Interviews conducted with two clinicians specializing in treating patients with borderline personality disorder and two providing MDMA-assisted therapy primarily for individuals with Post-Traumatic Stress Disorder (PTSD) have yielded insights into the similarities between these disorders. Based on this, the authors of the research suggest that the potential benefits of MDMA in treating borderline personality disorder warrant further detailed exploration. The paper was published in Journal of Psychedelic Studies.
Borderline personality disorder is a complex and often debilitating mental health condition characterized by pervasive and intense mood swings, unstable self-image, and tumultuous interpersonal relationships. Individuals with this disorder typically experience chronic feelings of emptiness and have difficulty establishing a stable sense of identity, leading to impulsive behaviors and self-destructive tendencies such as self-harm or suicidal thoughts.
One of the hallmark features of borderline personality disorder is a pronounced fear of abandonment, which can result in frantic efforts to avoid real or perceived rejection. This fear can lead to volatile and stormy relationships, alternating between idealization and devaluation of others. People with this disorder often have difficulty regulating their emotions and tend to experience rapid shifts from extreme anger to profound sadness or anxiety. These extreme mood shifts can be triggered by seemingly minor events.
At this moment, the exact causes of borderline personality disorder are not fully understood. There is sometimes an overlap between borderline personality disorder and posttraumatic stress disorder (PTSD) patients, with individuals meeting the criteria for both sometimes diagnosed with complex PTSD. Studies show that 30-50% of individuals diagnosed with PTSD also meet criteria for borderline personality disorder. PTSD is a mental health condition that can develop in individuals who have experienced or witnessed a traumatic event, leading to symptoms like flashbacks, nightmares, and severe anxiety.
Ann M. Inouye of Brown University and her colleagues observed that 3,4-methylenedioxy-methamphetamine (MDMA), also known as ecstasy, has been found effective in alleviating PTSD symptoms. MDMA is a synthetic drug that affects mood and perception, known for its euphoric and empathogenic properties, though it can have serious adverse effects and is illegal in many places.
However, recent studies have pointed to its potential therapeutic applications in treating certain mental health conditions, most notably PTSD, when administered in a controlled therapy setting. Moreover, some studies found it to be effective in treating PTSD patients whose symptoms did not improve after standard treatment (so-called treatment-resistant patients).
The authors note that, while there is quite a bit of research on the effectiveness of MDMA for treating PTSD, there is very little research on its effectiveness in treating borderline personality disorder. They state that borderline personality disorder is generally an understudied condition in modern mental health sciences.
Inouye and her colleagues wanted to explore the possibilities for treating borderline personality disorder using MDMA. For this purpose, they conducted interviews with two psychologists specializing in traditional therapeutic approaches for borderline personality disorders and two psychologists experienced in MDMA-assisted therapy.
The principal investigator of the study regularly met with these clinicians and discussed their experiences with using MDMA-assisted therapy, treating borderline personality disorders and possibly applying MDMA-assisted therapy on individuals suffering from borderline personality disorder.
During these interviews, clinicians identified numerous similarities between PTSD and borderline personality disorder. They noted that the psychotherapeutic treatment for borderline personality disorder, dialectical behavioral therapy (DBT), shares many procedural similarities with MDMA-assisted therapy. DBT focuses on enhancing self and interpersonal safety, mindfulness, emotion regulation in social contexts, and fostering a fulfilling life. MDMA-assisted therapy, on the other hand, aims at achieving peace, fulfillment, and purpose in life.
The study authors observe that the therapeutic goals of both approaches are aligned. Similar to individuals suffering from PTSD, those suffering from borderline personality disorder also cope with severe trauma. In borderline personality disorder, trauma is stemming from emotional invalidation and/or emotional attachment issues. Study authors conclude that it would be worth exploring whether MDMA-assisted therapy could be effectively used to treat individuals suffering from the borderline personality disorder.
“This study reinforced the need for further research on MDMA-AT [MDMA-assisted therapy] treatment for BPD [borderline personality disorder] individuals,” the study authors conclude. “Both MDMA-AT and BPD can be sensitive topics, but it is vital to explore them with vigilance. Such exploration demands ethical reflection, a consideration of relationships and suffering, and discussion surrounding treatment limitations. Interviewing two DBT [dialectic behavioral therapy] clinicians and two MDMA-AT clinicians was one way to examine the phenomenology of BPD individuals in a thoughtful manner.”
The study provides some insight into clinicians’ experiences with borderline personality disorder and MDMA-assisted therapy. However, it should be noted that this is a qualitative study solely based on interviews with four clinicians. It does not provide information about consequences and effectiveness of MDMA-assisted therapy in individuals suffering from borderline personality disorder.
The paper, “MDMA-assisted therapy for borderline personality disorder”, was authored by Ann M. Inouye, Aaron S. Wolfgang, and Lianne T. Philhower.
