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Treatment of Borderline Personality Disorder

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

The very nature of this condition, especially the interpersonal problems, makes the treatment of Borderline Personality Disorder challenging, because patients will tend to relate to their therapists and doctors with the same ambivalence, mistrust and desperation that characterize most of their close relationships. Treatment is thus best delivered in a comprehensive program by a team of experienced mental health workers who are able to address all facets of this condition while managing the delicate therapeutic relationship.

Some of the challenging behavioral patterns that are common among these individuals in treatment include:

Regression: This is when patients adopt childlike behaviors and expectations towards their therapists or doctors. Put in the situation of being offered help, patients with this condition may begin to crave the total and unconditional love and support that they feel has been lacking in their lives. They may thus stop relying on their own abilities to solve basic life problems and instead become increasingly dependent on their therapists and doctors to attend to their every need. When these patients feel that they are not receiving this total support, they may then start acting-out (see below). In order to prevent regression, treating teams will strive to maintain a very clear and consistent structure in their programs, with explicit goals and expectations.

Boundary violations: In keeping with the facts described above, patients with this condition will also have difficulty respecting the professional boundaries between themselves and their therapists or doctors, and will often expect to receive extra attention, to be told personal information, or to become friends or intimate partners with their mental health workers. Experienced treating teams know that it is important to resist crossing professional boundaries, even in seemingly trivial ways, for this could lead to regression.

Splitting: One way that patients try to obtain special attention and consideration from their mental health workers is by appealing to the sympathies of their therapists or doctors. Treating teams can often become divided when some workers begin taking extra steps to care or defend for a patient, while other workers see this as excessive and unwarranted. It is thus essential that treating teams hold regular meetings where they discuss all issues related to each patient, so that everyone can be on the same page and treatment can be consistent for every patient. It is also important that treating teams be responsible for managing all aspects of the patient's psychiatric care, including the treatment for other concurrent psychiatric disorders.

Acting-out: In treatment situations where these patients feel neglected or abandoned, or where they conclude that their expectations for help have not been met, they can become despondent or enraged and impulsively act-out their frustrations in dramatic, aggressive and self-destructive ways. Treating teams will need to have consistent ways of managing these situations, which are usually based on the psychotherapeutic approach that they use.

The actual treatment modalities that exist for Borderline Personality Disorder include psychotherapy and medication. Psychotherapy is considered the main form of treatment for this condition, while medications are often added to help alleviate particular symptoms [ref]. Treatment for other concurrent psychiatric disorders should also be included as needed.

 

Course & Prevalence

Psychotherapy