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Clinical psychopharmacology of borderline personality disorder: an update on the available evidence in light of the Diagnostic and Statistical Manual of Mental Disorders – 5

Ripoll, Luis H.a,b

Current Opinion in Psychiatry: January 2012 - Volume 25 - Issue 1 - p 52–58
doi: 10.1097/YCO.0b013e32834c3f19
PERSONALITY DISORDERS AND NEUROSIS: Edited by Charles B. Pull and Aleksandar Janca
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Purpose of review Clinical considerations for evidence-based treatment of borderline personality disorder (BPD) are outlined in the context of the best available evidence, discussed with reference to BPD traits currently identified in the upcoming Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-5) revision. The DSM-5 will highlight refractory affective, interpersonal, and identity symptoms in BPD as potential treatment targets. In addition to providing a framework for clinical decision-making, future research strategies will also focus on neurotransmitter systems of greater relevance to understanding overall personality functioning.

Recent findings Although only a few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, several meta-analyses and systematic reviews converge on the consensus effectiveness of lamotrigine, topiramate, valproate, aripiprazole, olanzapine, and omega-3 fatty acid supplementation. Stronger evidence exists for treating disinhibition and antagonism than negative affectivity, particularly interpersonal facets of such traits. In addition, basic research suggests a future role for modifying glutamatergic, opioid, and oxytocinergic neurotransmitter systems to treat BPD.

Summary Clinicians should utilize omega-3, anticonvulsants, and atypical antipsychotic agents in treating specific DSM-5 BPD traits, notably disinhibition, antagonism, and some aspects of negative affectivity. Future research will focus on normalizing opioid and oxytocin dysregulation, as an adjunct to evidence-based psychotherapy, in an effort to improve interpersonal functioning.

aJames J. Peters VA Medical Center, Mental Illness Research Education and Clinical Center (MIRECC), Bronx

bMount Sinai School of Medicine, Mood and Personality Research Program, New York, USA

Correspondence to Luis H. Ripoll, MD, James J. Peters VA Medical Center, Mental Illness Research Education and Clinical Center (MIRECC), 130 West Kingsbridge Road, Bronx, NY 10468, USA. Tel: +1 718 584 9000 x5231; e-mail: luis.ripoll@mssm.edu

© 2012 Lippincott Williams & Wilkins, Inc.