Evidence for the treatment of borderline personality disorder

The treatment of patients with borderline personality disorder (BPD) is notoriously difficult. Psychotherapeutic and pharmacological strategies have been investigated, and a few have shown promise. Dialectical behavior therapy (DBT) may be helpful in decreasing suicidal behavior and improving symptomatology, although the data are not strong, and the actual "type" of DBT employed may influence the outcomes. Although there are a variety of studies investigating a number of different medications for the treatment of BPD, there are few randomized, double-blind, placebo-controlled trials. Furthermore, the evidence base is limited by small sample size and variability in inclusion criteria and outcome measures among the different studies. Further study is needed with larger, randomized, placebo-controlled trials to clearly demonstrate benefit of any pharmacotherapy. To date, there is suggestion from some studies that neuroleptics, carbamazepine, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors may be effective, and there is evidence that benzodiazepines are detrimental. The role of electroconvulsive therapy remains unclear.