By: Erik Messamore, MD, PhD
Dr. Messamore is both a clinical psychiatrist and psychiatric researcher at the Lindner Center of HOPE. He reviews new or little-known clinical research findings at his website – DrErik.com
Borderline personality disorder is characterized by mood disturbance and impulsivity. Moods in borderline personality can shift rapidly and are often intense. Anger problems are common. In its most severe forms, people with borderline personality may dissociate or experience brief episodes of psychosis. Self-injury (often from cutting) and frequent suicide attempts are common. Borderline personality disorder affects about 3% of the adult population and accounts for over 20% of outpatient psychiatric visits.
Psychotherapy is the treatment of choice for borderline personality disorder, and Dialectical Behavior Therapy (DBT) is often the most well suited form of therapy for patients with borderline personality. DBT fosters mindful awareness and teaches coping skills that can significantly improve emotional regulation.
Unfortunately, there are no medications specifically designed to treat borderline personality disorder. Antidepressants, or “mood-stabilizing” agents, or antipsychotic medications may help reduce the severity of some of the symptoms. However the response to these treatments is highly variable. There is strong need for more options with less risk for side effects. Emerging research points to a possible benefit from omega 3 fatty acids.
Omega-3 fatty acids are important components of cell membranes, and they seem to be particularly important in brain function. Omega-3s such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are present in the brain and exist in relatively high concentrations in the nerve terminal regions, where most cell-to-cell communication takes place. Depression is less common in people whose regularly consume omega-3-rich foods such as fish. Even schizophrenia appears to be less disabling in countries with higher consumption of vegetables or fish. Laboratory research has firmly established that experimental creation of omega-3 deficiency causes abnormal behavior in lab animals. And in human studies, researchers have repeatedly discovered associations between omega-3 fatty acid levels and symptoms of psychosis, depression, impulsivity and self-harm.
Emerging research suggests that omega-3 fatty acids can be used therapeutically in borderline personality disorder. In treatment studies, researchers rely on just two omega-3 components: EPA and DHA. Silvio Bellino and colleagues from the University of Turin in Italy showed that EPA (1200 mg per day) plus DHA (800 mg per day), when added to therapeutic doses of Depakote, reduced impulsivity, anger, and self-harm in a group of patients with borderline personality disorder. In a separate study from Harvard University, Mary Zanarini and Frances Frankenburg showed that an 8-week course of treatment with EPA (1000 mg per day) outperformed placebo treatment in reducing depression and aggression in women with borderline personality. Research from Brian Hallahan’s group in Dublin, Ireland showed substantial reductions in suicidal thoughts and depression among patients with a history of multiple self-injury attempts (70% of the study sample had borderline personality disorder). Treatment in this study consisted of 12 weeks of daily EPA (1,220 mg per day) and DHA (908 mg per day). And finally, Paul Amminger led a study at the University of Vienna in Austria. The study focused on a group of adolescents with borderline personality disorder whose symptoms also suggested high risk of progression to psychosis. Volunteers in the study received either placebo capsules or active treatment with daily EPA (700 mg) plus DHA (480 mg) for twelve weeks. The EPA+DHA produced large decreases measures of depression, tension, anxiety, and impulsivity. The omega-3 fatty acids also prevented psychosis in the high-risk patients.
Side effects from omega-3 fatty acids are usually very mild. They are “generally regarded as safe” in the eyes of the FDA at the doses used in these studies. Scientists still have much work to do in figuring out which types of patients may most benefit from this kind of treatment, and what would be the best doses or durations of treatment.
Borderline personality disorder is a potentially severe condition that can be improved substantially with treatment. Psychotherapy is the most effective evidence-based treatment for borderline personality. It is encouraging to learn that EPA and DHA may help to reduce symptoms. These natural substances may prove to be useful parts of a combined biological and psychological treatment approach.