM)
General psychiatric management (GPM) shares some similarities with SCM. It is a treatment that relies on common sense practices that are readily learnable by generalist clinicians. It has a focus on helping to equip a patient with the skills and control needed to find stable work and to develop better social relationships.
While more limited in scope, general psychiatric management has many advantages, especially for those with limited time or living in areas with limited therapy resources available. It is easy for mental health professionals to learn and often requires the least time commitment of the therapy-based treatments discussed so far.
Medication alone is not generally the recommended treatment for borderline personality disorder. There is much debate about the best medication and what doses work best for people who have BPD and other mental health conditions stemming from their BPD.
With numerous caveats of note, in large part due to the diverse nature of borderline personality disorder patients and their potential symptoms, some of the most evidence-based medication treatments include the following:
- Amitriptyline (antidepressant)
- Topiramate, lamotrigine and valproate semisodium (mood stabilizers/anticonvulsants)
- Olanzapine (antipsychotics)
Self-care practices are fairly basic habits a person can adopt to improve their mental health. Oftentimes a person will learn these habits in therapy and be encouraged to practice them by a mental health professional, although many can also be adopted individually too.
Depending on your personal struggles, you can look up the self-care practices that are recommended for your specific symptoms, with tips available for people who suffer from self-harm urges, anger, depression, and more.
While self-care is generally not the ideal way for a person to treat their symptoms, it can be an excellent supplemental treatment. It can also help people who live in communities without mental health resources or who otherwise cannot access more expert help.
If you want to research self-care on your own, make sure you use resources that are evidence-based.
BPD Treatment FAQs
What is the most effective treatment for BPD?
Research has suggested that a number of BPD treatments are close enough in their general outcome that looking for “the most effective treatment” might instead be better rephrased as the treatment that best fits an individual’s needs.
Dialectical behavior therapy (DBT) is an excellent first choice, as it is generally recommended by specialists as an initial treatment. However, generalist clinicians can be helpful if properly trained in the right therapies. Medication can help a BPD patient with their symptoms, but it is not generally effective enough on its own as a treatment.
Can BPD be cured without therapy?
There is no cure for BPD. It is a lifelong condition that needs to be continually managed.
BPD would be difficult to recover from without the help of evidence-based therapy. While non-therapy measures like medication and self-care can absolutely help a person’s symptoms, there isn’t much evidence to support that they manage BPD on their own. Overall, therapy can help greatly improve quality of life.
What is the success rate of BPD treatment?
Recovery from borderline personality disorder is possible but difficult, with many patients in recovery also experiencing residual symptoms from the condition. While exact numbers are difficult to find, slightly more than half of the patients with BPD achieved recovery in a 2012 study.
Most people can reduce the severity of their symptoms with proper treatment, even if they cannot achieve complete recovery. It is also possible to lose one’s footing in recovery, which is more likely among certain risk groups. A return to treatment is needed in this case.
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