Different Therapies to Treat BPD

Structured psychotherapies have been found to be more effective in many studies than control conditions, and structured psychological interventions have been recommended by many clinicians as the best treatment for BPD. Commonly, a combination of medications, psychotherapy and support groups are used. Psychotherapy with one or two weekly visits with a clinician whom the patient trusts is essential. Dialectical behavior, psychodynamic, cognitive-behavioral and supportive psychotherapeutic approaches are frequently used in the treatment of this disorder.


The psychoanalytic approach is effective because it focuses on resolving incorrect representations of interpersonal relationships. With the proper support system these internalized views can be corrected. The goal of therapy should be an adjustment over time to the reality-oriented approach.

Dialectical Behavior Therapy

Dialectical behavior therapy and cognitive-behavioral therapy in group format are structured akin to classes. The group leader provides practice exercises that the patients can work on between sessions and dialectical behavioral therapy has a manual that is used weekly.

Dialectical behavior therapy was modified from the standard cognitive-behavioral model for BPD and is one of the only approaches backed by data. This successful therapy was developed by Marsha Linehan at the University of Washington in Seattle. It draws from the Buddhist idea of “mindfulness,” a calm awareness of the present moment, as a method of achieving behavioral change. It can be used in hospitals and outpatient programs as well as other settings.

Four patient skills are enhanced through dialectical behavior therapy. Mindfulness, the first skill, calls for an increased attention to one’s experiences. Interpersonal effectiveness teaches the patient to focus on assertiveness. Emotional regulation and distress tolerance are the last two vital skills taught to patients.

A number of clinical trials have been conducted on dialectical behavior therapy, and the results have verified that this therapy aids patients better than standard talk therapies. A reduction in self-injury, anger, suicide attempts and substance abuse have been evidenced with the use of dialectical behavior therapy.


Mentalization-based treatment was developed at University College London. This therapy focuses on helping patients with BPD to understand the mental states of others more clearly. It also aids in the patient’s understanding of their own mental states. While mentalization-based treatment has not been studied as extensively as dialectical behavior therapy, it appears to lower the rate of suicide attempts as well as the use of psychiatric mental health services. It may also increase a patient’s ability to maintain a steady job.

Interpersonal Therapy

Interpersonal or psychodynamic group therapies may be uncomfortable for those with BPD because they necessitate the expression of intense personal feelings. However, these groups can provide the chance to learn from people with similar life experiences. It is important to note that group sessions should be used in conjunction with other forms of treatment.


Medications have been proven effective in stabilizing impulsivity and emotionality for people with BPD. They are also helpful for reasoning and thinking abilities. Neuroleptics and atypical antipsychotic agents improve disordered thinking and behavioral issues of people with mental disorders. Commonly these medications are used to treat schizophrenia and bipolar disorder, but in smaller doses they work well for calming emotional reactivity and impulsivity. They also elevate mood, depression, anger and anxiety.

Atypical antipsychotic agents and neuroleptics were first used for the treatment of psychotic disorders. One side effect that can occur is tardive dyskinesia, an involuntary movement disorder that is typically associated with larger doses of the medication. Atypical antipsychotics may cause side effects such as insomnia, drowsiness, weight gain, breast engorgement or discomfort, or general restlessness. It is important to speak with a psychiatrist regarding the proper medications and their side effects.