New trials tackle the Borderline Personality Disorder riddle

BPD is the most common personality disorder in Australia, and has long confounded health professionals worldwide. It is linked with high morbidity and mortality rates, with research showing as many as 75 per cent of sufferers attempt suicide at least once and 10 per cent dying of suicide annually.

A major part of the challenges faced by those diagnosed with BPD comes due to fundamental misunderstandings about the condition itself, said MAPrc Director Professor Jayashri Kulkarni.

“We are talking about people who have experienced trauma of all sorts, emotional abuse, or emotional invalidation, physical or sexual abuse, and it has often started in their early life,” said Prof Kulkarni. “So, it is a trauma condition that is not universally recognised as one.

“Calling it a personality disorder further stigmatises the individual and also leaves clinicians without really great tools to be able to help, so there is high mortality and morbidity and a lot of distress.”

It is this renewed assessment of the condition's provenance that has, in part, inspired the direction of new trials, led by Professor Kulkarni and researchers at MAPrc and the HER Centre.

Historically, treatment for individuals diagnosed with BPD has relied upon antidepressants and antipsychotics. Research Fellow Dr Eveline Mu said both approaches lack effectiveness because they only respond to one symptom of the condition, and points to new drug approaches being studied to better address symptoms of the diagnosis.

“We are trialling a drug called Memantine, which is an Alzheimer's medication,” Dr Mu said. “Memantine targets the glutamate system in the brain which addresses the cognitive disturbances that make up all of the BPD symptoms.

“We’re finding that many participants trialling this drug are seeing their symptoms reduce, and some are reporting it has allowed them to stop and reassess situations before emotionally reacting, while self-harming is also reduced quite drastically as well.

“We've had patients who reach out to us as their last hope and say that within the first three weeks their suicidal ideation has pretty much gone and they see purpose in life.”

A second trial is testing the hormonal treatment estradiol in women with BPD diagnoses, with women making up approximately 75 per cent of BPD diagnoses globally.

“Our working theory is that when people have early life trauma, the stress on the body leads to hormone disturbances,” Dr Mu said. “So, targeting hormones for females promises to eventually improve the BPD symptoms.”

This approach of assessing the role of hormones in mental health distress, particularly among women, has long-been a research focus for Professor Kulkarni.

“We will conduct more trials, particularly in women looking at hormone manipulation using estrogen and other hormones to see if we can help,” Prof Kulkarni said. “But the big thing is that we stand side-by-side with our participants and our clients to understand what has happened from their perspective.

“I think that's a really critical thing to do and my hope is that we can influence the way services continue to deliver this particular sort of therapy.”