Ketamine treatment in patients with borderline personality disorder (BPD) may reduce symptom severity, but the evidence is preliminary and based on small samples. The review suggests that ketamine could be a potential therapeutic option for BPD, particularly for comorbid depression, though more rigorous studies are needed to confirm efficacy and safety. The authors note that existing studies have significant limitations, including lack of control groups and short follow-up periods.
Up to 45% of people with borderline personality disorder (BPD) experience insomnia and nightmares, which worsen emotion regulation, sleep quality, and arousal. Imagery rehearsal therapy (IRT), the standard treatment for nightmares, had not been tested in BPD. In a pilot study, 22 individuals with BPD received eight sessions of group IRT added to inpatient treatment, and were compared with 22 matched controls. Nightmare symptoms improved significantly during the intervention. The IRT group also showed greater reductions in intrusions, hyperarousal, and anxiety than the control group. IRT appears feasible and may reduce nightmare, trauma, and anxiety symptoms in BPD, though larger randomized trials are needed.
People with frequent nightmares show elevated high-frequency brain activity (beta and low gamma power) throughout the night compared to healthy controls, suggesting that cortical hyperarousal is a stable trait rather than a state limited to nightmare episodes. This heightened activity was reduced after six sessions of imagery rehearsal therapy, a cognitive-behavioral treatment. The findings indicate that the neural signature of hyperarousal in nightmare sufferers is both a persistent characteristic and modifiable by therapy, pointing toward potential treatments targeting high-frequency brain activity.