Borderline Personality Disorder (BPD) is characterized by a pervasive pattern of instability that affects mood, self-image, and interpersonal relationships. Individuals with this condition often experience intense and rapidly shifting emotions, a core feature known as affective instability, alongside marked impulsivity and a fear of abandonment. Treating BPD typically involves multiple interventions. This article explores the specific, adjunctive function of mood stabilizers in managing the symptoms of Borderline Personality Disorder.
Primary Treatment Approach for BPD
The foundational and most effective treatment for Borderline Personality Disorder is psychotherapy, not medication. BPD is fundamentally understood as a disorder of emotional dysregulation and difficulties in interpersonal functioning.
Dialectical Behavior Therapy (DBT) is the most established and extensively researched form of psychotherapy for BPD. DBT is a modified type of Cognitive Behavioral Therapy (CBT) that specifically targets the emotional and behavioral dysregulation seen in the disorder. It teaches patients four main skill sets:
- Mindfulness
- Distress tolerance
- Emotion regulation
- Interpersonal effectiveness
Cognitive Behavioral Therapy (CBT) can also be helpful, as it assists patients in identifying and changing distorted thought patterns and developing healthier coping mechanisms. Because BPD is a personality disorder involving deeply ingrained patterns of behavior and emotion, medication alone cannot provide the necessary skill-building required for long-term recovery.
The Role of Mood Stabilizers in Managing Symptoms
Mood stabilizers are not considered a primary treatment for BPD, but they can be a helpful component when used as an adjunctive treatment alongside psychotherapy. They are generally prescribed to manage specific, distressing symptoms rather than treating the core disorder itself. The use of these medications in BPD is different from their use in Bipolar Disorder, where they are used to prevent manic and depressive episodes.
By reducing the intensity of rapid mood shifts, the medication can help stabilize the patient enough to allow them to engage more effectively in psychotherapy. This reduction in affective instability facilitates the learning and application of the emotion regulation skills taught in DBT. The selection of a mood stabilizer is highly individualized and depends on the patient’s most disruptive symptoms.
While no medication is approved by the U.S. Food and Drug Administration (FDA) specifically for BPD, certain mood stabilizers have demonstrated efficacy in mitigating particular symptom clusters.
Specific Symptoms Targeted by Medication
Mood stabilizers primarily target three specific and challenging symptom clusters associated with BPD: affective instability, impulsivity, and chronic anger. By acting on neurotransmitters, these medications help buffer the nervous system against extreme emotional swings.
Lamotrigine, an anticonvulsant medication used as a mood stabilizer, has shown particular promise in addressing affective instability and anger. Its mechanism of action involves reducing the release of glutamate, an excitatory neurotransmitter, which contributes to its mood-stabilizing effects. Clinical trials suggest that lamotrigine can improve overall mood stability and reduce anger in individuals with BPD.
Another frequently used option is Valproate, also known as divalproex sodium, which is often prescribed to reduce impulsive aggression and irritability. This medication works by enhancing the inhibitory effects of Gamma-aminobutyric acid (GABA), calming overactive neuronal signaling. Studies have confirmed Valproate’s effectiveness in managing aggression and hostility, particularly in patients with high levels of impulsive behavior.
Other mood stabilizers, such as topiramate, may be considered for their effect on impulsive aggression and anger, though evidence is less extensive compared to lamotrigine and valproate. The choice remains symptom-specific.
Understanding Side Effects and Treatment Limitations
Mood stabilizers carry a risk of side effects that require careful management. For Lamotrigine, the most serious, though rare, concern is the development of a severe skin rash known as Stevens-Johnson syndrome, which necessitates a very slow, gradual dose increase. More common side effects can include:
- Dizziness
- Drowsiness
- Headache
- Nausea
Valproate has a different set of side effect considerations, including potential weight gain, gastrointestinal disturbances, and hair loss. Of particular concern is the need for regular blood monitoring to check liver function and platelet counts, as well as the risk of birth defects if taken during pregnancy.
The main limitation of pharmacotherapy in BPD is that medication only treats symptoms; it does not resolve the underlying relational and emotional skill deficits. Furthermore, not all patients respond well to mood stabilizers, and some may experience no benefit at all. Consistent engagement in psychotherapy remains the most reliable path to reducing BPD symptoms and improving long-term quality of life.