Treatment of borderline personality disorder: Potential of the new antipsychotic medications

Since their introduction, the newer atypical antipsychotics have been tested in a number of areas besides schizophrenia. In this article, studies of their use in borderline personality disorder (BPD) are reviewed. The authors first discuss the clinical characteristics of BPD and outline the issues that need to be addressed in designing treatment trials for this disorder. They then review treatment studies in BPD using low doses of traditional antipsychotics. These studies demonstrated that the traditional antipsychotics were effective in BPD but were also difficult to tolerate, mainly because of extrapyramidal side effects. Because the newer antipsychotic medications appear to be easier to tolerate, researchers have begun testing these newer agents in BPD. The authors review the studies that have been done to date using the newer antipsychotics in the treatment of BPD and conclude that the results are promising and that the new medications may even offer some advantages (e.g., for affective symptoms) that go beyond being as effective as traditional antipsychotics but without the extrapyramidal side effects. The article concludes with a discussion of areas meriting future research.