Key Takeaways:

The updated guidelines emphasize psychotherapy as the primary treatment for borderline personality disorder (BPD), while discouraging the use of ineffective medications.
Clinicians are advised to review patients’ medications at least every six months to determine which can be tapered or discontinued.
The American Psychiatric Association (APA) now highlights psychotherapy as the cornerstone of treatment for BPD in both adolescents and adults.

Dr. George A. Keepers, chair of the APA Practice Guideline Writing Group, noted that the revised guidelines reflect significant updates since the APA’s original recommendations in 2001.

He emphasized two main changes:

Several structured psychotherapies have been validated as effective for BPD, though no single therapy stands out as the definitive treatment.
There is no evidence supporting the use of pharmacotherapy for addressing the core symptoms of BPD, leading to new recommendations that minimize medication use and discourage prolonged polypharmacy.

Prevalence and Scope:
BPD affects up to 2.7% of the U.S. population, typically beginning during adolescence or early adulthood.

Summary of Recommendations and Suggestions:

Initial Evaluation:
- Include a thorough assessment of the patient’s reasons for seeking evaluation, treatment goals, psychiatric and treatment history, mental and physical health, cultural and psychosocial factors, and risks of suicide or aggression (recommendation, low confidence).
- Use quantitative measures to assess symptom severity and functional impairments that treatment should address (suggestion, low confidence).
Treatment Planning:
- Develop a comprehensive, person-centered treatment plan (recommendation, low confidence).
- Actively involve patients in discussions about their diagnosis and treatment, including psychoeducation (recommendation, low confidence).
Psychosocial Interventions:
- Employ a structured psychotherapy approach targeting BPD’s core features (recommendation, moderate confidence).
Pharmacotherapy:
- Evaluate co-occurring conditions, prior treatments, nonpharmacological therapies, and current medications before prescribing new medications (recommendation, low confidence).
- Limit the duration of psychotropic medication use, ensuring they address measurable symptoms and are used as an adjunct to psychotherapy (suggestion, low confidence).
- Reassess medications every six months to evaluate their effectiveness and identify those that can be reduced or stopped (recommendation, low confidence).