Transcranial Magnetic Stimulation (TMS) is an innovative, non-invasive treatment that can help relieve symptoms of BPD. First FDA-approved for major depressive disorder, TMS uses magnetic pulses to stimulate parts of the brain commonly affected in mood regulation, releasing neurotransmitters and helping balance brain activity. For people with BPD, TMS can improve emotional regulation, stabilize moods, and reduce impulsive behaviors.
In this article, we’ll discuss what you need to know about TMS treatment for BPD, including how it works, what to expect, and what the research says.
What is borderline personality disorder?
Borderline personality disorder (BPD) is a mental health condition characterized by intense mood swings, difficulty maintaining relationships, and a distorted self-image. People with BPD often experience intense emotions, impulsive or risky behaviors, and a deep fear of abandonment, which can significantly impact their daily lives and interactions with others.
One of the main features of BPD is emotional dysregulation, affecting a person’s ability to manage and respond to emotions – particularly fear or anger – effectively. This contributes to extreme mood swings and changing feelings for others, for example, from extreme closeness to extreme dislike. Another feature of BPD is impulsivity, which can manifest in risky behaviors like reckless driving, substance abuse, or self-harming actions.
Borderline personality disorder affects around 14 million adults in the U.S, yet it’s often undiagnosed or misdiagnosed. This is partly because its symptoms often overlap with other mental health conditions, like depression or anxiety.
Severe BPD can often result in self-harming behaviors and suicidal thoughts. Studies show that more than 75% of people with BPD engage in self-harm and nearly 80% attempt suicide at some point. This highlights the importance of accurate diagnosis and timely treatment to mitigate these risks and help people living with BPD improve their quality of life.
See: TMS for Anxiety: Benefits, Effects, and More
What causes borderline personality disorder?
The causes of BPD aren’t fully understood, however experts believe the condition could be linked to environmental factors such as child abuse or neglect. Genetics and brain abnormalities are also thought to play a role.
Symptoms of borderline personality disorder
BPD involves a range of emotional, behavioral, and cognitive symptoms, including:
Emotional instability
People with BPD experience intense and rapid mood swings, such as:
- Extreme anger or irritability
- Deep sadness or feelings of hopelessness
- Intense fear, shame, or humiliation
- Persistent feelings of emptiness or loneliness.
Unstable relationships
BPD can make it difficult to maintain stable relationships due to:
- Fear of abandonment, whether real or imagined
- Tendency to idolize someone one moment and devalue them the next
- Feeling suffocated or overly dependent in relationships
- Desperation to stop people from leaving
- Struggling to navigate conflicts without emotional extremes.
Impulsive and reckless behavior
Impulsivity in BPD can often lead to risky behaviors such as:
- Self-harm (e.g. cutting or burning)
- Substance or alcohol abuse
- Reckless spending or gambling
- Unsafe sexual behaviors.
Distorted self-image & cognition
People with BPD can struggle with their self-image and cognition, with symptoms including:
- A fluctuating or unclear sense of identity
- Wondering whether they actually exist
- Feelings of being ‘bad’ or unworthy
- Brief auditory or visual hallucinations
Borderline personality disorder treatment options
Treating borderline personality disorder can include psychotherapy, medication, and innovative therapies such as Transcranial Magnetic Stimulation (TMS).
Psychotherapy
Psychotherapy, or talk therapy, is the most common treatment for BPD, involving either one-or-one or group sessions with a trained mental health professional. Two common approaches to psychotherapy include:
- Dialectical Behavior Therapy (DBT): Designed specifically for people with BPD, DBT focuses on mindfulness, emotional regulation, and coping strategies. It helps people manage intense emotions, reduce self-harming behaviors, and improve relationships.
- Cognitive Behavior Therapy (CBT): CBT aims to help people with BPD recognize and reframe negative thoughts and behaviors that come from distorted perceptions. Over time, CBT can help people balance mood swings, reduce the frequency of impulsive or self-harming behaviors, and adopt healthier thought patterns and habits.
Medications
Medications aren’t often used as the first-line treatment for BPD, however they can help manage specific symptoms of co-occurring mental disorders, such as anxiety or depression. Depending on the individual and their symptoms, medications could include:
- Antidepressants: To stabilize mood and reduce depressive symptoms.
- Mood stabilizers: To help manage intense emotional reactions.
- Antipsychotics: To address more severe BPD symptoms, like paranoia or impulsivity
- Anxiolytics: To reduce symptoms of anxiety.
Family therapy
BPD doesn’t just affect the individual – it can also impact their loved ones. While more research is needed to understand how family therapy helps with BPD, studies on other mental health disorders suggest that involving family members can help support an individual’s treatment.
Family therapy includes:
- Educating family members and caregivers on BPD so they can better understand and support their loved one
- Addressing the emotional needs of family members and providing coping strategies so they can also look after themselves
- Offering strategies and advice on how to manage obstacles when caring for their loved one.
Transcranial Magnetic Stimulation (TMS)
TMS is a non-invasive, medication-free therapy that’s emerging as a promising treatment for BPD. First FDA-approved for major depression, TMS involves using magnetic pulses to stimulate specific areas of the brain involved in mood regulation. For people with BPD, this can help relieve mood instability, impulsivity, and co-occurring symptoms like anxiety and depression.
What is Transcranial Magnetic Stimulation (TMS)?
TMS is a non-invasive, outpatient medical procedure that uses magnetic pulses to stimulate nerve cells in the brain. It targets specific regions associated with mood regulation, helping relieve symptoms associated with depression and BPD.
The treatment was first FDA-approved for depression, with promising results, and is currently being explored for numerous other neurological and mental health conditions, including obsessive-compulsive disorder (OCD), fibromyalgia, autism, and anxiety.
Many people with BPD also struggle with depression. Since TMS has been shown to be effective in reducing and relieving depressive symptoms, it can help with BPD better cope with stressors and negative emotions. However, studies also show that TMS can also benefit additional symptoms specifically linked with BPD.
TMS is sometimes called repetitive transcranial magnetic stimulation (rTMS), referring to the repetitive nature of treatments.
Learn More: Short-Term and Long-Term Efficacy of Accelerated Transcranial Magnetic Stimulation for Depression
How does TMS work for BPD?
TMS uses targeted magnetic pulses to stimulate specific parts of the brain associated with emotional regulation and decision-making. People with BPD often have an underdeveloped amygdala and underactive prefrontal cortex. The amygdala plays an important role in regulating emotions, especially fear and anxiety, while the prefrontal cortex is essential for reasoning and decision-making. Abnormal activity in these parts of the brain can contribute to symptoms of BPD.
By targeting these areas with magnetic pulses, TMS helps stimulate and rebalance these neural pathways to improve emotional regulation, reduce impulsivity, and enhance a person’s ability to manage stress.
What to expect from TMS treatments
TMS treatment for BPD is usually prescribed for a total of 36 sessions administered over several weeks. Each session lasts around 20-30 minutes.
Here’s what to expect from the TMS process:
- Preparation: First, you’ll be seated comfortably in a chair while your TMS technician positions your head and answers any questions you may have about the treatment.
- Placing the coil: The TMS technician will place an electromagnetic coil against your scalp, near your forehead. This coil targets the regions of the brain associated with BPD.
- Mapping: If it’s your first session, you’ll undergo a brain mapping procedure. This helps the technician identify the correct location for treatments and ideal strength of magnetic pulses. This ensures your treatment is effective and comfortable.
- Stimulation: Once the dorsolateral prefrontal cortex (DLPFC) has been located, TMS treatments will begin. Repetitive magnetic pulses are delivered through the coil to targeted regions of your brain, stimulating nerve cells and helping address BPD symptoms. These pulses are painless, although some people might feel a slight tapping or tingling sensation.
- Monitoring: Your technician will be by your side throughout the whole treatment, monitoring your comfort levels and adjusting the intensity of magnetic pulses as required.
- Post-session: After the TMS session, you’re free to go home and continue your daily activities as usual. Because TMS doesn’t involve sedation, you can even drive yourself back to school or work.
- Follow-ups: TMS therapy involves multiple sessions. The exact number will depend on your specific condition, symptoms, and response to therapy.
If you are taking medication for BPD, you will continue to take them while undergoing TMS therapy unless advised otherwise by your medication management provider.
See: What is Brain Mapping for Transcranial Magnetic Stimulation (TMS)?
Can TMS treat borderline personality disorder?
BPD is widely regarded as being a difficult condition to treat, leaving patients with few treatment options. However, emerging research shows that TMS can be effective in reducing key BPD symptoms, such as anger, impulsivity, and mood instability.
Benefits of TMS for BPD include:
- Improved emotional stability: Studies show TMS can reduce mood swings and help patients better regulate negative emotions like anger and frustration.
- Reduced impulsive behaviors: Research demonstrates significant improvements in self-control and decision-making, helping reduce impulsive behaviors.
- Improved awareness: TMS patients often report feeling more motivated, sociable, and better able to understand and plan their behavior.
Research into TMS for BPD
The first study of TMS for BPD involved a 22-year-old woman who experienced improvements in depressive symptoms and impulsivity after a round of TMS treatments. Over the next three months, she also reported increased emotional control and stability, behavioral self-awareness, and improved motivation for change, sociability, and attention to other people’s behaviors.
Another study showed that, after just 10 TMS sessions, patients with BPD experienced improved anger, emotional instability, and ability to plan. A meta-analysis conducted a few years later also found TMS effective for reducing impulsivity and improving self-control in BPD patients. The following year, another study on TMS for BPD found that the treatment significantly reduced symptoms in every domain of BPD – especially anger, impulsivity, and mood swings.
These studies all highlight the positive results of TMS for treating BPD and depressive symptoms, expanding the treatment options available for those with the condition.
Continue reading: Accelerated TMS vs. Traditional TMS: Which One Makes Sense for You?
TMS versus electroconvulsive therapy
For people with both BPD and depression, recent research suggests that TMS is more effective than electroconvulsive therapy (ECT) in alleviating depressive symptoms.
One retrospective analysis shows that TMS therapy led to a continuous drop in self-reported depressive symptoms of people with BPD. This analysis examined data from over 1,400 patients and found that, on average, TMS reduced depressive symptoms in people with BPD more effectively than ECT. Patients with BPD who received TMS treatment reported an average 10-point drop in depressive symptom scores compared to an 8-point decrease for those who underwent ECT.
Potential side effects of TMS
TMS is considered safe and well-tolerated, however a few people may experience side effects from the treatment. These are usually mild and temporary, often disappearing within hours. With more sessions, as the body adjusts to therapy, the symptoms tend to disappear altogether.
Side effects of TMS therapy can include:
- Mild headaches
- Lightheadedness
- Scalp or neck discomfort
- Tingling sensations
- Twitching in facial muscles
- Fatigue or drowsiness.
In extremely uncommon cases, TMS may induce seizures. This risk is minimal, but if you have any concerns don’t hesitate to discuss them with us before treatment.
Who shouldn’t do TMS?
Although TMS is safe for most people, certain medical conditions may make it unsuitable.
TMS therapy isn’t recommended if you:
- Have a history of seizures, epilepsy, or other neurological disorders
- Have experienced brain injuries, such as traumatic brain injury, stroke, or tumors
- Are pregnant or breastfeeding
- Are currently using stimulant medications.
TMS uses magnetic pulses, which can interact dangerously with metallic objects in the head. You should not do TMs if you have:
- Cochlear implants
- Deep brain stimulators
- Aneurysm clips or coils
- Implanted electrodes or stents
- Shrapnel or bullet fragments
- Vagus nerve stimulators.
Rest assured that braces or dental fillings are completely safe and don’t interfere with TMS therapy.
If you’re not sure whether you’re eligible for TMS, don’t worry. We will detail the treatment and eligibility requirements with you during your initial consultation to make sure it’s safe and effective for your needs.
TMS for borderline personality disorder
TMS offers a promising treatment option for people with BPD, helping relieve symptoms such as mood swings, depression, and impulsive behaviors. If you or a loved one are ready to explore TMS for BPD, our team is here to guide you every step of the way. Contact us today to discuss your options and start reclaiming your narrative.
