Part of the puzzle that we are still putting together is the relationship between environment and biology in the person with borderline personality disorder. One thing that is interesting to note is that pharmacologists can artificially induce the profound dysphoria experienced by people with BPD by giving a subject the drug Procaine. I recommend a rehabilitative approach to the disorder with respect to the behaviors involved. The importance of a treatment alliance between patient and professional cannot be overstressed. Developing coping skills for the patient is vital.
Medications also play a role in treatment.
First, any co-occurring disorder, such as a major depression, or panic disorder, or adult residual ADHD, should be actively treated. If there is no clear cut disorder, then a planned sequence of medication trials targeted at specific symptoms may be instituted. The serotonin reuptake inhibitor antidepressants may be a medication of first choice, but for specific individuals, neuroleptics, anticonvulsants, tricyclic antidepressants, or even some anti-anxiety agents may be useful. Medication occasionally results in marked improvement, but far more often, it serves to modulate affect enough to make psychotherapy more productive and daily experience somewhat less disruptive.