Of all of the disorders in the DSM-IV, the Axis II disorders are among the most difficult to treat. Unfortunately, Borderline Personality Disorder falls into the Axis II grouping.
BPD is difficult to treat for a variety of reasons. Among the most significant reasons for this is that symptoms of borderline personality disorder and criteria for diagnosis of BPD indicate that a long history of unstable relationships is a hallmark of the disorder.
The primary component of treatment for BPD is psychotherapy,however, the combination of therapy and medication is often used. Since a large part of the treatment of BPD stems on a healthy relationship with a therapist, treatment can be difficult. However, once a treatment program is established, and the Borderline starts treatment, many of BPD’s damaging behaviors can be controlled, and even recovered from.
Psychotherapy
The initial phase of treament for a borderline will be psychotherapy. Once a diagnosis of BPD is obtained, treatment with therapy will be the first step.
Therapy is probably the most critical component in the treatment of Borderline Personality Disorder. Because of this, it is important that the borderline make every effort to build a healthy relationship with their therapist. This will mean the most success for the borderline. Because borderlines typically have a long standing history of unstable relationships, establishing a healthy relationship with their therapist may be their biggest challenge.
The nature of this disorder makes it very common for clients with BPD to have problems during their treatment process.Because of this, it is wise that the individual look for a therapist that specializes in treating borderline personality disorder.
The first goal of therapy will be to reduce or control any behavior that is seen as destructive, aggressive, or violent. Suicidal tendencies, self-harm or self-mutilation, or problems such as an eating disorder will be the first target of the therapy. There is no telling how long this phase of treatment will last, as it will vary from one person to the next.
If severe violence and aggressive tendencies are an imminent problem for the borderline, the initial phase of therapy can easily last several months.
Once it has been established that the individual is not as likely to either harm themselves or someone else, therapy will then begin to focus on the emotional aspect of Borderline Personality Disorder. Here the therapist will work with the borderline to learn skills that will help them to manage their emotions.
The therapist will teach the client means of controlling their feelings, controlling their anger, and controlling their unhappiness. Again, depending on the severity of the individual’s symptoms, this phase could also take several months, or even years. If mood regulation is a severe problem, very often it is at this point that medications will be introduced.
The different kinds of therapy involved in the treatment of BPD are:
- Cognitive Behavioral Therapy
- Dialectical Behavioral Therapy
- Pscyhodynamic Therapy
- Support Groups or Group Therapy
- Pharmaceutical Support
Treating Borderline Personality Disorder With Medication
Quite often, treatment of Borderline Personality Disorder is accompanied by the use of prescription medication or pharmaceutical support. The rationale behind this is that sometimes the mood swings, violence, aggression, and emotional instability is too much to handle for the person and they need immediate relief.
The use of psychotropic medication is very effective in handling the more intense symptoms of borderline personality disorder, and comes not only as a relief to the client suffering from BPD, but to those around them as well.
The most common medications used to treat Borderline Personality Disorder are:
- Antidepressants
- Antipsychotics
- Mood Stabilizers
- Anxiety Medication
Will Treatment Work?
This is the most common question asked by those living with or supporting someone they love with BPD. The short answer to this question is yes, but as with any treatment involving a mental health condition, the answer depends on the patient. Most Borderlines that enter treatment, follow their treatment plan, and stay in treatment, will find some relief from their symptoms of BPD within about a year.
It is estimated that within about 10 years of treatment, approximately half of those will find they no longer have any symptoms of BPD. This estimate is only at the 50% mark for the very reason that Borderlines have difficulty maintaining stable relationships.
So, the answer to whether or not treatment will work really depends on the Borderline. Overall, treatment of BPD is a long-term process, and in order for the Borderline to see changes in quality of life, they are going to have to stick to their treatment plan, often their greatest challenge.
References
American Psychiatric Association.”Practice guidelines for the treatment of patients with borderline personality disorder.” American Journal of Psychiatry. 2001. 158 (10): 1-52.
Gunderson, J. G. Borderline Personality Disorder: A Clinical Guide. 2001. Washington D.C.: American Psychiatric Publishing.
Hellman, I. D., Morrison, T. L. & Abramowitz, S. I. (1986)"The stresses of psychotherapeutic work: A replication and extension.Journal of Clinical Psychology. 1986. 42: 197.
