This article will review TMS for BPD, discussing the challenges and impact of living with borderline personality disorder as well as the need for new treatments. It will review the potential of transcranial magnetic stimulation (TMS) as a treatment for borderline personality disorder.
Introduction
This article will offer a comprehensive understanding of Transcranial Magnetic Stimulation (TMS) as a potential treatment for Borderline Personality Disorder (BPD). A borderline personality disorder is one of many categories of personality disorders as designated by the DSM-5. Treating BPD can be challenging because it is not usually something that can be cured or fixed but rather something whose symptoms have to be managed.
At present, management tends to revolve around talk therapy and medication, but this can still make it difficult to manage some of the symptoms or achieve long-term results, given that any form of medication can eventually lead to tolerance.
Transcranial magnetic stimulation, or TMS, offers a much safer treatment compared to pharmaceutical methods without any risk of addiction or tolerance development. Moreover, it doesn’t have the potential side effects or risks that regular medication can bring, which is why it has generated a lot of interest among people with borderline personality disorder.
Many questions have arisen around the topic of mental health disorders and TMS, like “Does TMS work for BPD?” and “How long do I need to use TMS for BPD?”
Patient experiences with TMS BPD treatment will differ but, in general, come with very limited risks and side effects and a promising opportunity for treatment outside of traditional pharmaceutical options or talk therapy.
Understanding Borderline Personality Disorder (BPD)
There are ten personality disorders divided into three categories. Cluster B encompasses several disorders, such as:
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Borderline Personality Disorder Symptoms
A borderline personality disorder is marked by a pattern of problems with self-image and interpersonal relationships. It also affects several areas of life with great impulsivity. People with BPD have five or more of the following:
- Frantic efforts to avoid being abandoned, whether that abandonment is real or imagined.
- Patterns of unstable interpersonal relationships are characterized by a person going between poor self-image and great idealization.
- Identity problems, particularly with an unstable self-image.
- Impulsivity causes a great deal of damage, such as substance abuse, reckless driving, impulsive sex, impulsive spending, and binge eating.
- Recurrent suicidal behavior, threats, or behavior.
- Mood problems can cause intense periods of anxiety, irritability, or dysphoria that last several hours or a few days.
- Chronic feelings of emptiness.
- Problems controlling anger, usually with intense or inappropriate displays of angry outbursts, physical fights, or temper.
- Stress-related paranoid ideation or dissociation.
People living with BPD struggle with problems in their relationships, with their self-image, and with impulsivity. It is common for those with BPD to be continually concerned with abandonment. That abandonment might be real, or it might be imagined or perceived abandonment. This fear of rejection or separation can cause significant problems with self-image, cognition, and behavior.
It, for example, can make people highly sensitive to even the smallest changes in their environment or circumstances, like panic when someone is late for or cancels an appointment.
Causes of BPD
There are several potential causes of BPD, although a single cause has yet to be identified. Some of the most common causes include:
- Genetics
- Issues with neurotransmitters in the brain, particularly the production of serotonin, which can increase impulsivity and depression
- Issues with brain development in the amygdala (responsible for regulating emotions), hippocampus (responsible for regulating self-control and behavior), and orbitofrontal cortex (responsible for decision-making and planning)
The development of these three parts of the brain tends to happen early in development, which means exposure to trauma during childhood can hinder the development.
What is TMS, and How Does it Relate to BPD?
Transcranial magnetic stimulation, or TMS, is a form of non-invasive, non-pharmaceutical treatment that can be used both on its own and in conjunction with other treatments, including therapy and medication.
Does TMS Work for BPD?
Yes, studies have confirmed that TMS and BPD offer a viable form of innovative care for those struggling with a personality disorder. TMS therapy for BPD, however, is not something that offers complete remission, nor is it something that can be done once with results that last forever.
Potential Benefits and Considerations
As mentioned, TMS can provide a great alternative to medication for borderline personality disorder, especially given that it doesn’t have side effects other than, in some cases, mild headaches for the first few sessions or irritation where the electrodes were placed on the head.
The TMS Treatment Journey for BPD
TMS therapy for BPD can last several weeks, but because there is no anesthesia or high risk of side effects, individuals can have short sessions on a regular basis, such as 20-minute sessions 5 days per week.
TMS BPD targets specific areas of the brain, sending magnetic pulses deep into the brain tissue. After an initial mapping session, a qualified specialist can determine where in the brain there might be a connection to BPD symptoms and use the TMS for BPD to try and target those areas.
Thereafter, TMS and BPD symptoms are measured and monitored, continually sending pulses into the areas of the brain that might be linked to symptoms and helping to stimulate blood flow and growth where there might not be any.
Duration and Frequency of TMS Sessions
As mentioned, sessions are typically short, lasting around 20 minutes, and individuals can choose, based on their personalized treatment plans with TMS for BPD, how frequently they want those sessions to occur.
There is no need to do a lot of preparation or set aside recovery time, and you can drive yourself. So many people find that the short sessions can be worked into their daily schedule for several days in a row.
Most TMS therapy for BPD lasts several weeks to a few months. However, it is important to note that while the treatment is effective, it is designed to provide acute relief, which means it doesn’t fix the problem permanently. As such, if you or someone close to you struggles with borderline personality disorder, this might be something that you have to work into your treatment plan every year, given that the results tend to last upwards of one year following treatment.
TMS Mechanism of Action in BPD Treatment
TMS BPD treatment offers a chance to stimulate growth and development in regions of the brain that might not have developed as they should have. It also provides a chance to stimulate areas of the brain that can encourage serotonin production.
Imaging studies have confirmed that TMS can improve dysfunction in the prefrontal cortex and the limbic system. Other reviews of current literature have shown there is some benefit to repetitive TMS therapy for BPD in managing symptoms.
In another case study, a 22-year-old female received ten sessions of high-frequency TMS therapy for BPD, specifically targeting the left dorsolateral prefrontal cortex. Assessments were conducted immediately following her last session as well as one month and three months after her treatment. The results of her assessments found that there was increased activity in several areas of the brain, including the superior frontal gyrus, the amygdala, and the parahippocampal, indicating that brain activity associated with severe BPD symptoms and depression as well as impulsivity was reduced with TMS.
Patient Experiences with TMS for BPD
Patient experiences with TMS will vary, but the general layout of plans, time frame, and Associated risks will look similar.
Personalized Treatment Plans
Firstly, it is imperative to work with a licensed professional to get a personalized treatment plan. If you have borderline personality disorder and you are working with a doctor or a psychiatrist to receive any type of treatment, they should know what you are doing and how frequently, and they might want to be in contact with your new TMS care team members.
Risks and Other Considerations
TMS comes with very few risks. It is an outpatient procedure, which means it doesn’t require any type of anesthesia, nor does it require preparations associated with inpatient or invasive procedures like dietary restrictions leading up to sessions or someone driving you home.
Given that it is a non-invasive process, one that only lasts an average of 20 minutes per session, it’s something that can easily fit into any schedule, and you don’t have to set aside a lot of time to recuperate afterward because there are limited side effects, if any.
In most cases, patients might experience a mild headache or irritation where the electrodes are placed on the head, but this tends to go away after several sessions, which means if you use TMs for BPD regularly, you will likely get over many of the side effects you experience the first time after you complete subsequent sessions.
Another consideration is longevity. Studies for the treatment of several mental health conditions have confirmed that TMS when used to target things like the prefrontal cortex, can provide relief from severe symptoms like impulsivity and depression for several months, if not a year after treatment. However, that is not long-term or permanent relief. This means that TMS is a form of treatment that, if successful, is likely something you will need to incorporate into your regular care program, using it as frequently as you need to quell the majority of your symptoms.
Note: TMS for BPD does not have to be used exclusively as your primary form of treatment. Because there are no contraindications with other medicine or with talk therapy, it is something that can easily be incorporated into an existing treatment plan. Whether you are on medication or not, or currently in therapy or considering therapy, you can easily work TMS into your program at any point.
Summing Up
Does TMS work for BPD? Yes, it offers relief from things like impulsivity and depression, common symptoms of borderline personality disorder. TMS therapy for BPD is a great, innovative form of care that can be incorporated into any type of routine or treatment plan you already have or use as your primary method for managing symptoms. It offers acute relief that can last for several months, if not a year, but this is based on your personal symptoms and experience.
There is great potential surrounding TMS as a promising treatment option for BPD. However, it is imperative that you consult with healthcare professionals to determine the most suitable approach for your circumstances and that if you are receiving any type of care already, you involve your care team in your consideration of TMS.