Omega-3 Fatty Acids and Borderline Personality Disorder

Article excerpt

The Problem

You have a patient with borderline personality disorder who is enrolled in dialectical behavior therapy and a regular exercise program. He is receiving treatment with a selective serotonin reuptake inhibitor, an antipsychotic, an antianxiolytic, and a mood-stabilizing medication, yet he continues to experience interpersonal difficulties. What else can you recommend to him?

The Question

Could diet affect the outcome of borderline personality disorder (BPD)? Are omega-3 fatty acids efficacious in treating BPD?

The Analysis

We performed a Medline search that combined "essential fatty acids, n-3 fatty acids, omega-3 fatty acids, fish, seafood, eicosapentaenoate, eicosapentaenoic, docosahexaenoate, or docosahexaenoic," and "borderline personality disorder."

The Evidence

BPD occurs in about 2% of the population and 20% of psychiatric inpatients. It is predominantly diagnosed in women (75%). The main components of this disorder include lack of sense of self, psychotism, tumultuous interpersonal relationships, impulsivity, impulsive aggression, and affective instability. About 6% of patients with borderline personality disorder commit suicide by 7 years after diagnosis. This rate is higher in patients with co-morbid disorders such as depression, substance abuse, or posttraumatic stress disorder.

The essential fatty acids are long-chain, polyunsaturated fatty acids obtained only through dietary plants and fish (Br. J. Psychiatry 2005;186:275-7). Lipids account for about 80% of mammalian brain dry weight, and EFAs account for about 20% of the lipids (Altern. Med. Rev. 2003;8:410-25). Essential fatty acids are made up of omega-3 and omega-6 fatty acids. The main omega-3 fatty acids in the central nervous system are eicosapentaenoate (EPA) and docosahexaenoate (DHA), and the main omega-6 fatty acid is arachidonic acid.

Our search yielded one study. Mary C. Zanarini, Ed.D., and Dr. Frances R. Frankenburg examined the effects of omega-3 fatty acids on BPD (Am. J. Psychiatry 2003;160:167-9). Thirty females were recruited through ads that asked, "Are you extremely moody? Do you often feel out of control? Are your relationships painful and difficult? …