In December of 2024, the American Psychiatric Association (APA) released an updated Practice Guideline for the Treatment of Patients with Borderline Personality Disorder (BPD). The new guideline aims to improve quality of care by offering evidence-based recommendations for assessment, treatment planning, psychosocial interventions, and pharmacotherapy. It highlights the importance of a comprehensive, person-centered treatment plan, collaborative discussions about diagnosis and treatment, and structured psychotherapies targeting core symptoms.
“As providers, we are all too familiar with the complexities of treating individuals diagnosed with BPD,” says PMHNP-BC and VP of Foresight Psychiatry Services, Jessica Vadovicky. “Historically, the lack of clear guidelines or treatment algorithms has often led to polypharmacy and intricate medication regimens that provide limited symptom relief,” she explained.
“The updated APA practice guideline is a welcome shift, particularly due to its emphasis on early and transparent discussions of the diagnosis. For too long, the label of BPD has been avoided due to stigma, yet acknowledging and identifying maladaptive coping patterns can be an essential therapeutic step for patients.”
Most notably, the guideline underscores that pharmacology is not the mainstay of treatment for BPD. At Foresight Mental Health, medication management is just one part of caring for one’s overall mental health . “Most clients seeing us for psychiatry will benefit from other services too. If appropriate, we will connect you with our Therapy and Nutrition teams,” said Vadovicky.
Medications, when used, should be approached conservatively, with clear, problem-focused goals and limited durations. “Thoughtfulness around what we are targeting, with what agent, and for how long is crucial in reversing the trend of overmedication and addressing the poor medication tolerance often seen in this population.”
Affecting fewer than 3% of the U.S. population, BPD is characterized by unstable relationships, intense emotions, poor self-image, and impulsivity. While the condition can persist for years, symptoms can remit and be managed with proper care.
This new guideline emphasizes psychotherapy as the most effective treatment while discouraging reliance on pharmacotherapy for core symptoms. Developed using a transparent process, this guideline is expected to enhance access to effective care and reduce risks associated with unnecessary medication.
Foresight Mental Health’s aligned partnership of therapy and psychiatry welcomes these insightful recommendations from the APA. As trauma-informed providers, we often see the origins of BPD in a person’s past adverse experiences. The unique collaboration that happens daily between our psychiatry and therapy teams makes embracing this shift in care for people presenting with BPD seamless.
If you or someone you care about needs mental health support, we’re here to help. Contact us today.
