Antipsychotics for Treating Borderline Personality Disorder

woman taking medication
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Your psychiatrist may prescribe antipsychotics for one or more of your borderline personality disorder (BPD) symptoms. 

Why Antipsychotics for Borderline Personality Disorder?

The term "borderline" was coined because early psychiatrists believed that the symptoms of BPD were "on the border" between neurosis and psychosis. For this reason, some of the first medications tested for BPD were antipsychotics.

Although we now know that BPD does not share features with psychosis (and is not a psychotic disorder), research has shown that antipsychotic medications may be effective in reducing some of the symptoms of BPD — specifically, anger and hostility, intense mood shifts, and cognitive symptoms, like paranoid thinking.

That being said, research shows that antipsychotics are not effective in improving anxiety, depressed mood, and ​impulsivity in BPD. In addition, while the short-term use of antipsychotics may be effective in BPD, the benefit of frequent and long-term use of antipsychotic is controversial.

Types of Antipsychotics

There are two main types of antipsychotics: typical and atypical.

Typical Antipsychotics. Typical antipsychotics are the older variety of antipsychotic medications, known as first-generation antipsychotics. They are less commonly used due to their potential for serious side effects like movement disorders. Some typical antipsychotics are:

  • Haldol (haloperidol)
  • Navane (thiothixene)
  • Stelazine (trifluoperazine)

Atypical Antipsychotics. Atypical antipsychotics are the newer generation of antipsychotic medications, and they produce less of the movement related to side-effects. Atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Caplyta (lumateperone)
  • Fanapt (iloperidone)
  • Geodon (ziprasidone)
  • Invega (paliperidone)
  • Latuda (lurasidone)
  • Rexulti (brexipiprazole)
  • Risperdal (risperidone)
  • Saphris (asenapine)
  • Seroquel (quetiapine)
  • Vraylar (cariprazine)
  • Zyprexa (olanzapine)

Side Effects of Antipsychotics

Tardive dyskinesia, a side effect that can occur from the long-term use of antipsychotics, involves uncontrollable movements of the face, lips, tongue, limbs, and fingers. It's irreversible, and the risk of developing it is higher with the typical antipsychotics than the atypical antipsychotics.

Other potential side effects are called extrapyramidal symptoms, like akathisia, an intense sense of restlessness and agitation. Extrapyramidal symptoms are also more common with the typical than the atypical antipsychotics. 

Neuroleptic malignant syndrome is a rare but very serious condition associated with antipsychotics involving high fever, delirium, and muscle rigidity. Neuroleptic malignant syndrome is also associated with seizures, rhabdomyolysis (muscle breakdown that can lead to kidney failure), coma, and death.

While the atypical antipsychotics are less likely to cause tardive dyskinesia and extrapyramidal symptoms, they are associated with other side effects like weight gain, new onset diabetes, a rise in cholesterol, sexual dysfunction, and heart problems.

As shown, there are a number of potential side effects associated with antipsychotics, and they vary by the type (typical vs atypical) of antipsychotic, as well as the individual medication. If your doctor prescribes an antipsychotic, be sure to review the side effects with your doctor and take the medication as directed. 

Bottom Line

Treating BPD requires an individualized approach—meaning what works for you is likely different from what works for someone else. It will take time for you and your doctor to devise a plan for optimizing your care for your BPD, and this plan may include both medication and psychotherapy.

The good news is that there are excellent treatment options available that can help you feel better and get well. A proper discussion and asking the right questions can get you on your way to figuring out the right option for you.

Borderline Personality Disorder Discussion Guide

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2 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ingenhoven, T.J., & Duivenvoorden, H.J. (2011). Differential effectiveness of antipsychotics in borderline personality disorder: meta-analysis of placebo-controlled, randomized clinical trials on symptomatic outcome domains. Journal of Clinical Psychopharmacology, 31(4):489-96.

  2. Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia: A Review and Update. Ochsner J. 2017;17(2):162-174.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.