Drug Treatment of Borderline Personality Disorder Symptomatic Dimensions: Evidence­ ‑Based Recommendations

Abstract

Borderline personality disorder (BPD) constitutes a hard tot treat personality disorder, characterized by persistent emotional dysregulation, identity and self­ ‑esteem instability, impulsivity, persistent interpersonal conflicts, and self‑harming behaviors. The intense subjective distress and increased healthcare needs are also characteristic. While psychotherapy remains the gold standard for treatment, pharmacotherapy is essential for many individuals with BPD. These guidelines aim for a better pharmacological management of BPD, based on a comprehensive literature review that included relevant studies and clinical guidelines from organizations such as National Institute for Health and Care Excellence, World Federation of Societies of Biological Psychiatry and Australian National Health and Medical Research Council. Distinct drugs can effectively target distinct symptom domains: cognitive­ ‑perceptual alterations, emotional dysregulation, impulsivity, and interpersonal dysfunction. Key findings indicate that antidepressants, particularly SSRIs and tricyclics, demonstrate efficacy in reducing depressive symptoms and impulsivity. Mood stabilizers, including lamotrigine and valproate, have shown benefits for emotional dysregulation and impulsive behaviors. Antipsychotics, notably aripiprazole and olanzapine, provide relief from severe emotional dysregulation and impulsive aggression. The efficacy of aripiprazole in the treatment of all symptom dimensions is highlighted. However, careful consideration of the side­ ‑effect profile is crucial, given the potential for adverse effects, particularly in vulnerable populations. Despite the recognized utility of pharmacological interventions, the limitations within the existing literature, such as methodological variability and lack of consensus on symptom definitions, complicate result interpretation. Therefore, longitudinal studies assessing both short­ ‑term and long­ ‑term outcomes of pharmacological treatments are warranted. A continued commitment to research, within a multidisciplinary framework, is essential for optimizing the clinical management of BPD and enhancing our understanding of the efficacy of pharmacotherapy in this complex disorder.