Borderline Personality Disorder Treatment (A Guide)
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In this blog post, we will discuss Borderline Personality Disorder treatment.
In the process, we will explain what it means to suffer from Borderline Personality Disorder, diagnostic criteria, signs, causes, and most prescribed drugs.
Borderline Personality Disorder Treatment: Is There a Cure?
There is no miracle pill or cure for Borderline Personality Disorder, but some of the most commonly prescribed drugs are mood stabilizers such as topiramate (Topamax) and lamotrigine (Lamictal), which are medications also referred to as anti-epileptic (used to treat partial complex seizure disorder).
Even though, there are several prescription drugs that serve as “Borderline Personality Disorder Medication”, they are not specific to the disorder and can only help with some of the symptoms.
Most health professionals tend to avoid prescribing medication since there is no specific drug to treat BPD and will only attempt to only lessen some of the symptoms, like depression, anxiety or low self-esteem but will not have a strong effect on symptoms like anger or emptiness.
The medication is prescribed only in cases the patients show strong signs of behavioral changes or if there is a risk it might incur in self-injury.
Most commonly Prescribed drugs:
In most cases of borderline personality disorder treatment, doctors will try to avoid medication unless there are severe symptoms that can’t get relieved using psychotherapy.
However, we list some of the most commonly prescribed medication to treat Borderline Personality Disorder symptoms:
- Quetiapine: is a second-generation antipsychotic medicine mostly used to treat schizophrenia (13 years old or older), this medicine is also used to treat in some cases of bipolar disorder and depression.
- Lithium: it is commonly used to treat depression or manic depression in patients with Bipolar disorder, it can help lessen symptoms related to anger, aggression, lack of sleep, impulsiveness and hyperactivity.
- Lamotrigine: anti-epileptic medication or an anticonvulsant, is mostly used to retard or lessen mood episodes, this is commonly used for patients with Bipolar disorder and can be used in adults and children under specific dosages.
- Risperidone: most used as an antipsychotic medicine that causes a change in the chemical signals in the brain allowing to treat schizophrenia and bipolar disorder.
- Fluoxetine: is an antidepressant that affects certain chemicals in the brain and it is mostly used in people with anxiety, depression and bipolar disorder. Normally this drug gets prescribed when other drugs have been used without major changes in symptomatology.
- Olanzapine: antipsychotic that blocks certain chemicals in the brain, commonly used to treat psychotic episodes and conditions like bipolar disorder, psychosis, and schizophrenia.
- Sertraline: is an antidepressant that affects the serotonin inhibitors in the brain, allowing to balance lessen symptoms related to panic attacks, anxiety, depression, and eating disorders. It’s mostly prescribed to treat post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
Borderline Personality Disorder: What is it?
Borderline Personality Disorder (BPD) can be described as the incapacity to control emotions and situations.
People that suffer or experience BDP feel and experience emotions more intensely and for extended periods of time, without the ability to control their emotions.
This can ultimately lead to stress and severe depression that can last from a couple of hours up to several days.
Border Personality disorder or BPD can be in most cases is characterized by specific signs and symptoms like depression, low self-esteem, impulsiveness, commitment issues, extreme fear of loneliness, explosive aggressiveness (than can lead to suicide attempts) and unpredictable mood swings, leaving them very confused and isolated.
Common symptoms of BPD can be recognized and can be treated with professional help if they are detected and treatment is provided.
People that suffer from borderline personality disorder, can often be misdiagnosed with depression or bipolar disorder due to the similarities and overlap of the symptoms between one condition and the other.
They can be identified by the following seven key behaviors or symptoms and they are:
1. Explosive aggressiveness
If you suffer from borderline personality disorder, you might experience extreme anger and the inability to control it, this can start from simple verbal abuse and elevated tone of voice and can quickly escalate to physical abuse, like breaking things or throwing them, this can continue until you are completely consumed by rage.
The episodes of anger can vary, they can last for a couple of hours up to a few days.
2. Self-injury
This behavior relates to the alarming tendency to cause inflicted wounds and the most common are lacerations or cuts.
Also, there might be verbalizations about suicidal thoughts or suicide attempts.
3. Fear of being alone or abandoned
This is one of the most prominent signs since it can cause a full spectrum of emotions.
They are basically terrified of being left alone or abandoned even in most trivial scenarios.
This can trigger feelings of betrayal, for example, if your partner goes to the store and is taking more time than usual, this will immediately cause an intense panic attack.
This could make the person with BPD adopt certain behaviors like extreme jealousy, being controlling and manipulative, followed by a constant clinginess and conflict, just to keep the other person with them.
4. Severe drug and alcohol abuse:
Often, to cope with the constant mood swings and to escape extreme anxiety and depression, people that suffer from BPD tend to abuse alcohol, drugs or other substances in seeking to partially relieve their emotional pain and distress.
5. Constant feeling of “Emptiness”:
There is always a constant feeling of not being enough or complete, most of the time caused by low self-esteem and fear of commitment, that can be followed by an unusual feeling of detachment, impulsive reactions and loss of the meaning of life.
6. Unstable relationships
People with BPD are prone to suffer from more intense and unstable relationships, their mood swings can make them love their partner and then hate them within a short period of time.
They might believe they don’t deserve you and start disliking them intensively, this is most of the times accompanied by clinginess and feeling that your partner cannot make you whole.
7. Psychotic episodes
There are reported cases of patients suffering auditory hallucinations (hearing voices) or having paranoid delusions that someone is trying to harm them when it is not the case.
This, if not treated, can escalate to severe psychosis.
Borderline Personality Disorder: Diagnostic criteria
Borderline Personality Disorder (BPD) is a complex condition primarily characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and emotions, as well as marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least 5 or more of the following, listed in the DSM-5 as:
- Frantic efforts to avoid real or imagined abandonment; this does not include suicidal or self-mutilating behavior covered in criterion 5.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating); this does not include suicidal or self-mutilating behavior covered in criterion 5.
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
If you think you might have BPD or relate to some of the criteria mentioned above, we advise you to get in contact with a mental health professional (ideally trained in BPD), so he or she can answer all your questions.
Origin of the term “Borderline Personality Disorder”
It was first described by Adolf Stern in 1938.
He first used it to refer to a group of patients whose conditions got worse during therapy and displayed psychic rigidity (seemed to be a protective mechanism against perceived changes in the environment or itself) and masochistic behavior.
This term was later expanded by Otto Kernberg in the late 1960s and 1970s.
How does Borderline Personality Disorder DSM-5 get diagnosed?
Since there are no specific laboratory tests or imaging tests that can help to identify this condition, the diagnosis is based on the symptoms that tend to appear in multiple contexts and have been present since adolescence or early adulthood.
There are some structured and semi-structured interviews used by mental health professionals to assist in making the diagnosis.
One of the most used and validated interview tools is the Diagnostic Interview for Borderline (Revised), which includes 97 items rated according to thoughts, feelings, and behaviors reported by the individual over a two-year period.
It is important to take into consideration that borderline personality disorder is most commonly misdiagnosed as:
- Bipolar Disorder
- Histrionic personality disorder or narcissistic personality disorder
- Mood and anxiety disorders
- Substance abuse disorders
- Posttraumatic stress disorder
Causes
- It has been said that stress during childhood may contribute to developing this condition.
- A history, during childhood, of physical and sexual abuse, neglect, separation from caregivers, or the loss of a parent is common among patients with borderline personality disorder.
- Genetics has been identified as a risk factor since some people are predisposed genetically to inherit the possibility of developing the condition.
- First-degree relatives of patients with borderline personality disorder are 5 times more likely to have the disorder than the general population.
- Brain chemistry imbalances during regulatory functions of the brain and neuropeptide systems may also contribute even though it hasn’t been identified in all borderline personality disorder individuals.
Treatment for BPD
Borderline personality disorder can be treated in various ways, but a differential diagnosis needs to be made to avoid overlapping symptoms and misdiagnosing (Bipolar disorder or severe depression).
The treatment will be administered by a licensed and trained psychiatrist, psychologist or mental health professional.
Additionally, support from family and friends is highly recommended to increase therapeutic success.
The preferred method and the most frequent would be Psychotherapy (cognitive-behavioral therapy) often combined with medication.
Why is this blog post about “Borderline Personality Disorder Treatment” important?
This blog is important because it provides a better understanding of the diagnostic criteria for Borderline Personality Disorder according to DSM 5, potential causes that contribute to developing BPD, current treatment options and Borderline Personality Disorder Medications.
Borderline personality disorder can affect a person’s daily interactions in several ways, causing unstable interpersonal relationships, anger, depression (feelings of emptiness) and they can even try to isolate themselves in thinking there is no one that can actually understand them.
Frequently Asked Questions for Borderline Personality Disorder Treatment (FAQs)
What medication is usually prescribed for borderline personality disorder?
The most used and prescribed drugs belong to the mood stabilizers category (like topiramate or lamotrigine and valproate semisodium).
These medications have shown to be effective in treating aggressive behavior in BPD.
Can BPD be treated with medication?
There are some medications that help BPD symptomatology (like mood stabilizers) but there isn’t any drug specifically made and prescribed for BPD.
Do mood stabilizers work for BPD?
Mood stabilizers have been prescribed t BPD patients to help with symptoms related to anger, irritation, depression, among others.
Is BPD worse than bipolar?
BPD is not better or worse than Bipolar disorder.
They belong to different categories, BPD is categorized as a personality disorder and Bipolar disorder is classed as a mood disorder.
However, they both can have suicidal thoughts and are at a higher risk of suicide than the general population
Do antidepressants help borderline personality disorder?
There are some studies that have demonstrated the effectivity of certain types of antidepressants in treating BPD related symptoms.
For example, SSRIs can be prescribed to reduce emotional instability, impulsivity, self-harm behaviors, and anger.
Recommended Reading
- When Your Mother Has Borderline Personality Disorder: A Guide for Adult Children
- Borderline Personality Disorder: Understanding Borderline Personality Disorder, and how it can be managed, treated, and improved
- Borderline Personality Disorder: The Ultimate Borderline Personality Disorder Survival Guide How To Live With Someone With BPD With Your Sanity Intact
- The Stronger Than BPD Journal: DBT Activities to Help You Manage Emotions, Heal from Borderline Personality Disorder, and Discover the Wise Woman Within
- Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder
References
- ROY H. LUBIT. Medscape [online]: What are the DSM-5 diagnostic criteria for borderline personality disorder (BPD)? Accessed: December 5th of 2019
- NCBI: Diagnosing Borderline Personality Disorder.
- NHS
- Borderline personality disorder Demystified
- Mayo Clinic
- US national library of medicine
- Harvard Medical School
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