Can TMS be Used to Treat Borderline Personality Disorder (BPD)?

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What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental health disorder that affects how you think and feel about yourself and others, making it difficult to function in daily life. It can cause issues with self-image, trouble controlling one’s emotions and conduct, and a history of unstable relationships.

You may find it difficult to tolerate being alone if you have BPD because you have an intense fear of abandonment or instability. Even if you desire to build meaningful and enduring relationships, improper anger, impulsivity, and frequent mood swings may drive others away.¹

Warning signs and symptoms of BPD may include:

• Excessive anxiety about being abandoned, even to the point of taking drastic efforts to prevent actual or imagined rejection or separation
• A pattern of erratic, passionate connections, such as abruptly idealizing someone yet thinking they don’t care enough or that they are harsh the next moment
• Quick shifts in goals and values, as well as a negative or nonexistent perception of one’s identity and self-image
• Stress-related paranoia and periods of disconnection from reality that might last a few minutes to a few hours
• Impulsive and risky behaviors, such as driving recklessly, engaging in unsafe sexual activity, going on shopping sprees, binge eating, misusing drugs, or sabotaging success by quitting a well-paying job or suddenly ending a fulfilling relationship
• Suicidal threats, actions, or self-harm, frequently brought on by a fear of being abandoned or rejected
• Broad mood swings that might last anywhere from a few hours to a few days and include extreme joy, irritation, guilt, or worry
• Persistent feelings of boredom and emptiness
• Very inappropriate anger that manifests as a frequent loss of temper, sarcasm, or violent altercations

It is unclear what causes borderline personality disorder. However, in addition to environmental issues, such as a history of child abuse, it may be related to:

• Genetics: According to research on twins and families, personality disorders may run in families or be closely related to other mental health issues.
• Brain abnormalities: According to several studies, the brain’s emotional regulation, impulsivity, and aggression-controlling regions have changed. Moreover, serotonin, one of the chemicals in the brain that regulates mood, may not work correctly.

Psychotherapy and, occasionally, medication are the primary forms of treatment for borderline personality disorder. However, your doctor could also advise hospitalization if your safety is in danger.

You can develop coping mechanisms and management techniques through treatment. Treatment is also required for other mental health conditions, such as depression or substance abuse, which frequently coexist with BPD. With psychotherapy, you may live a more secure, fulfilling life while feeling better about yourself.²

Therapy treatment options for borderline personality disorder include the following evidence-based treatments:³

• Dialectical Behavior Therapy (DBT): Individual and group treatment are included in DBT. It offers techniques for mindfulness and acceptance, such as how to accept your thoughts, feelings, and associated physical sensations in the moment. Also, it teaches you how to manage your emotions, put up with discomfort, and effectively interact with others.
• Cognitive Behavior Therapy (CBT): CBT targets current issues and symptoms, focuses on the connections between ideas, feelings, and behaviors, and aims to change negative thoughts, feelings, and behavior patterns that make functioning difficult.⁴
• Schema-Focused Therapy: Schema-focused treatment can be done in a group or one-on-one setting. It can assist you in identifying needs that have given rise to unhealthy habits that, though they may have once been necessary for survival, are now destructive.
• Psychodynamic Psychotherapy: This treatment seeks to assist you in understanding your emotions and interpersonal challenges through the growing bond between you and your therapist. You then use these realizations in relationships outside of therapy.
• Mentalization-Based Therapy (MBT): MBT is a form of talk therapy that enables you to recognize your current ideas and emotions and develop an alternative viewpoint. Thinking before acting is a critical component of MBT.
• Systems training for emotional predictability and problem-solving (STEPPS): Working in groups, STEPPS is a 20-week therapy program that includes your loved ones, caregivers, friends, or significant others. STEPPS is used in addition to other forms of therapy.
• Transcranial Magnetic Stimulation (TMS):⁵ TMS for borderline personality disorder is a non-invasive procedure that stimulates cells in areas of the brain, such as the dorsolateral prefrontal cortex, by delivering electromagnetic pulses using an electromagnetic coil. These pulses can control brain activity in targeted regions, potentially returning them to normal. Restoring the stability and balance in the brain helps reduce symptoms associated with the condition.
• Medications: Although the Food and Drug Administration (FDA) has not yet authorized any medications specifically for treating BPD, some may be able to help with symptoms or co-occurring conditions, including depression, anxiety, and aggression. Antidepressants, antipsychotics, and mood stabilizers are examples of medications that may help.

Insurance may be able to help cover the cost of therapy.

Athena Care is in-network with most major insurance plans. Find out more about your insurance coverage by calling your insurance company or contacting Athena Care at 877-641-1155.

Statistics on the Prevalence of Borderline Personality Disorder

• According to borderline personality disorder demographics, the prevalence of BPD in the United States is around 1.6%. However, this figure may potentially be much higher at 5.9%. In addition, higher percentages of patients with BPD are found in certain clinical settings.⁶
• Researchers are unsure why women are far more likely than males to receive a BPD diagnosis. Three women are diagnosed with BPD for every one man, or around 75% of those who suffer from BPD.
• Current research suggests that males may be equally affected by BPD but are frequently misdiagnosed with post-traumatic stress disorder (PTSD) or depression.⁷
• Almost 70% of people with BPD will attempt suicide at least once in their lifetimes.⁸
• With a rate of 8 to 10%, more than 50 times higher than the risk of suicide in the general population, persons with BPD will actually commit suicide.
• In a recent study, more than 40% of BPD sufferers have previously received an incorrect diagnosis for another illness, such as bipolar disorder or major depressive disorder (MDD).⁹
• Bipolar disorder has been discovered in up to 20% of BPD patients, making diagnosis and treatment more challenging than with a single condition.

TMS Treatment for Borderline Personality Disorder

Transcranial Magnetic Stimulation, or TMS, is a non-invasive alternative therapy that uses electromagnetic fields to activate brain regions that aren’t functioning well. A small coil is positioned over the head throughout the treatment. Without obstructing the scalp and bone, the magnetic field produced by the coil’s electric current can influence the activity of the nerve cells.¹⁰

Here’s what you can expect during TMS treatment for BPD:

1. You’ll be led to a treatment area where you’ll be seated in a comfortable chair. The TMS professional or physician will give you earplugs (or another form of ear cover) to wear throughout the process. This is because the magnet’s sound is so strong that it can harm your hearing.¹¹ You won’t require general anesthesia and will be awake during the treatment.
2. Your technician will measure your head if it is your first session to identify where the magnetic coil should be positioned. They will also collect additional measurements to customize the TMS machine settings.
3. The TMS professional will then place an electromagnetic coil against your scalp near the forehead. The electromagnet then generates a continuous flow of painless magnetic pulses, stimulating particular areas of the brain, frequently turning on and off. This briefly produces a tapping or clicking sound, known as mapping, before pausing. The tapping sensation will also be felt on the forehead throughout the mapping process.
4. The professional will progressively raise the magnetic dose until your fingers or hands begin twitching to determine the appropriate quantity of magnetic energy. This is called the motor threshold. It’s a baseline for establishing the optimal dosage. During BPD TMS treatment, the brain stimulation intensity can be changed following any symptoms or side effects.¹²
5. Treatment will last anywhere from 30 to 60 minutes. Then, after treatment, you can drive yourself home and carry on with your regular routines.

The amygdala is the part of the brain that handles emotions. It is hyperactive in illnesses like depression and anxiety, which often co-occur alongside borderline personality disorder. According to brain scans, BPD patients present with a relatively small amygdala. This is an indication that this brain region is more active. Moreover, the prefrontal cortexes of those with BPD are inactive. This is the area of the brain that allows you to reason. This explains why impulsivity and depression are more common in BPD patients.¹³

TMS treatment for BPD may be used to treat specific symptoms associated with the disorder and depressive symptoms. In addition, according to studies, repetitive transcranial magnetic stimulation (rTMS) can lessen the severity of BPD symptoms.^14,15 Furthermore, a study found that just 10 TMS treatments improved issues with aggression, emotional instability, and planning skills in a small group of BPD patients.¹⁶ And according to a 2017 meta-analysis, TMS is a successful treatment for impulsivity reduction and self-control enhancement in BPD patients.¹⁷

TMS therapy for BPD is an effective treatment superior to other types of treatment because of its relative safety and lack of side effects. In addition, it can support the efficacy of other treatment methods, like psychotherapy and medication(s).

When Should TMS be Used to Treat BPD?

Researchers have noted that those who haven’t responded to psychotherapy or medication may benefit from TMS for BPD. However, TMS only has FDA approval for those with major depressive disorder (MDD) or obsessive-compulsive disorder (OCD) who have not responded to conventional treatments.

Although it isn’t the first line of treatment, TMS therapy for BPD provides hope to those who haven’t experienced improvements from other, more traditional therapies.

How Will I Know TMS Treatment for BPD is Working?

Most mental health conditions require a long-term commitment to recovery. In addition, attending all TMS BPD treatment sessions and continuing to take any medication(s) as directed is essential.

After TMS therapy for borderline personality disorder, some people won’t notice any improvements for several weeks, while others may experience results immediately. For instance, you could notice a reduction in depressive symptoms. But it’s also possible that some people won’t see any improvements or changes at all.

Are There any Side Effects or Risks of Using TMS for BPD?

Most TMS side effects are mild to moderate if they occur at all. However, they may consist of the following:¹⁸

• Headaches (most common)
• Lightheadedness
• Scalp pain
• Neck pain
• Tingling
• Face twitching
• Sleepiness
• Altered state of mind during treatment
• Seizures (most rare)¹⁹

No research suggests that TMS for borderline personality disorder exacerbates or worsens symptoms associated with the disorder. However, additional research is needed, especially since borderline personality disorder TMS treatment isn’t FDA-approved.

Who Should Avoid TMS for BPD Treatment?

Those with certain medical implants should avoid TMS therapy for borderline personality disorder. Metal implants or gadgets that interact with magnetic fields can cause complications. In addition, you may not be eligible for TMS if you have stents, implanted stimulators, a pacemaker, a medicine pump, cochlear implants, or gunshot fragments in your body. Metal in areas that exceed 10cm from the head is usually acceptable.²⁰

Additionally, people with certain medical issues, like a history of seizures and brain damage, and those who are pregnant should avoid TMS for BDP.

Lastly, let your TMS administrator know if you use prescription or over-the-counter drugs, dietary supplements, or vitamins. Serious consequences might arise from using certain medicinal combinations. Discussing the above concerns with a medical professional prior to TMS therapy for BPD is crucial.

Cost & Insurance Coverage for TMS for BPD

The following are the typical expenses for TMS for borderline personality disorder. Your location and other variables may affect these prices. As a result, they might not accurately represent what you’ll pay in Tennessee.

The FDA has not yet authorized TMS treatment for borderline personality disorder, therefore, many insurance companies won’t cover it. The average cost of TMS therapy is $400 to $500 for each session.²¹ The overall cost may be around $15,000 because most patients require numerous sessions to reach desired results.

Athena Care has multiple TMS treatment clinics throughout Tennessee, and we are also in-network with most major insurance plans. Therefore, filling out our free and confidential online insurance verification form is the best way to get all the information needed to begin TMS therapy for BPD.

Allow our expert, knowledgeable care coordinators to handle the challenges of contacting your insurance provider for more information about your coverage. After submitting the no-obligation form, a care coordinator will review your policy and explain your treatment options. Any information you provide or discuss is kept entirely confidential.