Treatment for Borderline Personality Disorder

First-Line Treatment: Psychotherapy

The American College of Physicians, as reported in the Annals of Internal Medicine, recommends core components of Dialectical Behavior Therapy (DBT) including skills training for emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness techniques 1

The Journal of Child Psychology and Psychiatry and Allied Disciplines suggests using motivational interviewing techniques to enhance treatment engagement, and explaining that treatment aims to reduce distress and improve quality of life rather than focusing on personality "flaws" 2
A standard course of DBT involves 12-22 weekly sessions, with consideration of longer treatment duration for more severe presentations, as recommended by the Journal of Child Psychology and Psychiatry and Allied Disciplines 2

The Annual Review of Clinical Psychology recommends targeting specific comorbid conditions, such as depression and anxiety, rather than core BPD symptoms, and monitoring closely for adherence issues, considering Brief Motivational Intervention (BMI) if medication adherence is poor 3, 4

The Annals of Internal Medicine suggests implementing crisis response planning with clear identification of warning signs and coping strategies, and considering short-term use of low-potency antipsychotics rather than benzodiazepines for acute crises 1

The American Academy of Child and Adolescent Psychiatry recommends SSRI (fluoxetina, sertralina) as the preferred choice for comorbid anxiety disorders due to their safety profile 5
The use of benzodiazepines for chronic anxiety management is not recommended due to the high risk of disinhibition and dependence in this population 5

For affective dysregulation and mood instability, mood stabilizers such as valproate, lamotrigina, and topiramato have shown benefits for anger, aggression, and affective lability, although the evidence is based on small single studies, limiting the robustness of the results 5
The American Academy of Child and Adolescent Psychiatry suggests that SSRI (fluoxetina, sertralina) remain the preferred choice for comorbid anxiety disorders, with realistic expectations regarding their impact on core DBP symptoms 5

For comorbid depression, treatment with SSRI is recommended, as for major depression, but with realistic expectations regarding the impact on core DBP symptoms 5
The American Academy of Child and Adolescent Psychiatry recommends avoiding benzodiazepines for chronic anxiety due to the risk of behavioral disinhibition and dependence 5