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Borderline Personality Disorder Treatments & Medications
Living with Borderline Personality Disorder? Or have a loved one who does? Learn about different Borderline Personality Disorder treatment options, home remedies and compare Borderline Personality Disorder medications.
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Borderline Personality Disorder
Borderline Personality Disorder Treatments and Medications
Medically reviewed by Raymond Zakhari, DNP, EdM, NP-BC
Last Updated: 10/05/2020
What is borderline personality disorder
Living with impulsive behaviors, unstable moods, distorted self-image, and suicidal behavior can be extremely difficult to deal with. These are just some of the symptoms that characterize borderline personality disorder (BPD), which affects up to 1.4% of people living in the United States. People with BPD have difficulty regulating their emotions and are easily triggered into intense emotional episodes. They also have great difficulty stabilizing themselves after a flare-up or emotional episode.
People with borderline personality disorder are easily triggered by anything that makes them feel abandoned, rejected, or criticized. This could be anything from a fight with a spouse to a friend not returning a phone call. The triggering event then causes the person to experience a drastic shift in mood which could result in anger, impulsivity, substance abuse, self-harm, or other self-destructive behaviors.
Borderline personality disorder is often treated with a combination of psychotherapy and medication. Hospitalization may be necessary in extreme situations if someone is attempting self-injury or making suicide attempts.
BPD can sometimes be underdiagnosed or misdiagnosed as bipolar disorder. Doctors and researchers are always searching for new ways to ensure that people are properly diagnosed, because this means that treatment will be accurate and successful.
Beyond proper diagnosis, doctors and researchers are also searching for new treatment options for borderline personality disorder. The principal investigator on a National Institute of Mental Health study, Dr. Mary Zanarini, is looking into a new treatment called psychoeducation. New treatment options will hopefully bring new relief to those living with the intense emotions and symptoms of BPD.
It takes proper diagnosis and a good treatment program to bring relief to people living with BPD. This guide gives an overview of borderline personality disorder medications that a health-care provider may prescribe or recommend to treat BPD.
Borderline personality disorder diagnosis
Anyone can experience borderline personality disorder, though people who’ve had traumatic childhoods, women, or people who have a family member with BPD have a higher risk of developing the disorder.
Borderline personality disorder is similar to bipolar disorder in many ways, and can therefore be difficult to diagnose. This article in Psychiatric Times explains the importance of correctly diagnosing BPD separately from bipolar disorder. A psychiatrist or other mental health professional will conduct a comprehensive clinical interview to diagnose BPD, and then determine the best treatment option from there.
A mental health professional may ask the following questions to help confirm a diagnosis:
Is there a history of mental illness in your family?
Do you have thoughts of suicide?
How would you describe your childhood?
Are your symptoms continuous or sporadic?
Do you use any drugs or alcohol?
Borderline personality disorder treatment options
Borderline personality disorder symptoms are most effectively and commonly treated with a combination of psychotherapy and medication. This combination of therapy and medication doesn’t treat borderline personality disorder itself, but treats the symptoms associated with it. Some people with BPD may supplement psychotherapy and medication with natural remedies to help manage the emotional symptoms of BPD. The right course of treatment depends on the individual and that person's specific symptoms.
Psychotherapy can include individual therapy, mentalization-based therapy (MBT), cognitive behavioral therapy (CBT), and dialectical behavior therapy (DBT), to name a few. The objective with psychotherapy is to teach people how to understand and manage their behavioral symptoms and improve their distress tolerance. Therapy tends to be very effective at preventing flare-ups and episodes that come with BPD. A counselor or therapist can help someone learn what triggers them and how to move through a triggering situation. Different types of psychotherapy focus on different things, and may have varying results.
Medications are often prescribed along with psychotherapy to help alleviate emotional symptoms. Anticonvulsants, antidepressants, and antipsychotics are all classes of drugs commonly used (off label, as no medications have FDA indications specifically for any personality disorder) to treat BPD. There is not one single drug that can cure borderline personality disorder, but a mental health professional can determine which drug will best treat someone’s symptoms.
Some natural and home remedies such as meditating and getting enough sleep may help people reduce symptoms associated with BPD such as anger, mood swings, and impulsivity. It’s important to talk with a therapist or counselor to determine the right type of therapy for you.
Borderline personality disorder medications
There is not one single medication approved by the FDA for BPD treatment. Anticonvulsants, antidepressants, and antipsychotics are typically prescribed to help treat and manage borderline personality disorder symptoms. A health-care professional can determine the proper dosage and form of medication on a case-by-case basis.
BPD Medication: Treating Borderline Personality Disorder Symptoms
BPD medication can help manage certain symptoms of borderline personality disorder. Learn more about mood stabilizers and other treatment options.
Types of BPD Medications
By Kristalyn Salters-Pedneault, PhD Updated on February 14, 2022
Medically reviewed by Daniel B. Block, MD
sturti / Getty Images
Table of Contents VIEW ALL Reasons for Use Types Side Effects Challenges Precautions
There is currently no borderline personality disorder (BPD) medication specifically approved by the Food and Drug Administration (FDA). However, some drugs have been found to be effective in some cases of BPD.1
BPD is sometimes treated with medications for anxiety or depression, for instance, which may reduce some symptoms. Medications may also be used to treat psychological conditions that frequently co-occur with this condition, such as major depressive disorder.
Medications are often used in conjunction with psychotherapy and other treatments rather than being a stand-alone option.2 Learning more about different borderline personality disorder medications can help you find the right one for you.
Why Use BPD Medication?
There are a number of reasons why people may want to try medications for borderline personality disorder. The important thing is to always work with your doctor to determine which medication options might be right for you based on your symptoms and needs.
BPD medication may help:Reduce symptom severity: Medications may help people better manage some of the symptoms of BPD, such as mood swings, irritability, depression, anxiety, and stress-related paranoia.Improve functioning: Because medications may make some symptoms less severe, they might also help improve functioning in areas including relationships and daily living.Prevent worsening of symptoms: Some symptoms of BPD may grow worse if left untreated, so taking medication to improve those symptoms may be helpful. Research has found that BPD symptoms do tend to decline in frequency and severity as people age.3Treat co-occurring conditions: Borderline personality disorder often co-occurs with other conditions that can interact, overlap, and make it more difficult to accurately diagnose BPD. Conditions that commonly co-exist with BPD include depression, anxiety disorders, eating disorders, substance use disorders, and bipolar disorder.4Decrease risk of suicide: BPD is associated with an increased risk of self-harm and suicide.4 Because medications may help reduce symptom frequency and severity, they may also lessen this risk.Improve treatment adherence: Not only do some medications ease BPD symptoms, but they can also make it easier to engage in other forms of treatment for BPD, such as psychotherapy.5
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Types of BPD Medication
There is no medication that specifically treats BPD. However, there are several types of medications that may be useful for treating BPD symptoms. The type of medication that your doctor prescribes will depend on your specific symptoms and needs.
Antidepressants were developed for people with major depressive disorder and other disorders characterized by low mood. But many people with BPD are treated with these medications as well.1
There are many types of antidepressants that have been studied for use with BPD. These include tetracyclic and tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs).6
Common antidepressants include:
Nardil (phenelzine) Prozac (fluoxetine)
These medications may help with sadness, low mood, anxiety, and emotional reactivity, but do not seem to have a strong effect on other BPD symptoms (e.g., anger, impulsivity).
The term "borderline" was coined because early psychiatrists believed that the symptoms of BPD were "on the border" between neurosis and psychosis. For this reason, some of the first medications tested for BPD were antipsychotics.
Antipsychotic drugs can have a positive effect on a variety of non-psychotic disorders, including BPD. They have been shown to reduce anxiety, paranoid thinking, anger or hostility, and impulsivity in patients with BPD.1
Common antipsychotics include:
Medications with mood-stabilizing properties and some anticonvulsant or anti-seizure medications have been used to treat the impulsive behavior and rapid emotional changes associated with BPD. And research suggests that these classes of drugs seem to be commonly used in people with BPD.7
Common anticonvulsants and mood stabilizers for BPD include:
Borderline personality disorder: current drug treatments and future prospects
Individuals with borderline personality disorder (BPD) suffer from marked affective disturbance, an unstable sense of self, difficulty in interpersonal relationships and heightened impulsivity, leading to high rates of self-harm and suicide. Patients ...
Ther Adv Chronic Dis. 2010 Mar; 1(2): 59–66.
PMCID: PMC3513859 PMID: 23251729
Borderline personality disorder: current drug treatments and future prospects
Bayanne Olabi and Jeremy Hall
Author information Copyright and License information Disclaimer
This article has been cited by other articles in PMC.
Individuals with borderline personality disorder (BPD) suffer from marked affective disturbance, an unstable sense of self, difficulty in interpersonal relationships and heightened impulsivity, leading to high rates of self-harm and suicide. Patients are often refractory to treatment and are at high risk for acute or dangerous presentations, with a serious impact on mental health services. There has been much debate on the effectiveness of pharmacotherapy in treating different facets of the psychopathology of the disorder. Several guidelines recommend the use of antidepressant agents, mood stabilizers for affective dysregulation and impulsive-behavioural dyscontrol, and antipsychotics for cognitive-perceptual symptoms. However, concerns have recently been raised regarding the strength of evidence for these treatment recommendations in BPD. Here, we review the evidence for efficacy of the main psychotropic medications used in BPD, drawing, in particular, on evidence from randomized controlled trials and meta-analyses. Overall, meta-analysis provides little evidence to support the use of antidepressant medication in BPD outside episodes of major depression. However, there is evidence for the use of both mood stabilizers and antipsychotic medications for the treatment of specific aspects of the disorder. Most existing studies have been conducted on small numbers of patients, and there is a requirement for further large-scale trials to substantiate these findings. In addition, given the limitations of current pharmacological treatment of BPD, there is a pressing need to investigate potential new therapeutic targets, including neuropeptides, such as the opioids and vasopressin, and drugs targeted at ameliorating the biological effects of early life stress.Keywords: antidepressants, antipsychotic medications, borderline personality disorder, mood stabilizers, epigenetics
Borderline personality disorder (BPD) is a common and disabling psychiatric condition. Epidemiological studies suggest that 2% of the general population have BPD, and the condition is diagnosed in up to 15% of psychiatric inpati-ents and 50% of inpatients with a diagnosis of personality disorder [Torgersen et al. 2001; Widiger and Weismann, 1991]. BPD is a clinically heterogeneous condition, encompassing disturbances of affective regulation and impulsivity [Links et al. 1999], with symptom clusters of impulse-behavioural dyscontrol, cognitive perceptual symptoms and disturbed interpersonal interrelatedness [Skodol et al. 2002; American Psychiatric Association, 2001], as well as associated affective states including depression, anxiety, anger and tension [Coid, 1993]. Research on the management of BPD has been challenging; the multifaceted nature of the disorder [Clarkin et al. 1983] and comorbid diagnoses [Zanarini et al. 1998a, 1998b], mitigate against homogeneity in patient cohorts. In addition, heterogeneity in outcome measures and methodology across clinical trials mean that treatment efficacy is often difficult to assess [Mercer et al. 2009; Binks et al. 2006].
There is evidence that long-term psychotherapy can be a useful form of treatment in those with BPD [Zanarini, 2009; Davidson et al. 2006], and it is often preferred to pharmacological treatment due to reports of the limited efficacy of drug therapy [Zanarini, 2004]. Despite this, pharmaco-therapy has been recommended as an adjunctive, symptom-targeted component of treatment [Oldham et al. 2004; American Psychiatric Association, 2001]. Previous meta-analyses have concluded that pharmacotherapy could exert a beneficial effect on certain core traits of BPD [Lieb et al. 2010; Mercer et al. 2009; Binks et al. 2006; Nose et al. 2006] and there is a growing body of evidence that different classes of agents, such as antidepressants, mood stabilizers, antipsychotics and neuroleptics, can be used in the treatment of specific symptoms [Abraham and Calabrese, 2008; Binks et al. 2006; Nose et al. 2006]. Polypharmacy is common [Lieb et al. 2004; Zanarini et al. 2001] but the use of multiple drugs is not evidence based, and is likely to reflect the failure of any one agent to provide adequate symptom amelioration.
A number of studies have been conducted to assess the efficacy of various medications in the management of patients with BPD. Here, we present a summary of randomized clinical trials (RCTs) of antidepressants, antipsychotics and mood stabilizers for the treatment of BPD.
Pharmacotherapy for BPD
There is strong evidence that depressive symptoms are common in individuals meeting criteria for BPD. Previous studies have reported comorbidity rates between BPD and major depressive disorder of up to 61% [Comtois et al. 1999], with this figure rising to as high as 98% in hospitalized inpatients prior to treatment [Zanarini et al. 2003]. The suggestion that BPD is an atypical form of affective disorder led researchers to investigate the use of therapies aimed at treating the mood disorder in BPD [Kroll and Ogata, 1987]. The use of antidepressants in the management of BPD has been investigated for decades, and evidence supporting their effectiveness in treating BPD has ranged from case reviews [Pinto and Akiskal, 1998] to double-blind, randomized and controlled trials [Simpson et al. 2004; Rinne et al. 2002; Coccaro and Kavoussi, 1997; Soloff et al. 1993; Parsons et al. 1989; Cowdry and Gardner, 1988].