Antipsychotics for Treating Borderline Personality Disorder

Antipsychotics may help improve thinking and reduce anger in BPD.

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 side-effects. The six atypical antipsychotics are:

  • Zyprexa (olanzapine)
  • Clozaril (clozapine)
  • Seroquel (quetiapine)
  • Abilify (aripiprazole)
  • Geodon (ziprasidone)
  • Risperdal (risperidone)

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.

While the 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.

In addition, some of the individual antipsychotics carry their own unique side effects. For instance, a rare but potentially fatal side effect of the atypical antipsychotic clozapine is agranulocytosis, a decrease in white blood cells. Regular monitoring of blood counts is required when this agent is used.

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. 


Albers LJ, Hahn RK, & Reist C. Handbook of Psychiatric Drugs, Current Clinical Publishing Strategies, 2008.

American Psychiatric Association. (October 2001). Practice Guidelines for the Treatment of Patients with Borderline Personality Disorder." American Journal of Psychiatry, 158: 1-52.

Ingenhoven, T.J., & Duivenvoorden, H.J. (2011). Differential effectiveness of antipsychotics in borderline pesonality disorder: meta-analysis of placebo-controlled, randomized clinical trials on symptomatic outcome domains. Journal of Clinical Psychopharmacology, 31(4):489-96.

Stoffers, J., Völlm, B.A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2010). Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews, Jun 16;(6):CD005653.

Triebwasser, J, and Siever, LJ. (2007). "Pharmacotherapy of Personality Disorders." Journal of Mental Health, 16: 5-50, February 2007.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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