Treating Borderline Personality Disorder (BPD)

For many people, treatment for BPD includes psychotherapy and medication. Treatments aim to address all symptoms associated with BPD. The goal is to reduce distress, improve your relationships, and boost your quality of life.

Research shows that over 70% of people with BPD experienced childhood trauma, such as physical, sexual, or emotional abuse or neglect, which can leave deep emotional imprints. BPD can cause profound fears of abandonment and rejection.

Other symptoms of BPD can include extreme changes in mood, impulsive behavior, chronic feelings of emptiness, relationship difficulties, and substance use.

BPD can also cause you to see others as entirely good or bad, which is a defense mechanism called “splitting.” You may also have thoughts of self-harm or suicide. And in times of deep distress, people with BPD may harm themselves or attempt suicide.

If you’ve been diagnosed with BPD, you may also experience other mental health concerns, such as depression, anxiety, eating disorders, or attention deficit hyperactivity disorder (ADHD). An effective treatment plan should consider all co-occurring issues, too.

The most effective treatment for BPD is individual psychotherapy and, sometimes, group therapy. Right now, there aren’t any FDA-approved medications for BPD; however, in some cases, antidepressants and mood stabilizers may be helpful.

Researchers have found that several different types of therapy can successfully treat borderline personality disorder.

Mentalization-based treatment

Mentalization-based treatment (MBT) teaches you how to “mentalize,” which involves making sense of other people’s intentions and behaviors in different ways. Individuals with BPD may misread another person’s behavior as hurtful or rejecting, leading to intense emotional reactions and assumptions.

MBT helps you make fewer negative assumptions, which can ease feelings of distress. MBT therapists encourage a “curious” mind, which promotes cognitive flexibility. MBT therapists provide individual and group therapy.

Dialectical behavior therapy

Developed by psychologist Marcia Linehan, PhD, dialectical behavior therapy (DBT) is one of the most researched treatments for BPD. DBT teaches you four skills:

• Mindfulness helps you focus on the present moment and accept yourself and your life circumstances with compassion.
• Distress tolerance helps you get through challenging situations. These skills can include distraction techniques like playing a game on your phone, pleasurable activities like taking a bubble bath, and cognitive exercises like accepting a difficult situation.
• Emotion regulation are tools to help you better handle upsetting emotions like anger, sadness, and feelings of abandonment. For instance, if you’re isolating, your DBT therapist may have you reach out to a friend.
• Relationship skills help you set boundaries, communicate your needs, and build more supportive connections with others.

DBT includes many types of support, including weekly therapy, group therapy, and phone support, and coaching with your therapist.

Transference-focused psychotherapy

Transference-focused psychotherapy (TFP) is a twice-weekly therapy that uses the client-therapist relationship to help you become more aware of your relationship patterns.

TFP therapists believe that the same thoughts, feelings, and behaviors that are present in your personal relationships will also emerge with your therapist. TFP therapists also help you see yourself and others with greater self-compassion.

Schema-focused therapy

Schema-focused therapy (SFT) is a twice-weekly therapy that combines cognitive behavioral therapy (CBT) with psychodynamic and emotion-focused therapy. SFT therapists believe that people with BPD may adopt one of four schemas:

• detached protector
• punitive parent
• abandoned/abused child
• angry/impulsive child

SFT therapists help you alter your “schemas,” which are your thoughts, feelings, and behaviors about the stressful situation. They also focus on “re-parenting,” which means learning to treat yourself with love and compassion as a way of healing childhood trauma.

There isn’t one medication that can treat BPD symptoms, and researchers are still looking at which medications might be most helpful.

So far, mental health professionals have found that certain medications may help treat symptoms such as mood changes, emotional dysregulation, and impulsive behaviors. In addition, medication can often treat mental health conditions like ADHD, depression, and anxiety, which often co-occur with BPD symptoms.

Here are some commonly prescribed meditations:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs, such as Zoloft, Prozac, Celexa, and Lexapro, can treat symptoms of depression and anxiety, which frequently co-occur with symptoms of BPD.

Mood stabilizers

Mood stabilizers, such as Lamictal, Depakote, and Lithium, can treat intense fluctuations of emotions and impulsive behaviors.

Self-care is an essential part of treatment. Finding self-care tools and support systems that work for you can help you feel understood and less alone. Here are some self-help strategies that you can try, if they seem helpful.

Mindfulness

Researchers have found that mindfulness-based practices, such as meditation, can ease symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD).

Here’s a meditation you might consider. If mindfulness interests you, you can also download mindfulness apps or watch mindfulness videos on YouTube.

Journaling

If you enjoy writing, journaling is a way to express your thoughts, feelings, and fears. Naming your emotions can make them feel less scary and overwhelming.

Identify joyful activities

When emotions are intense, turning to joyful or pleasurable activities can help. Identify three activities that bring you joy. You might consider taking a walk, baking, taking a bubble bath, or listening to relaxing music.

Learning about other peoples’ experiences with BPD

It can feel lonely or isolating to live with BPD, especially if you don’t know anyone else living with the condition. Connecting with other peoples’ experiences with BPD might help you feel less alone.

Amanda Webster, for example, was diagnosed with BPD many years ago. With therapy, Amanda has learned to manage her symptoms and hopes to help others. Her YouTube channel is a place where people living with BPD can find peer support and understanding.

MedCircle has a great YouTube interview with a woman named Sammy Grimm on how she manages her BPD. Her boyfriend, Bryan, also makes a cameo appearance to talk about their relationship.

Here’s a blog aimed to reduce the stigma surrounding BPD and provide resources and tools for people living with this mental health concern. This is a great blog post written by someone living with BPD as well.

Psych Central’s Inside Mental Health podcast includes an episode about the stigma associated with BPD and an episode about diagnosis and treatment for this mental health concern.

Shamala Del Rosario is a wife, mother, and grandmother living with BPD. On her podcast, Shamala talks about her recovery, her childhood trauma, and tools for coping with symptoms of this mental health concern.

With many therapies and resources available to treat BPD, living with this mental health condition is more manageable than ever. Taking the first step to talk with a therapist or join a support group may seem scary at first, but treatment and self-care can pay off in the long run.

If you’re living with BPD, finding the right types of resources and support is an important part of your treatment.

Perhaps begin with Psych Central’s myth-busting article to help separate facts from fiction about BPD.

Resources like the National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA) can provide contact info for crisis hotlines and help you find a psychiatrist. The National Alliance on Mental Illness (NAMI) can answer many of the questions you have about living with BPD.

If you’re looking for a therapist, the American Psychological Association has a searchable database of licensed psychologists throughout the United States. Meetup has a list of DBT groups around the world.

The Mental Illness Happy Hour is a weekly podcast hosted by Paul Gilmartin that explores mental health concerns, trauma, substance use, and negative thinking. And on Instagram, Elyse Fox heads up the Sad Girls Club, an inclusive, online group for BIPOC women living with mental health concerns.