Treatment of Borderline Personality Disorder
"“The role of the therapist is to reflect the being/accepting self that was never allowed to be in the borderline.”
― Michael Adzema
Overwhelming emotions can cloud your judgment and lead to hurtful words or risky behaviors, causing guilt and shame later on. Breaking free from this cycle is possible with BPD treatments and coping strategies to regain control over your thoughts, emotions, and actions.
Dialectical Behavioral Therapy (DBT)
DBT, developed by Marsha Linehan, is a highly recognized and extensively studied treatment for BPD. It integrates dialectics and validation strategies to help individuals acquire skills and shape behaviors. DBT believes that BPD symptoms and clinical features stem from high emotional sensitivity in individuals and invalidating environments that fail to address their vulnerabilities effectively.
DBT suggests that people with BPD can improve how they handle their emotions and relationships by learning skills that boost mindfulness, help them cope with distress, regulate their emotions, and navigate interactions with others.
Other Therapeutic Approaches
Several forms of therapy have proven to be highly effective in treating several mental health conditions and disorders. Some focus on specific goals, while others offer a change in perspective to treat specific disorders. Although DBT has been proven to be the best form of treatment for individuals with BPD, these other modalities can also offer evidence-based approaches to address clinical features and symptoms of BPD and co-morbidities.
Cognitive Behavioral Therapy
Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen our emotional difficulties, depression, and anxiety. CBT focuses on identifying 'core beliefs', and combating negative core beliefs. This therapy centers on establishing problem solving skills and showing patients how to cope with their problems in a more positive manner. CBT focuses on giving patients the tools they need to return to their daily routines.
Eye-Movement Desensitiation and Reprocessing Therapy (EMDR)
EMDR is a structured therapy primarily used to treat traumatic experiences and distressing memories. It involves different stages and follows a specific protocol:
Preparation: The therapist starts by assessing the client's history, trauma, and current symptoms.
Assessment: The therapist and client choose a specific traumatic event or distressing memory to focus on during the session.
Desensitization: During this phase, the client holds the traumatic memory in mind while experiencing bilateral stimulation, which can be achieved through eye movements, auditory tones, or tapping.
Reprocessing: In this stage, the client focuses on the traumatic memory while engaging in bilateral stimulation. The therapist encourages the client to notice any spontaneous associations, thoughts, images, or insights that arise.
Installation: After the client's distress related to the defined trauma decreases, the therapist assists in establishing positive beliefs that are more adaptive and accurate, countering the negative beliefs associated with the memory.
Body Scan: The therapist guides the client in conducting a body scan to identify any remaining tension or discomfort linked to the memory.
Closure: To end each session, the therapist ensures the client is emotionally stable and provides grounding techniques or coping strategies to manage any residual distress that may arise outside of therapy.
Re-evaluation: In following sessions, the therapist evaluates the progress made and identifies any new targets that require attention.
Narrative Therapy
Narrative therapy is a type of counseling that sees individuals as seperate from their issues and harmful actions. This approach enables clients to create space from their challenges, aiding them in recognizing how these issues may be serving a purpose of protection rather than harm.
A therapist may utilize several techniques in narrative therapy, such as 'Telling One's Story (Putting Together a Narrative)', Externalization Technique, Deconstruction Technique, Unique Outcomes Technique, and Existentialism.
Structural Family Therapy
The main goal of structural family therapy is to create or restore healthy boundaries and improve communication within the family. The therapist works towards restructuring the family dynamics by addressing alliances, boundaries and rules/hierarchy.
A therapist conducting structual family therapy may utilize techniques such as Joining, Family Mapping, Creating Boundaries, Highlighting and Modifying Interactions, Reframing, Unbalancing, Enactment and Family Sculpting.
Transference-Focused Psychotherapy (TFP)
TFP primarily addresses the challenging interpersonal dynamics in a person's life and the intense emotions that result from them. These dynamics become apparent during interactions with the therapist, known as transference, and are explored together to resolve the splits between positive and negative aspects that contribute to emotional and relational instabilities.
TFP aims to facilitate change by assisting patients in developing a more balanced, integrated, and cohesive understanding of themselves and others.
Schema-Focused Therapy (SFT)
Schema-focused therapy (SFT) is a type of therapy that aims to bring about structural changes in a person's personality. It combines various techniques, such as behavioral, cognitive, and experiential approaches, to address the therapeutic relationship, daily life, and past traumatic experiences.
SFT emphasizes the importance of the bond between therapist and client. The therapy specifically targets four schema modes associated with borderline personality disorder: detached protector, punitive parent, abandoned/abused child, and angry/impulsive child. The goal of SFT is to modify negative patterns of thinking, feeling, and behaving, and to develop healthier alternatives that empower the individual to regain control over their life.
Psychopharmacology
Recent studies show that mood stabilizers like topiramate, valproate, and lamotrigine, as well as second-generation antipsychotics such as olanzapine and aripiprazole, along with omega-3 fatty acids, can help manage affective symptoms and impulsive behaviors in patients with Borderline Personality Disorder.
Second-generation antipsychotics (SGAs) and serotonergic antidepressants have shown effectiveness in addressing various core symptoms of BPD, such as mood swings, anxiety, and impulse control issues.
Atypical antipsychotics may also be beneficial in managing psychotic and dissociative symptoms in individuals with BPD, while specific antiepileptic medications can be helpful in treating mood instability, impulsivity, and anger in some cases.
There is currently no approved medication for BPD, so clinicians must thoroughly evaluate the advantages and disadvantages of drug therapy. Additional research is necessary to determine personalized treatment approaches, taking into account the diverse nature of BPD and potential coexisting conditions.
Second Generation/Atypical Antipsychotics
Examples: Olanzapine, Aripiprazole (Abilify), Clozapine, Quetiapine (Seroquel), Geodon, Risperidone, Latuda,Invega, Rexulti, etc.
These medications are used to decrease mood swings, psychosis, mania, severe aggression, depression, agitation, or tics. They are commonly used instead of typical antipsychotics because they typically cause less severe side effects.
Serotonergic Antidepressants (SSRIs)
SSRI Examples: Citalopram, Fluoxetine (Prozac), Celexa, Zoloft, Lexapro etc.
SSRIs help with depression by boosting serotonin levels in the brain, a neurotransmitter that communicates between nerve cells. By preventing serotonin reabsorption into neurons, SSRIs increase the amount of serotonin for better communication between brain cells.
SSRIs are selective in targeting serotonin specifically, distinguishing them from other neurotransmitters.
Norpinephrine and Dopamine Reuptake Inhibitors (NDRI)
Example: Burproprion (Wellbutrin)
These antidepressants work by blocking transporter proteins, allowing more norepinephrine and dopamine to stay active in the brain, potentially alleviating depression symptoms over time. This is achieved by preventing the reuptake of these neurotransmitters into the cells that released them.
Wellbutrin is the only used NDRI to treat depression in the US, but Ritalin is also an NDRI - commonly used to treat ADD/ADHD.
Antiepileptic Medications & Mood Stabilizers
Examples: Lithium, Valproate, Topiramate, Depakote, Gabapentin, Lamotrigine (Lamictal), etc.
Antiepileptic Drugs have been found to aid in the treatment of
Impulsivity, aggression and impulse control, commonly found in Cluster B Personality Disorders.
While BPD is not classified as a mood disorder, mood instability is a significant aspect of the condition. Therefore, mood stabilizers may help manage symptoms by reducing mood swings, impulsivity, and associated disorders.