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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 BPD 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.
Anticonvulsants
Anticonvulsants work by helping to stabilize moods and impulsive behavior. Common side effects of anticonvulsants include changes in vision, unusual behavior, and allergic reaction. Some commonly prescribed anticonvulsants include:
Antidepressants/Anxiolytics
Antidepressants can help people with borderline personality disorder experience relief from symptoms such as emotional reactivity, depression, and anxiety. Taking an antidepressant may come with certain side effects, allergic reaction, or unusual bleeding. Here’s a list of antidepressants sometimes used to treat BPD:
- Fluvoxamine
- Prozac
- Zoloft
- Lexapro
Antipsychotics
Antipsychotics are used to treat borderline personality disorder because they help reduce impulsive behavior, anger, anxiety, and other similar emotions that result from BPD. Common side effects associated with antipsychotics include unusual behavior, seizures, uncontrollable muscle movements, and blurred vision. Here are some popular antipsychotic drug brand names:
What are the best medications for borderline personality disorder?
There is no one universal BPD medication that’s best for everyone. Individual symptoms and responses to treatment vary. A doctor can determine the best medication for BPD based on an individual’s symptoms, medical history, and response to treatments. Here’s an overview of popular medications that a doctor may prescribe.
| Best medications for borderline personality disorder | ||||
|---|---|---|---|---|
| Drug name | Drug class | Administration route | Standard dosage | Adverse effects |
| Abilify (aripiprazole) | Antipsychotic | Oral Intramuscular, and long acting injectable | 5-30 mg taken orally once per day | Allergic reaction, compulsive behavior, unusual behavior, seizures |
| Carbatrol(carbamazepine ER) | Anticonvulsant | Oral | 200 mg taken twice daily | Blurred or double vision, behavioral changes, allergic reaction, unusual bleeding |
| Fluvoxamine maleate | Antidepressant | Oral | 100 mg tablet taken as directed by a healthcare professional | Seizures, unusual behavior, allergic reaction, uneven heartbeat |
| Haloperidol | Antipsychotic | Oral Intramuscular, and long-acting injectable | 0.5-5 mg tablet taken 2-3 times daily as directed by a healthcare professional | Seizures, uncontrollable muscle movements, blurred vision |
| Lamictal (lamotrigine) | Anticonvulsant | Oral | 25 mg taken orally once per day to start | Nausea, skin rash, unusual behavior, blurred vision |
| Zyprexa (olanzapine) | Antipsychotic | Oral | 10 or 15 mg taken once per day as directed by a healthcare professional | Unusual behavior, uncontrollable muscle movements, confusion |
| Topamax (topiramate) | Anticonvulsant | Oral | 25 mg taken twice daily to start | Changes in vision, confusion, behavioral changes |
A prescribing mental health professional determines the best dosage based on medical conditions, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are some common side effects of borderline personality disorder medications?
As with any medication, there are always potential side effects, and adverse effects. Common side effects associated with borderline personality disorder medications include changes to behavior, confusion, involuntary and uncontrollable muscle movements, vision problems, and seizures. Contact your doctor or pharmacist if your side effects persist or worsen.
Borderline personality disorder medications may cause allergic reactions that result in hives or difficulty breathing. Allergic reactions can be life-threatening. You should seek immediate medical care if you believe you are experiencing an allergic reaction.
This list of side effects is not comprehensive. Ask a healthcare professional for more details regarding the possible side effects of a particular medication.
Home remedies for borderline personality disorder
Many people rely on home remedies and natural treatments to help treat their borderline personality disorder. Certain lifestyle changes may help prevent BPD from worsening. Home remedies, natural treatments options, and lifestyle changes are all ways that people who have BPD can try to reduce their symptoms. Many natural supplements are not approved by the FDA. Here are some popular home and natural remedies for borderline personality disorder:
- Going to therapy or counseling. Seeking talk therapy or counseling is one way people learn important coping skills to address their borderline personality disorder. A therapist can help someone manage destructive thoughts and behavior. Even talking with a loved one can help with feelings of emptiness and other symptoms of borderline personality disorder.
- Taking a bath with Epsom salts. Taking a bath can help with symptoms of anxiety and sleeplessness that may make BPD symptoms worse, which could help alleviate things like migraines and depression that are associated with BPD.
- Getting enough sleep. Getting enough quality sleep has been shown to help with symptoms of anxiety and depression that people with borderline personality disorder experience. Things to help get a good night's sleep include making your bedroom dark and slightly cool, having a set bedtime each night, taking a relaxing bath or journaling before bed.
- Managing depression and anxiety. Depression and anxiety are commonly associated with borderline personality disorder. Working to reduce stress, anxiety, and symptoms of depression can be really beneficial. Exercising regularly, eating a healthy diet, seeking counseling, and meditating are all really good ways to help manage depression and anxiety.
Frequently asked questions about borderline personality disorder
What medication is usually prescribed for borderline personality disorder?
Borderline personality disorder is often treated with anticonvulsants, antidepressants, or antipsychotics. There is no medication that is best for treating BPD. The type and amount of medication prescribed will depend on the individual’s symptoms The following medications are commonly used to treat distressing symptoms of BPD:
What triggers a person with borderline personality disorder?
There are many things that can potentially trigger someone with borderline personality disorder into an episode. Interpersonal relationship problems (such as perceived abandonment) are a common trigger. Getting into an argument with a spouse, relative, friend, or coworker can be highly stressful for someone with BPD. Other common triggers include rejection, losing a job, ending a relationship, or reliving negative memories.
Can BPD be cured?
Borderline personality disorder is a complex disorder to live with and treat. It is among the most treatable personality disorders, and symptoms can be greatly reduced with consistent therapy. It can’t be cured entirely, but can be well managed and treated. According to the National Alliance on Mental Illness, most people respond well to comprehensive treatment that includes medication and psychotherapy. Natural and home remedies are also used in conjunction with more traditional treatment options to help manage symptoms.
Do mood stabilizers work for BPD?
Mood stabilizers can help manage common symptoms like mood shifts, irregular emotional responses, and impulsivity. Mood stabilizers can’t fix BPD alone and are often used as part of a comprehensive treatment plan that includes psychotherapy.
Is BPD worse than bipolar?
Borderline personality disorder and bipolar disorder (BPAD) are sometimes confused, or thought of as being the same condition. Borderline personality disorder is a personality disorder, and bipolar disorder is a type of mood disorder. People with BPD experience ongoing, varying moods and behaviors. It’s possible for people who have bipolar disorder to go long periods of time without symptoms with proper treatment. Borderline personality disorder could potentially be considered worse than bipolar disorder because those with BPD don’t experience as much stability between episodes. Both disorders are serious conditions and require appropriate medical attention.
Related resources for borderline personality disorder
- Harvard Health Publishing on treating borderline personality disorder
- Diagnosing and treating borderline personality disorder
- Patients with bipolar and borderline personality disorder
- American Psychiatric Association on personality disorders
- National Alliance on Mental Illness on borderline personality disorder