By: Andrew Hopkins, PA-C
What is Borderline Personality Disorder?
Borderline Personality Disorder, or BPD, is a mental illness that is accompanied by many signs and symptoms. Those with BPD may experience abrupt changes in mood, or “mood swings.” They may also have difficulty creating and maintaining relationships. People with BPD may question their self-worth and identity, often leaving them feeling “empty.” These individuals are more likely to be overcome with emotion, making it difficult to make clear and logical decisions. They may be described as “impulsive,” as they may be more likely to take part in risky behaviors with potentially dangerous consequences (i.e. reckless driving, sexual promiscuity, drug use, gambling). In an effort to control emotions and stabilize their mood, individuals with BPD often engage in cutting, or other forms of self-injury. They may also experience frequent thoughts of suicidality, but it is important to note that Borderline Personality Disorder is not the same thing as Depression or Bipolar Disorder.
There is no blood test to diagnose BPD. This diagnosis is only made clinically, meaning that it requires a thorough discussion of symptoms and mood history with a clinical professional (such as a therapist, psychologist, or psychiatrist).If there is suspicion for BPD, referral to a clinician with experience in this field may be helpful to quickly and accurately make a diagnosis. Historical symptoms, observed behavior, and discussion with friends and loved ones may help to diagnose BPD.
Am I alone?
The prevalence of BPD is estimated to be between 1.6 and 5.9 % of the general American population.1,2 It appears to affect both men and women equally. Based upon the available evidence, there does not appear to be a strong connection between BPD and ethnicity.1
Why do I have BPD?
The exact cause of BPD remains unknown. However, there appear to be a number of important factors which lead to the development of symptoms. Most of the available evidence suggests the development of BPD is due to genetic, neurobiologic, and psychosocial factors.3
Studies on twins suggest an underlying genetic component to BPD.4,5 Other studies suggest structural and chemical abnormalities within the brain as a possible contributing factor.6,7 Further research is needed to determine specific causal risk factors.
Is there treatment for BPD?
Psychotherapy is the first-line treatment for individuals with BPD. Specifically, Dialectical Behavioral therapy, or DBT, has been shown to be effective in reducing anger and suicidal thoughts.8 DBT has also been shown to be effective in reducing suicide attempts, use of the Emergency Room and need for Psychiatric Hospitalization.9 While there are various forms of effective Psychotherapy for BPD available, a 2012 systematic review and meta analysis showed that “DBT was the most robustly supported by clinical trials”.8
What about medicine?
Psychotherapy remains the first-line treatment for BPD. While medicine can be used in addition to therapy, it should not be considered the as the first step in treatment. Medication for BPD is more likely to achieve reduction of symptoms rather than remission; Therefore, the goal of medicine is to lessen symptoms of BPD while psychotherapy does the “heavy-lifting”.10-17 The use and benefit of medication in BPD, although shown in research, is “off-label.” The Food and Drug Administration (FDA) has not formally approved any medication for the treatment of BPD.
Based upon available evidence, three classes of medication have been shown to be effective for symptoms of BPD: Antidepressants, Mood-Stabilizers, and Anti-Psychotics. There are no head-to-head studies proving superiority amongst these three classes. Choosing which medication class to use relies on carefully evaluating the potential benefits of the medicine versus the potential risks. It is also critical to have a discussion on the limits of what medication can do in BPD, so as not to set unrealistic expectations.
Medicine at Potomac Behavioral Solutions
Potomac Behavioral Solutions offers both DBT and Medication for the treatment of BPD. We aim to offer the most effective treatment for BPD, and this includes using medication in certain circumstances. If you are seeking treatment for BPD and you are curious if medication is right for you (or if you are looking to discontinue medication), it may be helpful to schedule an appointment with one of our Medication Providers in order to explore all of your options.
Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69:533.
Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006; 63:757.
American Psychiatric Association Practice Guidelines. Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. Am J Psychiatry 2001; 158:1.
National Institute for Health and Clinical Excellence. Borderline Personality Disorder: Treatment and Management. 2009. http://www.nice.org.uk/CG78 (Accessed on February 10, 2010).
Nosè M, Cipriani A, Biancosino B, et al. Efficacy of pharmacotherapy against core traits of borderline personality disorder: meta-analysis of randomized controlled trials. Int Clin Psychopharmacol 2006; 21:345.
Mercer D, Douglass AB, Links PS. Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms. J Pers Disord 2009; 23:156.
Herpertz SC, Zanarini M, Schulz CS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry 2007; 8:212.