From causative factor to treatment target
This recently published narrative review in Sleep Medicine Reviews explores how sleep disturbance may play a causal role in the development and maintenance of borderline personality disorder (BPD). While sleep disturbances like insomnia, nightmares, and circadian disruption are very common in patients with BPD, they are currently rarely addressed in both treatment and research.
Building on behavioral and neurobiological models of sleep’s role in emotional memory and regulation, the review outlines a vicious cycle of poor sleep and emotional dysregulation which may exacerbate BPD symptoms like affective instability, impulsivity, and suicidal behavior, and hamper effectiveness of psychotherapeutic BPD treatment. Based on these insights, several promising sleep treatment approaches in BPD are proposed, that are relatively short and can be administered prior or in parallel to standard BPD treatment, such as cognitive behavioral therapy for insomnia (CBT-I) and pharmacological modulation of nighttime hyperarousal. The review highlights the need for further research into these sleep-focused treatment strategies and positions sleep as a promising new treatment target for BPD.
Shanna van Trigt, Tanja van der Zweerde, Eus J.W. van Someren, Annemieke van Straten, Hein J.F. van Marle. A theoretical perspective on the role of sleep in borderline personality disorder: From causative factor to treatment target. Sleep Medicine Reviews, Volume 81, 2025, 102089, ISSN 1087-0792,
https://doi.org/10.1016/j.smrv.2025.102089.