Borderline personality disorder affects as many as 6% of adults (about 14 million Americans) at some point in their lifetimes. It affects 20% of patients admitted to psychiatric hospitals and 10% of people in outpatient mental health treatment. While this disorder was only recognized in 1980 by the psychiatric community, ongoing research in the last few decades has provided insightful data and raised awareness.1 Doctors commonly treat symptoms of this disorder with some form of non-medication-based psychotherapy. However, people may also be prescribed medication for borderline personality disorder (BPD).
While the precise causes of BPD are unknown, experts believe a combination of the following are key contributing factors:
Genetics: Although a specific gene has not been identified as a direct cause of BPD, studies on twins suggest the disorder has strong hereditary ties. BPD is about five times more prevalent in people with first-degree relatives with the disorder.
Environmental factors: People who experience trauma during childhood are at an increased risk of developing BPD. This includes physical or sexual abuse as well as neglect or separation from parents.
Brain function: It is thought that the parts of the brain that control emotions and decision-making/judgment may not communicate well with one another in people with BPD. This suggests that there may be a neurological basis for some of the symptoms.2
- Mood swings
- Rage and angry outbursts
- Impulsive thoughts and behaviors
- Extreme sensitivity to rejection
- Severe depression
- Feelings of emptiness or worthlessness
- Thoughts of suicide and self-harm
- Troubled interpersonal relationships
- A tendency to alternate between idealizing and vilifying others
Psychotherapy for BPD
Types of psychotherapy most typically used to address the classic emotion-destabilizing effects of BPD include dialectical behavior therapy, cognitive behavioral therapy (CBT) and psychodynamic psychotherapy. These approaches help affected individuals improve their ability to recognize dysfunctional emotional responses and develop new ones that support everyday functioning and well-being.
Interpersonal Therapy for BPD
Doctors sometimes use an approach called interpersonal therapy or interpersonal psychotherapy (IPT). During this type of treatment, therapists take steps to increase the patient’s ability to communicate effectively in back-and-forth exchanges that characterize social interactions. IPT practitioners rely on improvement of interpersonal function as a pathway to relieving the underlying emotional/psychological distress that commonly forms a core element of serious mental illness.
Medications for Borderline Personality Disorder
A combination of interpersonal psychotherapy and medication may be used because therapy alone often does not sufficiently address BPD symptoms. The most commonly prescribed medication is a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). SSRIs produce beneficial effects by boosting the brain’s levels of serotonin. When serotonin levels in the brain fall, the ability to control mood fluctuations decreases. Conversely, when serotonin levels in the brain rise, the ability to control mood fluctuations increases.
Doctors most typically prescribe SSRIs to treat major depression or other forms of depressive illness such as premenstrual dysphoric disorder. They are also prescribed for obsessive-compulsive disorder (OCD) and eating disorders that manifest with OCD behaviors. In addition, other potential uses for SSRIs include treatment of post-traumatic stress disorder (PTSD), alcohol use disorder (alcoholism/alcohol abuse), and two anxiety-based conditions called panic disorder and specific phobia.
- Fluoxetine (Prozac, Rapiflux)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox CR)
- Escitalopram (Lexapro)
- Paroxetine (Pexeva, Paxil)
The Benefits of Combination Therapy
In a study published in the journal Psychiatry Research in January 2015, a team of Italian researchers analyzed the use of interpersonal therapy and fluoxetine in 27 patients with relatively severe BPD symptoms. The 27 patients allocated to combined therapy were treated for 32 weeks with 20 to 40 mg/day of fluoxetine and interpersonal therapy (IPT-BPD). Pharmacotherapy and IPT were started at the same time with a total of 34 IPT-BPD sessions.3
A 2010 study by the same Italian team concluded that combined therapy with IPT-BPD was superior to fluoxetine respective to three core symptoms of BPD (interpersonal relationships, affective instability and impulsivity), anxiety symptoms and subjective quality of life (subjective perception of psychological and social functioning). The goal of the latter study was to examine key data that predicted the response to combined therapy in the patients assessed in the previous efficacy study. The researchers acknowledged that the findings were limited by the small study size. However, they concluded that patients with more severe BPD and a higher degree of core symptoms (e.g. fear of abandonment, affective instability and identity disturbance) have a better chance to improve with combined therapy with fluoxetine and IPT-BPD.3,4
While some people with BPD are high functioning in specific settings, in private they may experience near constant emotional turmoil. The majority of people with BPD suffer from the core symptoms described above and this can lead to a host of problems such as impulsive or reckless behavior and unstable relationships. There is no need to suffer in silence. Treatment for BPD is just a phone call away, so if you believe you are suffering from BPD or suspect a loved one may have this disorder, contact a mental health professional today.
- An Overview of BPD. NEA.BPD website. http://www.borderlinepersonalitydisorder.com/what-is-bpd/bpd-overview/ Accessed June 10, 2016.
- Borderline Personality Disorder. National Alliance on Mental Illness website. https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder Accessed June 10, 2016.
- Bellino S, Bozzatello P, Bogetto F. Combined treatment of borderline personality disorder with interpersonal psychotherapy and pharmacotherapy: predictors of response. Psychiatry Res. 2015 Mar 30;226(1):284-8. doi: 10.1016/j.psychres.2014.12.064. Epub 2015 Jan 13.
- Bellino S, Rinaldi C, Bogetto F. Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy. Can J Psychiatry. 2010 Feb;55(2):74-81.