Harvard Mental Health Letter

Treating borderline personality disorder

Borderline personality disorder (BPD) is a challenge to treat not only because it is complicated and stigmatized, but also because its symptoms reflect ingrained patterns of thinking and behavior. Although it is heterogeneous in nature, causing different clusters of symptoms in different people, the disorder has three major clinical components: a fragile sense of self that impairs relationships with other people, impulsiveness, and emotional volatility. Many patients with BPD also have other mental health problems, such as a mood disorder or post-traumatic stress disorder. Drugs may be moderately helpful at reducing particular symptoms, such as depression or anxiety, but they do not address core personality traits and behaviors. As such, psychotherapy remains the mainstay of treatment for patients with BPD, although there is no "one-size-fits-all" treatment. Dialectical behavior therapy is probably the most common psychotherapy used for BPD, but other options have emerged. A review of four psychotherapies concluded that all were equally effective overall, but that each had specific advantages. As such, clinicians and patients can decide on an individual basis which treatment is most appropriate. The impact of BPD extends well beyond the individual patient, causing suffering in family members as well. Loved ones, like therapists, may struggle with how to respond constructively to a patient's volatile moods and demands. For that reason, family members may also benefit from psychotherapy.
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