Changing Information and Concepts of Pharmacotherapy and Psychotherapy of BPD

Considerable progress has been made in the past decade on the effective use of mediations and psychotherapy in the treatment of borderline disorder. The pharmacological approach to treatment has shifted from that recommended by the American Psychiatric Association Practice Guideline published in 2001 (REF. 30).  In the APA Guideline, SSRIs such as Prozac, were suggested as the first line treatment for emotional and behavioral dyscontrol, with the addition of low doses of antipsychotic agents, if needed, for congnitive-perceptual impairments such as paranoia and dissociative episodes. Since then, research has indicated a shift away from the SSRIs to the mood stabilizers (e.g., Topamax and Lamictal) and antipsychotic medications, particularly the second generation antipsychotics.(REF. 27)

Two overlapping theories of  the application of psychotherapy in the treatment of BPD have recently emerged.(REFs 31,33). Though different in one significant respect, the general approach proposed by these authors is that more attention needs to be made to the common strategies of the BPD-specific psychotherapies, because they have not demonstrated clear differences in outcomes.