Electroconvulsive Therapy in Treating BPD

A Psychiatric Treatment With a Controversial History

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Electroconvulsive therapy (or ECT) is a psychiatric treatment with a long and controversial history. The treatment involves briefly passing an electrical current through the brain. This procedure is not used to treat borderline personality disorder (BPD), but it is used to treat severe depression that has not responded to adequate medication trials and under other clinical circumstances.

Since many people with borderline personality disorder also suffer from depression, some people who receive electroconvulsive therapy have BPD.

Using ECT Effective for Borderline Personality Disorder

Even though electroconvulsive therapy is used to treat severe depression in people who have borderline personality disorder, there is research that suggests that ECT is not as effective in treating depression for people who also have BPD.

One study, published in 2004, looked at the effects of ECT in 139 patients, all of whom had major depression and 20 of whom also had borderline personality disorder. The study found that eight days following treatment, those with borderline personality disorder didn't score as well on a depression symptom measurement scale as those who didn't have a personality disorder or those who had a different type of personality disorder.

The patients in that study who had borderline personality disorder were more likely to be women, to be younger, and to have medication-resistant depression, but the study authors noted that these factors didn't account for their poorer response to electroconvulsive therapy.

Researchers have agreed that ECT doesn't seem to work as well in patients with borderline personality disorder, although the reasons for this aren't clear.

The Bottom Line

The research literature in this area is small and inconsistent, so it does not mean that people who have both depression and borderline personality disorder should not receive ECT. However, it is something to consider when you are weighing the risks and benefits.

While ECT does have a long and controversial history, it is recognized as an effective treatment for severe depression by the American Psychiatric Association (APA). The APA has issued guidelines for the use of ECT that ensure that the procedures are carried out with your safety and well-being in mind.

Some people do experience unwanted side effects from electroconvulsive therapy (for example, memory loss), so you should talk about the risks and benefits with your provider if you are considering ECT.

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  • American Psychiatric Association. Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. American Journal of Psychiatry, 1581-52, 2001.

  • Feske U et al. Clinical Outcome of ECT in Patients With Major Depression and Comorbid Borderline Personality Disorder. American Journal of Psychiatry. 2004 Nov;161(11):2073-80.

  • Rasmussen KG et al. Do Patients With Personality Disorders Respond Differentially to Electroconvulsive Therapy? A Review of the Literature and Consideration of Conceptual Issues. The Journal of ECT. 2015 Mar;31(1):6-12.

  • Weiner RD. Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A Task Force Report of the American Psychiatric Association, (2nd ed.), American Psychiatric Publishing, 2001.

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