Causes of Borderline Personality Disorder

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• Impaired brain chemistry (treated with medications). The neurotransmitters dopamine, serotonin, acetylcholine, and norepinephrine may be involved.
• Early environmental influences (anything from long-term isolation for an early infectious disease to severe physical or sexual abuse).
• Triggers that bring on symptoms (such as divorce or adolescent traumas).

Treatment of Borderline Personality Disorder

When a person with BPD allows themselves to be treated (denial is often part of the disorder), treatment generally consists of:

• Medications, which are often successfully used to reduce depression, dampen emotional ups and downs, and put the brakes on excessive impulsivity. Antidepressants can help with depression, while mood stabilizers such as Depakote, Tegretol, or Lithium can help with mood swings. Selective Serotonin Re-uptake Inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil may help control impulsivity, as may Effexor, a related antidepressant. Tegretol may be helpful for controlling excessive anger and irritability.
• Therapy, especially cognitive-behavioral therapy. The major problems are finding a qualified therapist and getting the Borderline patient into therapy. Researcher Marsha Linehan’s cognitive-behavioral method of treatment, called Dialectical Behavior Therapy (DBT), has been shown in empirical research to help BPD patients experience less anger, less self-mutilation, and fewer inpatient psychiatric stays than patients who received other forms of treatment.

Expectations (prognosis)

Borderline personality disorder has a poor outlook because noncompliance with treatment is common.

Complications

• Drug abuse
• Suicide attempts
• Eating disorders
• Depression

Future Progress

Studies that translate basic findings about the neural basis of temperament, mood regulation and cognition into clinically relevant insights—which bear directly on BPD—represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.

continue: More Detailed Information on Psychotherapy for BPD

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Reviewed: 04/2006