Treatment of borderline personality disorder
- Andrew Skodol, MD
Andrew Skodol, MD
- Section Editor — Personality Disorders
- Research Professor of Psychiatry
- University of Arizona College of Medicine
Borderline personality disorder (BPD) is characterized as instability of interpersonal relationships, self-image, and emotions, and by impulsivity.
Patients with borderline personality disorder (BPD) often receive mental health treatment [1,2]. The disorder is more widely studied than any other personality disorder . Despite these efforts, patients with BPD continue to suffer considerable morbidity and mortality.
The treatment of BPD will be reviewed here. The epidemiology, clinical features, course, assessment, and diagnosis of BPD are discussed separately. The diagnosis and treatment of other personality disorders are also discussed separately. (See "Borderline personality disorder: Epidemiology, clinical features, course, assessment, diagnosis, and differential diagnosis" and "Personality disorders" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis" and "Treatment of antisocial personality disorder".)
First-line treatment for borderline personality disorder (BPD) is psychotherapy [4-6]. Psychotropic medications are used as adjuncts to psychotherapy, targeting specific BPD symptom clusters. Psychotherapies and medications with efficacy in BPD are described below.
Several psychotherapies have been developed or adapted to treat patients with borderline personality disorder, including :
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- Common factors
- - Dialectical behavior therapy
- - Mentalization-based therapy
- - Transference-focused therapy
- - Good psychiatric management
- - Cognitive behavioral therapy
- - Systems Training for Emotional Predictability and Problem Solving (STEPPS)
- - Schema-focused therapy
- Overall efficacy
- Intensity and duration
- Comparing psychotherapies
- Therapy selection
- - Mood stabilizers
- - Antipsychotics
- - Antidepressants
- Side effects
- CLINICAL MANAGEMENT
- General principles
- Level of care
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS