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Borderline personality disorder (BPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a mental disorder. As defined by the National Institute of Mental Health (NIH), borderline personality disorder is an illness characterized by an ongoing pattern of varying moods, behavior, and self-image. The combination of these symptoms often results in difficulty maintaining relationships. It is highly common for an individual diagnosed with borderline personality disorder to have a deep-seated fear of abandonment making it difficult to tolerate being alone. This paired with intense, sometimes irrational, expressions of emotional instability often push others away making it exceeding difficult for an individual with borderline personality disorder to foster and maintain meaningful, lasting relationships. The scientific reason as to why an individual develops borderline personality disorder remains unknown. The onset of BPD typically occurs in early adulthood. The symptoms of borderline personality disorder are usually worse in young adults, and although the condition may gradually improve with age, BPD is a lifelong condition. 

Treatment

The first step in the treatment process is to obtain an accurate diagnosis from a qualified mental healthcare provider. Borderline personality disorder is notoriously known as an illness that is exceedingly difficult to diagnose. However, a thorough psychological evaluation can provide the most detailed diagnosis, which in turn will greatly inform treatment recommendations. The treatment plan for a person diagnosed with BPD will be a unique to the individual. In order to accommodate all the needs of an individual diagnosed with borderline personality disorder, a treatment plan could include and/ or emphasize any combination of the following options: 

  • Individual psychotherapy, also known as “talk therapy,” some of which can include any of the following:
    • Dialectical behavior therapy (DBT): is a form of cognitive behavior therapy (CBT) that focuses on how one’s thoughts and beliefs can lead to actions and behaviors. This skills-based approach teaches how to manage emotions, tolerate distress and improve relationships though group and individual therapy sessions. 
    • Schema-focused therapy: incorporates aspects of CBT and psychoanalytic theories. It helps to identify unmet needs that have led to unhealthy ways of thinking about the world. Conducted in an individual setting or group setting, schema-focused therapy challenges maladaptive beliefs and behaviors and focuses on promoting positive life patterns. 
    • Mentalization-based therapy (MBT): emphasizes thinking before reacting. This is accomplished through helping an individual identify his or her own thoughts and feelings and creating an alternate perspective on the situation.
    • Transference-focused psychotherapy (TFP): helps an individual understand and process his or her emotions and interpersonal difficulties through the developing relationship between the individual and his or her therapist. 
  • Encouraging healthy and frequent self-care practices
    • Eating nutritiously
    • Establishing good sleep habits 
    • Regular exercise
    • Remaining hydrated
    • Practicing calming techniques (i.e. meditation, yoga, journaling, etc.)
  • Medication: The Food and Drug Administration (FDA) has yet to approve a medication specifically designed to treat borderline personality disorder. There are, however, certain medications that can help to alleviate and/ or reduce some of the symptoms arising from BPD or co-occurring disorders (i.e. depression, anxiety, etc.). Common examples of types of medication prescribed as a component of one’s BPD treatment plan include: 
    • Antidepressants
    • Anticonvulsants/ mood stabilizers 
    • Anti-anxiety medications/ anxiolytics
    • Antipsychotics

Customized treatment plans that comprise of a variety of different therapeutic modalities, and are used when treating borderline personality disorder, so as to ensure that the individual’s nuanced needs are appropriately addressed. Every person is different and each will require a distinct combination of the various treatment options when it comes to learning effective coping mechanisms and implementing emotional regulation techniques needed to effectively manage borderline personality disorder, long-term.