There's no single "best" medication for Borderline Personality Disorder (BPD), as no drug specifically treats the core disorder; instead, doctors use medications like SSRI antidepressants (e.g., Fluoxetine, Sertraline), atypical antipsychotics (e.g., Aripiprazole, Olanzapine), and mood stabilizers (e.g., Lamotrigine, Valproate) to target symptoms like depression, impulsivity, anger, or mood swings, often combined with specialized therapy like DBT for best results.
Commonly-prescribed mood stabilizers and anticonvulsants for those with BPD include:
Dialectical Behavior Therapy (DBT): Also referred to as the "Gold Standard" of treatment for borderline personality disorder treatment, the therapy aims at helping patients develop skills to deal with challenging emotions and learn self-awareness, healthy relationship skills, and emotional regulation.
Atypical antipsychotics to manage severe symptoms including psychotic symptoms, impulsiveness, aggression, affective instability, and dysfunction in interpersonal relationships. Examples of antipsychotic drugs used for treating BPD include olanzapine (Zyprexa) and aripiprazole (Abilify).
Due to high comorbidity of BPD with addictive disorders, use of substances with high dependence potential should be avoided if possible. The use of unsafe drugs with risk of overdose (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOIs]) should be avoided.
Benzodiazepines may worsen symptoms for some individuals.
Research suggests that benzodiazepines may worsen the symptoms of impulsivity and suicidality in people with BPD, so their use is discouraged.
Indications for Hospitalization
Inpatient care is generally not indicated, unless the goals of treatment are well defined. However, some individuals with borderline personality disorder (BPD) need to be hospitalized as a result of suicidal or other self-injurious behavior.
The evidence reports that around 20–50% of patients with borderline PD experience psychotic symptoms [4], also that psychotic disorders are observed in 38% of these patients and the prevalence of 20% of psychotic disorder diagnosis not otherwise specified is the most common subtype [10].
Risperidone. Current data have suggested that many symptoms of BPD may be ameliorated with risperidone. In an open-label study (N = 15), risperidone (final mean dosage, 3.27 mg/d) had a statistically significant 21% decrease in BPRS scores from baseline after 8 weeks.
BPD splitting involves intense shifts in perceptions and emotions. People may quickly alternate between idealising and devaluing people, situations, and themselves. This can lead to unstable relationships, rapid mood swings, impulsive behaviour, and difficulty tolerating ambiguity.
But there are lots of positive things you can do to support them:
The 24-hour rule is meant to encourage patients to seek help from the therapist at earlier stages of a crisis while the therapist can still offer assistance and not after the patient has already chosen maladaptive behaviors.
Clinicians can be reluctant to make a diagnosis of borderline personality disorder (BPD). One reason is that BPD is a complex syndrome with symptoms that overlap many Axis I disorders. This paper will examine interfaces between BPD and depression, between BPD and bipolar disorder, and between BPD and psychoses.
Why BPD Symptoms Peak in Early Adulthood. In the 20s, identity formation and independence conflict with emotional vulnerability. Research shows impulsivity and mood swings occur most frequently between the ages of 18-25.
A “Favorite Person” is someone with whom a person with BPD forms an intense emotional attachment. This relationship is often marked by a combination of deep admiration, dependence and fear of abandonment. The FP becomes a central figure in the individual's life, often absorbing much of their emotional energy and focus.
A study investigating new treatments for borderline personality disorder (BPD) has identified that infusions of ketamine may help to reduce the severity of symptoms.
Psychotic symptoms in BPD can include paranoia, auditory hallucinations, visual distortions, and severe dissociative episodes. Relationship conflicts and abandonment fears commonly trigger psychotic episodes in people with BPD.
Borderline personality disorder and stimulants use can also co-occur, increasing the risk of addiction and worsening BPD's mental illness symptoms, such as anxiety and aggressiveness. Psychedelics and BPD are another dangerous combination, as these drugs can elevate the risk of psychotic episodes and erratic behaviors.
If Borderline Personality Disorder (BPD) is left untreated, symptoms worsen, leading to severe emotional instability, chaotic relationships, chronic emptiness, and a significantly higher risk of self-harm and suicide, alongside developing co-occurring mental health issues like depression, anxiety, and substance abuse, severely impacting daily functioning and overall quality of life.
While psychopathy and BPD share characteristics such as impulsivity, they are distinct disorders with unique features. Psychopathy is often associated with a lack of empathy and remorse, manipulative behavior, and a grandiose sense of self-worth.
Fear of Abandonment & Being Alone
For many with BPD, the fear of abandonment represents one of the most challenging aspects of living alone. This core symptom can trigger intense emotional responses when physically separated from others for extended periods.
Clinical experience suggests that patients with borderline personality disorder are more likely to have a history of both outpatient and inpatient psychiatric treatment than patients with other psychiatric diagnoses. Five cross-sectional studies have confirmed this impression (1-5).
You can only be given medication after an initial 3-month period in either of the following situations: You consent to taking the medication. A SOAD confirms that you lack capacity. You haven't given consent, but a SOAD confirms that this treatment is appropriate to be given.
Offer Distractions. Redirecting the focus of the individual during a BPD episode can provide a helpful break from overwhelming emotions. Distractions allow them to regain control of their feelings and may help them calm down more quickly.