You are absolutely correct that antipsychotics (or any drug for that matter) won’t fix BPD, but they can help. Since they put a huge damper on the intensity with which emotions are felt they can be helpful in reducing emotional dysregulatuon and it’s correlates (self-harm, suicidal ideation and attempts) by just... reducing emotionality. They are also quite effective at reducing aggression. A
study on zyprexa plus DBT for BPD showed that the combination helped patients improve on more symptom measures (depression, anxiety, impulsivity aggression) than DBT alone (w/ placebo).
Psych meds in general but especially antipsychotics are hugely overprescribed off-label and shouldn’t replace therapy for personality disorders, but are needed if it’s a case where the person is unaware that they need to change and is extremely self-destructive or is hurting others (like Abby, although the Schizoaffective is part of that too—if she really has it; see next paragraph). BPD is very treatable and has a good prognosis—in a study by Mary Zanarini et al., up to 85% achieved remission in 10 or 12 years I think, although many continued to have impaired psychosocial functioning. People with BPD aren’t broken, imo, just people who have developed a lot of extremely maladaptive, damaging, and often very unpleasant behaviors and they need to gain enough self-awareness through therapy to realize what they are doing wrong and work very hard to change it. It’s not easy and takes a shit ton of motivation, persistence, and ability to deal with setbacks in a resilient manner rather than collapsing and reverting back to the old behaviors and thinking patterns. Not everybody can do that and that’s why you see a lot of people with BPD who don’t get better.