Borderline Personality Disorder medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Borderline personality disorder (BPD) is a serious mental health condition characterized by difficulties in controlling emotions. It occurs in approximately 2-6% of adults according to the National Institute of Mental Health but is not as well known as other major mental illnesses such as depression, schizophrenia, and bipolar disorder.

BPD is far more prevalent in women (about 75%) than men, contributing to the notion that it’s a “women’s” mental illness. Men, however, do experience BPD and may go undiagnosed due to the bias and stigma associated with the disorder.

What is borderline personality disorder?

All people face emotional instability and uncertainty in their lives at some point. For people with BPD, this is a pattern that happens often and interferes with their daily functioning and the ability to maintain interpersonal relationships.

BPD affects people in different ways, depending on their age and the length of time they have been suffering from it. People who live with BPD can experience dramatic mood swings that last for a few hours to a few days. Some people may experience problems with self-image, self-harm (such as cutting), impulsivity, fear of abandonment, and feelings of emptiness.

There is no single cause of BPD and is likely caused by several factors including:

• Genetics
• Brain chemical imbalance
• Brain development issues
• Environmental factors such as neglect, or physical, emotional, or sexual abuse

How is borderline personality diagnosed?

BPD is typically diagnosed in early adulthood, and not in children or teenagers. It can be difficult to diagnose as it shares many of the same symptoms as bipolar disorder. This misdiagnosis has been shown to delay or prevent recovery.

Other disorders, such as major depressive disorder, anxiety disorders, eating disorders, substance abuse, and other mood disorders can often exist along with BPD.

A mental health professional can diagnose symptoms of borderline personality disorder based on the diagnostic criteria for BPD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) after conducting an in-depth interview.

These symptoms of BPD can include:

• Intense fear of abandonment
• A pattern of unstable relationships with family members or loved ones
• A distorted self-image or sense of self
• Risky, impulsive behavior such as gambling, reckless driving, spending sprees, unsafe sex, substance abuse, and binge eating
• Self-harming behavior such as cutting yourself
• Reoccurring thoughts of suicide or suicidal threats
• Wide mood swings lasting from a few hours to a few days
• Intense, inappropriate anger
• Constant feeling of emptiness

What are some borderline personality treatment options?

BPD symptoms can be effectively treated with psychotherapy and medication. You may require hospitalization if you are experiencing suicidal behavior or your safety is at risk.

Psychotherapy

Also called “talk therapy”, it is usually the first line of therapy in people with BPD. Effective types of psychotherapy include:

• Dialectical behavior therapy (DBT). DBT can be individual or group therapy. It was designed for patients with BPD and focuses on the concept of mindfulness, in which you are aware of your current situation and emotional state. DBT also teaches coping skills to help you manage your emotions as well as reduce self-destructive behaviors.
• Cognitive behavior therapy (CBT). CBT helps you identify thought patterns that negatively impact your behaviors and emotions. By identifying and changing these patterns, you can reduce mood swings and anxiety symptoms and may reduce the number of self-harming behaviors and suicidal thoughts.
• Schema-focused therapy. This type focuses on your emotions and changing specific unhealthy ways of thinking. This is a more flexible approach but can take years of treatment to see improvement.
• Mentalization-based therapy (MBT). This type of therapy helps you see your situation from a different point of view and emphasizes thinking before reacting.

Medications

Currently, there are no drugs that are FDA approved to treat borderline personality disorder. Certain medications such as antidepressants like SSRIs, antipsychotics, anxiolytics, and anticonvulsants are used as mood stabilizers or to treat other symptoms of BPD.

What is the best medication for borderline personality disorder?

The best pharmacotherapy treatment of borderline personality disorder will depend on the individual’s specific symptoms, medical history, medications that the individual is already taking that may potentially interact with BPD medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best treatment plan for you. The table below includes a BPD medication list of the most prescribed BPD medications.

Best medications for borderline personality disorder

Your healthcare provider will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.

What are the most common side effects of borderline personality medications?

The side effects will vary based on which class of medication you use. For the 4 major classes, these are some of the common side effects.

Antidepressants

• Headache
• Insomnia
• Fatigue
• Decreased sex drive
• Unusual bleeding
• Nausea
• Diarrhea

Antipsychotics

• Drowsiness
• Dizziness
• Weight gain
• Blurred vision
• Uncontrolled muscle movements
• Dry mouth

Anticonvulsants/Mood stablizers

• Drowsiness
• Confusion
• Headache
• Vision changes
• Nausea
• Unsteady when walking or standing

Antianxiety

• Drowsiness
• Fatigue
• Difficulty concentrating
• Loss of coordination

Can borderline personality be treated with home remedies?

The first line of treatment for BPD is not prescription medications. Therapy has shown to be effective in decreasing the symptoms of BPD. Other home remedies that can help with BPD symptoms include self-care activities such as regular exercise, getting enough sleep, eating a healthy diet, as well as good stress management.

Frequently asked questions about borderline personality disorder

What is the best treatment for BPD?

The most effective treatment is psychotherapy such as dialectical behavior therapy, which is the most studied and effective method in treating BPD. Other psychological therapies that are also effective in the treatment of BPD include schema therapy, cognitive behavior therapy, and mentalization-based therapy.

Antidepressants, mood stabilizers, anxiolytics, and antipsychotic medications may be added to help treat symptoms.

Is there a cure for BPD?

Although it can’t be cured entirely, it can be managed and treated effectively so that symptoms are greatly reduced.

What is the difference between BPD and bipolar disorder?

While they both have some of the same symptoms, there are a few key differences between the two conditions.

• While people with bipolar experience both manic episodes and depressive episodes, people suffering from BPD experience intense emotional pain and feelings of emptiness, anger, hopelessness, and loneliness.
• In BPD, mood changes may only last for a few hours at a time. In bipolar disorder patients, these mood shifts tend to last for days or even weeks.
• Mood changes in BPD are usually in reaction to a stressor, such as an argument with a loved one, whereas mood changes in bipolar disorder may occur for no reason.

How do you encourage someone with BPD to seek help?

The most important part is to listen. Make them feel heard and that you genuinely care. And when encouraging them to seek professional help, suggest it will allow them to talk to someone about their thoughts and feelings.

Related resources for borderline personality disorder

• Overview of BPD. National Education Alliance for Borderline Personality Disorder
• What is Borderline Personality Disorder? rotr.org. Gateway to mental health services
• Causes – Borderline Personality Disorder. NHS
• Borderline Personality Disorder overview. Mayoclinic.org
• Borderline Personality Disorder overview. National Institute of Mental Health
• Mental Health Medications. National Alliance on Mental Illness