Treatments for BPD
It is vitally important that the patient get a good psychiatric evaluation by a board-certified psychiatrist who specializes in personality disorders before treatment begins. It is worthwhile to do this because the course of the patient's entire treatment may be determined by an initial evaluation. The
Borderline Personality Disorder Resource Center can help patients and families find such a
practitioner in the patient's general geographic area.
By the time a family member has been diagnosed as suffering from Borderline Personality Disorder, so much stress has been generated in the family that everyone is affected. For this reason, it is advisable for the entire family to seek support services.
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Levels of Care | Therapy | Medication | Support Groups
Levels of Care
If outpatient therapy reaches a stalemate or is interrupted by repetitive suicide attempts, or if the patient cannot stay consistently with a therapy and continues to disrupt his or her own life and that of others, the family and patient may want to seek consultation in a center specializing in the treatment of Borderline Personality Disorder. A thorough assessment may lead to the recommendation of a more specific individual therapy, adjunctive group or family therapy, referral to substance abuse treatment, or more intensive treatment in the form of hospitalization or a day hospital program.
Day hospital treatment, where the patient is committed to attending daily therapy sessions and workshops but resides at home, is helpful both in enabling patients to understand their problems and how these affect others, and also in bringing patients into close daily contact with others who are working on those problems. Borderline patients tend to support each other–sometimes in a negative way, to be sure, but more often in a very positive way. Articulate, candid and forthright, they are often extremely effective in cutting through the denials and excuses and the blaming of others that so hamper a person's ability to see his or her own problems. The recognition of the illness and the determination to overcome it have everything to do with successful treatment.
Without adequate treatment, the illness can be lifelong, and all too often ends in suicide. With good treatment, the outlook is very favorable indeed in many cases. Among the 500 BPD patients studied by Dr. Michael Stone at the Columbia Psychiatric Institute over more than 20 years, 4 out of 10 are clinically recovered 10-20 years after their point of entry into the study during hospitalization. Seventy-five percent are self-supporting and doing reasonably well. The suicide rate was 7% as of 16 years post-admission. The patients who recovered tended to be those who persisted in psychotherapy over many years.
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Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. The individual outpatient psychotherapy for the BPD patient usually consists of 2-3 therapy sessions a week over a period of years. The therapist works with the patient to understand the meanings and motives of his or her behavior, and to strengthen his or her capacity to endure frustration, anger and loneliness without acting impulsively upon those feelings.
One form of therapy that is psychodynamic in nature is known professionally as transference-focused psychotherapy (TFP). This therapy is geared primarily at understanding the underlying causes of the patient's borderline condition and working to build newer, healthier ways of thinking and behaving for the patient. For more information, please click on one of the links below.
Dialectical Behavior Therapy (DBT)
Dialectical Deconstructive Therapy (DDT) (Coming soon!)
Mentalization-Based Therapy (MBT)
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By Judit Gordon-Lendvay, M.D.
Medication may be needed as part of outpatient treatment. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used in low doses when there are distortions in thinking and, at low doses, for anxiety.
Patients with marked mood swings sometimes benefit from certain drugs ordinarily used to treat epilepsy like mood stabilizers. Patients with severe depression or eating disorders may benefit from antidepressant medication. Small doses of the neuroleptic drugs typically used for schizophrenia sometimes help BPD patients in periods of severe stress. Lithium is sometimes helpful, and may make it possible to use lower doses of other drugs. Minor tranquilizers or sedatives should be considered only with caution since they are dangerously habit forming. The treatment professional who has experience in treating BPD will be the best source of knowledge on what medications may or may not benefit the Borderline patient depending on his or her symptoms and individual needs.
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