Sunday, December 9, 2012

BPD and Medication

A counselor friend this week asked me the following question:  If there is no medication for Borderline Personality Disorder why are so many on medications?  Pretty valid question.
No medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective. source
I have meet many people with BPD who have another diagnosis (or 5); Anxiety disorders, depression, PTSD, etc.  So for some people they are receiving medication for a separate disorder, which sometimes has overlapping symptoms.  For those of you who follow me on Twitter you know my issue with being people misdiagnosed with a plethora of other diagnosis, that gets added to each year when BPD is the only one.  Putting that aside I also think some people with BPD (especially those whom are newly diagnosed) are given Benzodiazaphines (I will save my opinion on that for another rant) to cope with the anxiety caused my BPD.

I work full-time in a prison, the female inmates are in a 6-month program, I find that month 1 everyone is knocking on my door about medications, someones their mental illness is valid often it is not (mostly due to drug use.)  Month 2-3 some mental health issues come to surface, as the program is intensive 20-hour a week therapy and people are now dealing with things they have stuffed for so long and they have a decent amount of clean time.  Right now my group is in month 3, what started as 11 on medication (out of 21) is now 5.  I asked the group why it has dwindled down significantly in 90 days.  The answers not surprising; 'we now have cog skills, I started journaling, grounding techniques, coping skills, I take to my bunkie about it.'  Many of these women are using skills over medication.*

So maybe medication is not available to you (Big Pharma will be another rant as well,) or maybe you are on medication and looking to gain more coping skills- here is a list of modes to get well for BPD:

  • Dialetcical Behavioral Therapy Self-study material
  • EMDR mostly used to handle trauma
  • EFT (tapping)
  • MBT used more in UK (Thanks to anon comment for the info)
  • Social Support. Talk to others who may understand what you are going through. 
  • Behavioral Activation. Engage in an activity that might take your mind off the stressful situation for a little while. 
  • Relaxation Exercises. Practice a relaxation exercise, such as deep breathing or progressive muscle relaxation.
  • Grounding. Practice grounding exercises that are designed to keep you "grounded" in the present moment, rather than caught up in replaying events in your head, worrying about the future or zoning out. 
  • Mindfulness Meditation. Practice mindfulness meditation, which helps you to observe and describe your experiences without judging or rejecting them. 
  • Active Problem-Solving. Consider the problem at hand: Is there a way to solve the problem directly? (source for 5-10)

*I am not saying medication may not be necessary for some


  1. Schema therapy and mentalization based therapy are also used to help those with BPD, in the UK there is also CAT (cognitive analytic therapy)although I don't know if this is effective as seems quite new - maybe someone could comment on that?

    I prefer not to take any meds, as the trade off with side effects is not worth it to me, just my personal choice, I realise everyone is individual in their symptoms and needs. I think part of the problem is lack of access to effective therapies which leaves people with meds as the only help available to them whether they want them or not.In the past when I was on meds it was due to being wrongly diagnosed with depression which (surprise surprise !)then didn't respond to short term cbt.

    1. Thanks for the information. I have read a few articles on MBT and still don't "get it" would love to hear from someone going through it. CAT sounds a lot like DBT Chain Analysis.

      I have had clients ask me why their insurance company does not cover DBT group. My answer, "It's cheaper to keep you on meds than a 2 years weekly group, weekly one-on-ones and phone calls in between." Unfortunately insurance companies are not interested in seeing if you are feeling better, relationships improving, etc but making a profit.

  2. Hi, Alicia! I found your blog through Twitter. I see you have mindfulness in the list you posted. I like to think I have "dealt with" the causes of my PTSD. (I chose medication instead of therapy because I didn't feel that blathering on about it was going to help anyone. I'm not bashing therapy but that's my personal choice.)

    Mindfulness is so helpful but I add a little twist: "Okay. I feel this. It's okay that I do. My family is safe and happy. So am I. How can I take this feeling and use it to be of service to someone else?" I find that helps snap me out of getting stuck.

    Can't wait to read the rest of your blog!

  3. That's a great twist to turn it outward and do something for someone else. I could see that being really useful for someone in recovery from substances too.

  4. Hi - thanks for the article! I know I'm asking a difficult question here - but does medication help lessen the stress that a BPD suffers (with anxiety and other strong emotions)? I'm really stuck when it comes to deciding whether to take anything - I don't want to - but feel my body may be suffering with everything I'm putting it through.

    1. Hi Katie,

      Yes, although medication can help with some "parts" of BPD such as depression and anxiety and for some people other diagnosis make it necessary, I believe that coping skills are a more long-term solution rather than a band-aid to deal with some of the symptoms. I would talk to your psychiatrist about what medication can do for your symptoms. Many people with BPD take medications.