Borderline personality disorder: A review of treatment approaches

Borderline personality disorder (BPD) is attracting renewed clinical and research interest as epidemiology studies are objectively reporting its prevalence and severity. Utilizing modern tools, rates of BPD are now reported as 1-2% of the general population. These findings combined with reports of the high rate of utilization of psychiatric services lead to a greater appreciation of the significance of the illness. Further, support groups such as National Alliance on Mental Illness are pushing for greater action. This paper provides a review of pharmacotherapy approa-ches to BPD by describing results of the numerous classes of compounds that have been tested for the illness. The publication of objective criteria for BPD in DSM III led to an emergence of standard clinical trials. The studies of typical and atypical antipsychotic medications -some showing efficacy and some not-are reviewed. Also, the trials of SSRIs, SNRIs, MAOIs, anticonvulsant mood stabilizers and lithium are discussed. This is followed by a discussion of empiric assessments of psychosocial treatment trials which leads to the concluding section on new studies assessing combined psychosocial and medication treatment. As combined psychosocial and medication treatments are frequendy applied to BPD patients, this research holds promise for the future.