Treatments

Proper treatment of borderline disorder involves the following components: taking responsibility, locating a primary clinician, determining the most appropriate level of care for you, evaluating your need for medication, and selecting the type of psychotherapy that will be most effective for you, participation in education and support opportunities for both you and your loved ones.

1. Taking Responsibility

If you have borderline disorder, it is essential that you understand clearly and believe deeply that you, more than anyone or anything else, have the ability and responsibility for gaining increasing control over your life.
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2. Primary Clinician

You will need help. The number and complexity of decisions involved in the proper treatment of a patient with borderline disorder requires that a highly skilled clinician assumes a central role in helping you. This person is referred to as your primary clinician, and ideally will be a psychiatrist experienced in treating borderline disorder.
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3. Level of Care

Most patients with borderline disorder are most appropriately treated as outpatients. However, there are times when acute inpatient or residential care is necessary. Under most circumstances, this decision is best made by you, your primary clinician, and your family or spouse.
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4. Medications

Medications play three very important roles in the treatment of most patients with borderline disorder. 1) They are effective in reducing at least three of the four major  symptoms of the disorder. 2) They thereby enhance the rate and quality of improvement derived from psychotherapy. 3) Finally, medications are effective in treating other emotional disorders that frequently are associated with borderline disorder, for example, depression, anxiety/panic attacks, and ADHD, and physical disorders such as migraine headaches.
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5. Psychotherapy

Psychotherapy is a very important component of your treatment program. A number of different psychotherapeutic approaches appear to be effective in the treatment of borderline disorder. I have treated some patients with medications because they refuse to enter therapy, even with strong urging. Some of them, especially older patients with reasonably stable lives and relationships, appear to benefit with a reduction of emotional dysregulation. However, most do not benefit as much as they might with therapy.
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6. Education and Support

During the past decade, an increasing number of educational and support groups have been formed for patients with borderline disorder, and for their families. Many of these have been the result of the efforts of lay advocacy groups dedicated to increasing knowledge about, and reducing the stigma associated with borderline disorder.
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