Living with Borderline Personality Disorder
Medication for Borderline Personality Disorder
Typically, selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment. SSRIs reduce depression, anxiety, anger, impulsivity and self-injurious and suicidal behavior (Bockian, Porr & Villagran, 2002).
Paul Soloff, M.D., a psychiatrist at the Western Psychiatric Institute and Clinic at the University of Pittsburgh and an expert on BPD, has written extensively about matching medication with symptoms, and has developed these categories.
- Cognitive-perceptual: problems with thought and perception, such as paranoid thinking, suspiciousness and hallucinations.
- Impulsive-behavioral dyscontrol: impulsivity, aggressive behavior, suicidal threats, substance abuse.
- Affective-dysregulation: mood instability, intense and inappropriate anger, feelings of sadness.
According to a recent meta-analysis, which looked at medication efficacy for various personality disorders, antipsychotics were effective in treating cognitive-perceptual symptoms, while mood stabilizers were effective in treating anger and the impulsive-behavioral dyscontrol (Ingenhoven, Lafay, Rinne, Passchier & Duivenvoorden, 2010). Some research also has shown that olanzapine, an atypical antipsychotic, can reduce BPD symptoms, but not all studies have found this, Dr. Schulz said.
In general, a major drawback is that few studies have compared “medications in head-to-head trials,” Dr. Schulz said. Still, there’s been considerable research and many studies do show encouraging results, he concluded.
Maximizing Medication’s Effectiveness
According to Dr. Schulz, these are some of the ways to maximize the effectiveness of your medication.
- Discuss possible side effects with the prescribing physician. “The physician and patient need to always candidly review the benefits of the prescribed medication in comparison to side effects and move on to other medications or see if the patient still needs medication if side effects outweigh benefits,” he said.
- Take medication as prescribed, and be open with your doctor. “If a patient doesn’t discuss taking medication irregularly, the psychiatrist may think the medication isn’t working and either increase the dose or change medications when such a plan isn’t necessary.”
- Be patient. “Medications generally show best effects over time,” so you won’t experience “immediate or miraculous results.”
- Avoid alcohol and drugs.
Self-Harm in People with Borderline Personality Disorder
Self-harm is common in BPD. People usually self-harm to dull or deal with their emotional pain or to stop feeling numb, Salters-Pedneault said. They also might self-harm to punish themselves, according to Chapman, co-author of Freedom from Self-Harm.
Self-harm is different from suicide. In fact, “Many people engage in self-harm in order to reduce suicidal thoughts and urges,” said Salters-Pedneault, who’s had many clients worry that if they stopped self-harming, they’d become suicidal.
To help clients reduce self-harming behaviors, Chapman first explores their purpose. Next, he works with the client to find healthy but similarly beneficial substitutes for the self-injury. As part of DBT, Chapman also conducts a “chain analysis” to learn “what led to the self-harm, what the consequences were and how to break up this chain of events in the future.”
In addition, clients learn how to “identify their emotions early on before they become overwhelming,” Salters-Pedneault said. Emotions, she tells clients, are helpful because they provide valuable information.
Suicide is sadly all too common in borderline personality disorder. “About 75 percent of people with BPD have attempted suicide at least once in their lives,” Chapman said. About 10 percent will complete suicide.
At Chapman’s treatment center, to prevent suicide, they take a detailed history of the suicidal behavior (and continue to regularly assess risk) and remove anything that can be used to commit suicide. They ask their clients to fill out a “diary card” to keep track of suicidal urges.
If a person is currently suicidal, Chapman helps the client better understand why suicide seems like the best option. If a person has tried to commit suicide, Chapman and the client map out the chain of events, and work on what would fix these issues.
Hospitalization for suicidal borderline patients is frequently very problematic. It may reinforce the very behaviors you’re trying to reduce in treatment, such as turning to suicide instead of using new coping skills to deal with painful emotions, Dr. Wheelis said. If a person “feels attended to, heard and comforted [when hospitalized], it’s likely to reinforce the behavior that led to the hospitalization.” Suicide attempts aren’t manipulative; people with BPD are responding to “contingencies which can be reinforcing or punishing, she said. “If being in the hospital is aversive to a patient, it’s likely that the suicidal behavior which led to the hospitalization may diminish the behavior.”
Suicide is also treated by helping people with BPD “create a life that feels more valuable…so that life stops feeling so meaningless,” Salters-Pedneault said. “We help clients get in contact with their reasons to stay alive and build a life worth living,” Chapman said.
Focusing on suicide makes a person think they’re out of options, which is simply untrue. As Chapman said, “it’s like being locked in a dark room and only seeing the door with the light under it [the suicide door], when in fact, there are several doors; the client just has to turn away from the suicide door to see them.”
For Loved Ones of a Person with BPD
It’s “important for family members and people in the patient’s social network to be as supportive as possible,” Chapman said. Support your family member while he or she is trying out new skills and then reward the changes. Know what to do in a crisis, and tell your loved one that you’ll work as a team and learn about DBT.
Most often, people with borderline personality disorder feel misunderstood. You can help by remembering that your loved one is “doing the best they know how,” and “try to validate the part of their experiences and behaviors that make sense to you,” Baugh said. “One thing you can always validate is on the basis of people’s history and brain chemistry,” he said. For instance, you might say, “If I had been through what you have this week, I’d probably feel just like you do.”
But “Don’t validate the invalid,” Baugh said. Instead, find something that you believe is appropriate. “You can validate a person’s intention to do the right thing and focus on whatever positive actions they did during the day,” even as simple as getting out of bed.
Unfortunately, it’s not uncommon for people with BPD to refuse treatment. Many don’t think they have a problem. They may believe that this is who they are, and that everything would be fixed if others reacted to them the way they’d like, Bockian said. “But I’ll work with whoever is motivated,” he said. He works with loved ones, such as parents, to help improve their lives and learn to interact more effectively with the person with BPD.
Bockian helped one client interact with his wife and better understand her behavior, which seemed wildly unpredictable. Before therapy, the client would attribute her anger to an immediate cause. But there were deeper issues. Beneath complaints about his driving simmered feelings of rejection, which really precipitated many spats. His client started talking to his wife about these feelings instead of waiting until an argument exploded. This gave him a greater sense of control, helped him take her behavior less personally and alleviated a lot of his anxiety.
For additional information and resources
Here are just some of the helpful resources for borderline personality disorder you’ll find online:
- BPD Central: maintained by BPD expert and author Randi Kreger.
- BPD Family: Salters-Pedneault cautioned that though she highly recommends this source for loved ones, readers should keep in mind that some people have been hurt by their family member with BPD and are speaking from this perspective.
- TARA: a large non-profit organization for BPD.
- BPD on Verywellmind: includes tons of information on BPD.
Bockian, N.R., Porr, V., & Villagran, N.E. (2002). New Hope For People With Borderline Personality Disorder. New York: Three Rivers Press.
Ingenhoven, T., Lafay P., Rinne, T, Passchier, J., & Duivenvoorden, H. (2010). Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. Journal of Clinical Psychiatry, 71, 14-25.
Tartakovsky, M. (2020). Living with Borderline Personality Disorder. Psych Central. Retrieved on September 20, 2020, from https://psychcentral.com/disorders/borderline-personality-disorder/living-with/