What is the treatment of choice for clients with borderline personality disorder?
PsychotherapyThere are different types of therapy for borderline personality disorder (BPD). Show
Therapy may be given one-on-one and through support groups, enabling people with BPD to interact with others. The most effective type of therapy appears to be dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT seeks a balance between accepting BPD and changing beliefs and behaviors by teaching skills to:
With DBT, people learn tools, exercises, and concrete things they can do to manage their emotions when certain challenging situations arise and they are feeling unstable. Other forms of therapy for BPD include: Transference-Focused Psychotherapy (TFP)This form of therapy is rooted in the patient’s confused and contradictory sense of identity associated with emotionally intense mental images of themselves and others. The therapist helps the patient unconsciously reassign extreme positive or negative images associated with one person to another person, such as the therapist. In that moment, the therapist talks with the patient to interpret and understand why the patient distorts his or her sense of self and images of other people. Therapy addresses intense shifts in emotions as patients learn to reflect and verbalize what they’re feeling, rather than acting out these emotions impulsively. Schema-Focused Therapy (SFT)This type of therapy focuses on reframing “schemas,” or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image – possibly brought on by negative childhood experiences – that affects how people react to their environment, interact with others, and cope with problems or stress. Mentalization-Based Therapy (MBT)Mentalization refers to the ability to focus and reflect on beliefs, intentions, feelings, and thoughts in oneself and in others. This ability is thought to be compromised among people with BPD; their capacity to “mentalize” can fluctuate and become impaired when they are under stress (particularly the stress of rejection or disappointing interactions with other people). Supportive PsychotherapyA form of psychotherapy in which consistency, support from others, and a hopeful attitude are used to sustain the patient through periods of crisis and encourage small gains over time. This approach encourages the transformation from acting out to verbalizing psychological conflicts and developing adaptive outlets for emotions. Psychological treatments (talking therapies) are the best way to treat BPD. These treatments usually involve talking with a health professional one-to-one, or sometimes attending special groups. Medication is not recommended as a person’s main treatment for BPD. For someone who is already receiving psychological treatment, medication may be helpful to manage particular symptoms. Electroconvulsive therapy (ECT) does not work for BPD. Goals of treatmentFor many people with BPD, important goals are:
When should treatment start?Early treatment is best for people with BPD. It is important to get a diagnosis as soon as possible, so that a health professional (e.g. your GP, psychiatrist, or clinical psychologist) can arrange the right treatment. Even if your diagnosis is not certain, you can still start treatment. Many of the psychological treatments that are effective for BPD can also be useful for other mental health conditions. Young people, including teenagers, can have BPD and can start treatment as soon as the diagnosis is made. Psychological treatment (talking therapy)Several types of psychological treatment are effective for treating BPD. Psychological treatment can be provided by psychiatrists and psychologists. It is sometimes also provided by GPs, nurses, social workers and occupational therapists with special training. BPD treatments that are available in some parts of Australia and New Zealand include:
The availability of BPD treatments differs between regions. More about psychological treatments One type of psychological treatment may not suit everyone. If possible, you should be given a choice between treatments that are available. Young people with BPD symptoms should be given psychological treatments that are especially designed for their age group (if available). Treatment for young people should be for a planned period of time – not continued indefinitely. People aged under 25 years may benefit from treatment in specialised mental health services designed for young people. If you have another mental health condition as well as BPD, both conditions should be managed at the same time. Examples of common conditions include eating disorders, drug and alcohol problems, depression and anxiety. Will I need medication?Medication is not recommended as a person’s main treatment for BPD. Medication can make small improvements in some BPD symptoms, but does not improve BPD itself. Your doctor may prescribe medication to manage particular symptoms in the short-term. You may need medication for a short while during a crisis. Normally this medication should be stopped soon afterwards. More about medication for mental illness Will I need to go to hospital?Hospital treatment is not a standard treatment for BPD. Hospital treatment is generally used only for short-term care when really necessary, for example to deal with a serious crisis. If you need to go to hospital, it should be to achieve specific goals that you have agreed with your doctor. About psychiatric hospitals What is the first line treatment for borderline personality disorder?First-line treatment for BPD is psychotherapy [5-7]. Psychotropic medications are used as adjuncts to psychotherapy, targeting specific BPD symptom clusters. Adjunctive use of symptom targeted medications has been found to be useful [8].
What is the goal of treatment for borderline personality disorder?Goals of treatment
to overcome emotional problems (such as depression, anxiety and anger) to find more purpose in life (e.g. by making a positive contribution to their community) to build better relationships. to learn how to understand and live with yourself.
What is the treatment of choice for personality disorders?Psychotherapy, also called talk therapy, is the main way to treat personality disorders.
Which treatment for borderline personality disorder is most supported by research?Dialectical Behavioral Therapy (DBT)
The most well-known, well researched, and widely available EBT for BPD is DBT [39, 40].
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