Medication in Borderline Personality Disorder (BPD) 💊

Medications can be helpful in BPD

BUT

Key is helpful for what ? 👇

Borderline Personality Disorder (BPD) can be conceptualised as a combination of:

1. Neurodevelopmental changes resulting from allostatic load (such as trauma or other 'inconsistencies' in early experiences) leading to heightened emotional responses, emotional dysregualtion etc.

2. Personality development, where emotional regulation and behavioural patterns consolidate alongside neurodevelopmental changes. These have consolidated at a time of upheaval which means the default behaviours are safety / fear / mistrust driven.

When we use medication we are primarily addressing 1 👇

helping to stabilise the heightened salience / amygdala activation so that the patient can better engage in the process of changing 2.

Why is this important?

A heightened amygdala and overactive salience network can make behavioural change challenging. 🚨

Emotional dysregulation impairs learning, particularly frontostriatal learning, which is critical for behavioural change. 🧠

After all, how many of us can effectively learn or pt when we are emotionally overwhelmed?

So the dichotomous understanding is really reflective of the split that underlies the essence of BPD which prevents these patients from obtaining biological treatments that can help. ✅

Can we really conceptualise this condition without biological aspects?

Neuropsychoanalysis forms the foundation here.

To avoid polypharmacy we must recognise the domains we are targeting. The polypharmacy that occurs in BPD is simply the medication regime reflecting the emotional confusion of the patient. ❌

Targeted psychopharmacology can make a difference. ✅

When we understand the neurobiology and psychodynamics one recognises that the split is a semantic debate.