Which Borderline Personality Disorder Therapy Is Effective?

Medically reviewed by Andrea Brant, LMHC
Updated October 12, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.
The American Psychiatric Association (APA) defines personality disorders as conditions in which “one's way of thinking, feeling, and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time”. Borderline personality disorder (BPD) is a mental health condition that falls into this category. It is important to be aware of BPD, especially if you know someone with the condition.

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Symptoms of borderline personality disorder

One of the key identifiers of borderline personality disorder is an individual’s intense fear of being abandoned or of experiencing any type of instability.
People with BPD tend to be frightened of being alone, which may cause them to react in extreme ways—which can paradoxically push people in their lives away even more. Common BPD symptoms include:
  • Paranoia
  • A lack of connection with reality
  • Impulsive behavior or self-destructive behavior, including self-harm
  • Mood swings
  • Inappropriate behaviors or anger
  • Suicidal threats or attempts for suicide
  • Unstable relationships with family, friends, and romantic partners

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Note that the above isn't an exhaustive list of symptoms and that they may present in any number of combinations and levels of severity. Each person can experience the disorder differently.

What causes BPD?

There are a variety of theories in therapeutic communities about where exactly this disorder comes from and why someone may develop it. It’s likely due to a combination of factors. In general, most experts assume that the following components may play a role in a person’s development of a personality disorder like BPD:
  • Heredity/genetics
  • Differences in brain development
  • Stress or trauma in childhood

Can borderline personality disorder therapy and treatment cure the disorder?

According to a study published by the National Library of Medicine, receiving a diagnosis of borderline personality disorder is generally seen as lifelong. While it’s not typically thought of as “curable”, research suggests that symptoms can be improved, and various types of therapeutic treatments have demonstrated effectiveness in helping treat borderline personality disorder. From group psychotherapy to online therapy to one-on-one sessions with mental health professionals, there are several psychotherapy options available to people living with BPD.

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What is an effective mental health treatment for borderline personality disorder?

It’s important to note that someone with BPD can still live a healthy life while receiving treatment for BPD. When it comes to seeking treatment for BPD, both medication and therapy are often used to manage symptoms. There are several counseling modalities that may provide the best help with the disorder. Speaking with a mental health professional to determine the best treatment plan for you is usually helpful in choosing the best therapy focus for BPD. Consuming a healthy diet rich in Omega-3 fatty acids may also improve BPD symptoms.

Dialectical behavior therapy (DBT)

Dialectical Behavioral Therapy (DBT) is a type of cognitive behavioral individual therapy (also often referred to as systems training) to treat BPD and other mental health conditions. Dialectical behavior psychotherapy can help people learn to tolerate and control intense emotions. It typically focuses on helping the individual learn coping skills so that they can react more effectively when they’re in difficult situations or mental states, and/or feel strong emotions arising, so they can better manage distress. This type of therapy also emphasizes learning interpersonal skills to help improve relationships, as well as cultivating a sense of mindfulness to aid in the patient’s ability to tolerate distress and foster emotional predictability. DBT can take the form of individual and group sessions.

Schema-focused therapy

This type of therapy focuses on the way that an individual’s unhealthy upbringing can lead to an unhealthy development of ideas and attitudes about themselves and the world around them. These issues can lead to mental health problems; people’s mental states may be unstable or negative. One of the goals of schema focused treatment is to shift some of these negative beliefs present in a patient’s own thoughts in a more positive direction. It seeks to change the flawed and/or damaging perspectives a child may have internalized from a difficult environment growing up and transform them into healthier, more positive views that can help address symptoms, improve interpersonal relationships, create a better self-image, and improve other mental health problems. Group schema therapy, in conjunction with weekly individual therapy, has been shown to be especially effective. Group therapy can be especially beneficial for those looking for connection with others as part of their healing.

Mentalization-based therapy

In mentalization-based therapy (MBT) is a well-studied type of psychodynamic psychotherapy that can effectively treat BPD. MBT, also referred to as transference-focused counseling or transference-focused psychotherapy, emphasizes how the thoughts, feelings, and behaviors of the individual may affect those of others. It’s a socially focused therapy that helps the person tune into the impacts of the choices they make. Since symptoms of BPD often have the potential to negatively impact others, mentalization-based therapy can help a person learn to better manage their behaviors. This can lead to improved relationships with family members and other loved ones; improved social skills; and an overall bettered quality of life. Mentalization-based therapy is an excellent method for assisting persons with BPD in understanding themselves and becoming sensitive to the feelings of others.

Therapy for emotional predictability

Systems Training For Emotional Predictability And Problem-Solving, known as STEPPS, is an adjunct therapy option that combines cognitive behavioral therapy, skills training, and elements from systems therapy. It is typically offered as a 20-week group outpatient program, and can effectively improve symptoms of borderline personality disorder as well as improve depression related to BPD.

Counseling and medication to treat borderline personality disorder

Certain medications may be an important component of treatment for someone with borderline personality disorder. It may help them manage symptoms, prevent symptoms from worsening, and treat co-occurring disorders such as depression, anxiety, post-traumatic stress disorder, or eating disorders. Their effects may also help a person adhere to their psychotherapy treatment, which can be integral for long-term success. The most common types of medications prescribed for BPD include antidepressants, antipsychotics, anxiolytics, and/or mood stabilizers. A psychiatrist can evaluate a person’s specific situation and make recommendations accordingly for the right treatment and good psychiatric management of medications. 

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Online therapy for BPD

In-person counseling sessions have traditionally been the norm for treating a variety of mental health disorders. However, online therapy is becoming an increasingly popular option for those who prefer to connect with a therapist from the comfort of their home. It’s a more available format for people who can’t travel to a provider’s office regularly or who have trouble locating a provider in their area. It’s also typically more cost-effective since virtual providers have fewer overhead costs. 

Research from 2022 suggests that online psychotherapy can be an effective treatment for personality disorders. Other studies have suggested that it can be as effective as in-person sessions for a variety of mental health conditions such as depression and anxiety, which can coexist with borderline personality disorder. If you’re interested in pursuing online therapy, you might consider a platform like BetterHelp. You’ll be asked to fill out a brief questionnaire about your needs and preferences and will then be matched with a licensed provider accordingly. You can speak with them via phone or video call and exchange in-app messages between sessions as needed. They can evaluate you and your situation and help you address the challenges you may be facing. See below for client reviews of BetterHelp counselors.

Counselor reviews

“Loretta has undoubtedly changed my life. In my late attempt to deal with trauma, she has shown me the light at the end of the tunnel. Through various strategies and methods she has provided me, I have become less paranoid, guilt-ridden, and anxious. I am so glad I decided to start using BetterHelp and was paired with Loretta.”
“I can't speak highly enough about David. I came to BetterHelp about 3 months ago with severe PTSD that was ruining my life and my relationships. In a short time, I began to learn better and healthier coping mechanisms, tools to stop and change thought patterns and find a new sense of peace and confidence. What a difference. I would recommend David to anyone who may be seeking help from trauma and anxiety, he is very good.”

Takeaway

People with BPD can benefit from certain types of treatment, which may include different forms of talk therapy potentially in conjunction with medication. Counseling options include individual and group therapy, phone coaching, and online therapy; popular modalities for BPD include dialectical behavior therapy (DBT), transference-focused therapy (TFP), mentalization-based therapy (MBT), and more. Consulting with a mental health professional in person or online may be a helpful first step toward managing this disorder.

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