Borderline persona dysfunction (BPD) is a psychological well being situation that impacts how individuals assume, really feel and relate to others. It may be deeply distressing for the individual experiencing it, for his or her family members and the professionals making an attempt to assist. Though individuals typically disagree in regards to the label for this situation, what really issues is guaranteeing individuals entry evidence-based assist after they want it most.
Many individuals don’t realise this, however no remedy is formally accredited to deal with BPD within the UK, US or Europe (Gartlehner, 2021, NICE, 2009). As an alternative, the essential remedy beneficial by specialists is psychological remedy (NICE, 2009).
However right here’s the real-world twist: regardless of these suggestions, psychiatric medicines are generally prescribed, typically throughout a number of varieties of medication. These embrace antidepressants, antipsychotics, sedatives, and temper stabilisers (Paton, 2015). A big European research of over 2,000 hospitalised sufferers with BPD discovered that 9 out of ten sufferers have been on remedy, with greater than half taking three or extra medication without delay (Bridler, 2015). Comparable findings have been noticed throughout totally different settings, the place over 50% of individuals with BPD have been prescribed three or extra psychiatric medicines (Tennant, 2023). Even long-term, information confirms that folks with BPD are constantly extra doubtless than these with different persona problems to take a number of psychiatric medication (Zanarini, 2015).
On the similar time, some newer analysis suggests there could also be short-term advantages from sure medicines. For instance, a Finnish inhabitants research, just lately summarised in a Psychological Elf Weblog, discovered that antipsychotics have been linked with decrease charges of suicide makes an attempt and violent behaviour in individuals with persona problems (Herttua, 2023).
So, why is prescribing in BPD so frequent? And what does it inform us about psychological well being in observe?
A current research led by Joshua Confue and colleagues (2025) explored this query. Their findings present an vital glimpse into how psychological well being look after BPD really works and the place it would want to enhance.
Whereas psychological therapies are remedy beneficial in tips, it’s common for individuals with a BPD analysis to be prescribed remedy.
Strategies
The researchers did a scientific evaluate, a kind of research taking a look at all of the related analysis on a subject to attract conclusions. They looked for research printed since 1994 and targeted on why medicines are prescribed for adults with BPD, together with sufferers with different co-existing psychological well being circumstances (comorbidity).
They examined a number of main analysis databases, overlaying a broad vary of research varieties, together with each numbers-driven analysis and research that discover individuals’s experiences. This mixture helps seize the complexity of prescribing remedy for BPD, which includes each scientific information and human elements.
From 102 research recognized initially, 13 research from totally different international locations have been included within the evaluation. It’s potential that smaller research not printed in mainstream journals and databases weren’t captured.
Outcomes
The 13 research assorted in pattern dimension, from 9 to 550 individuals.
Folks with BPD have been extra more likely to be prescribed medicines if:
- They have been older
- They’d different psychological well being circumstances (normally despair or anxiousness)
- They’d been hospitalised previously
- They have been seen as posing a threat to themselves or others.
In different phrases, prescribing wasn’t nearly BPD, it was typically about what else was happening.
In some research, greater than 50% of sufferers have been prescribed three or extra psychiatric medicines.
Research that appeared into the experiences of pros prescribing medicines and sufferers gave a extra detailed image of the explanations behind the numbers. Nonetheless, solely two research checked out affected person views.
The researchers recommend that medical doctors typically really feel strain to behave, particularly in disaster conditions. Prescribing can really feel like “doing one thing” within the face of affected person struggling.
In addition they recommend that some sufferers might count on medicines, and never prescribing them can pressure the therapeutic relationship.
Lastly, the evaluate group recommend that nationwide tips are troublesome to use within the context of real-world complexity as restricted entry to therapies or constrained service time can improve reliance on remedy.
Professionals stated that nationwide tips have been exhausting to implement in actual world advanced situations.
Conclusions
The authors concluded that though scientific steerage advises towards routine remedy use for BPD, prescribing is frequent and influenced by a number of elements. These embrace affected person elements equivalent to age, different circumstances and presenting signs but additionally clinician emotion, relationships between clinicians and sufferers, and systemic pressures.
This evaluate highlights the explanations behind the disconnect between evidence-based suggestions and the scientific actuality, but additionally recognises that restricted analysis exists on the elements at play.
General, whereas additional analysis is required, this evaluate offers a promising basis for understanding prescribing behaviours in BPD and creating methods to enhance outcomes for these sufferers.
There’s a disconnect between evidence-based suggestions and scientific actuality, however restricted analysis exists on the elements at play.
Strengths and limitations
This is likely one of the first systematic critiques to deliver collectively proof on what drives prescribing choices in BPD. That alone makes it an vital contribution, as a result of regardless of excessive charges of remedy use in observe, the explanations behind this have not often been synthesised in a structured method.
A giant energy of this evaluate is the way in which it combines very several types of proof. As an alternative of focusing solely on numbers, the authors introduced collectively statistical research and qualitative analysis that included affected person and clinician views. This provides a richer image of why prescribing occurs.
The authors discovered that comorbidity performs a job in prescribing choices. Nonetheless, due to the character of the research included, it’s not all the time potential to find out whether or not medicines have been prescribed for BPD signs or for co-existing circumstances equivalent to despair or anxiousness.
Following worldwide requirements (PRISMA) ensured the evaluate was carried out transparently and systematically. However, solely 13 research met inclusion standards, and most had comparatively small pattern sizes. This limits how confidently the findings may be utilized to all sufferers with BPD.
Numerous proof offers perception, however small research numbers restrict how broadly the conclusions may be utilized.
Implications for observe
This evaluate highlights that prescribing in borderline persona dysfunction is never a simple, guideline-driven resolution. As an alternative, it’s formed by a mixture of scientific, relational, and organisational elements.
Sure affected person demographics equivalent to age, comorbidity, and symptom profile are vital when making prescribing choices. Nonetheless, expectations of care and relationships between professionals and sufferers additionally have an effect on the probability of individuals with BPD receiving medicines. Many clinicians reported prescribing to ease misery, to take care of belief, or as a result of they felt helpless when different choices weren’t accessible. This factors to a sensible fact: enhancing prescribing in BPD isn’t solely about following tips, it’s about strengthening the therapeutic relationship and ensuring each sufferers and professionals really feel supported. The place long-term therapies are troublesome to entry, prescribing might turn out to be a default.
Given the excessive prevalence of prescribing regardless of restricted proof of profit, there’s a have to systematically monitor, and research potential drawbacks, unwanted side effects, or long-term issues of those medicines in individuals with BPD.
As BPD typically co-exists with different psychological well being circumstances (Shah, 2018), some prescriptions might goal co-occurring circumstances like despair or anxiousness relatively than BPD itself. Understanding this helps clarify a part of the image.
Within the scientific world, it will be significant that:
- Clinicians are clear with sufferers about why medicines are prescribed, together with what remedy can and can’t do, so expectations are sensible.
- Clinicians can replicate on prescribing decisions. Is remedy is getting used for signs, to protect the connection, or due to strain?
- Healthcare providers prioritise continuity of care as sufferers worth consistency and belief, which might typically cut back reliance on prescribing as a “holding” measure.
- Remedy is accessible, as a result of with out it, each sufferers and clinicians might really feel left with few options.
Prescribing in BPD sits on the intersection of proof, human relationships, and system constraints. Recognising this complexity may also help transfer observe away from automated prescribing, in the direction of care that’s extra considerate, clear, and patient-centred.
Prescribing in BPD sits on the intersection of proof, human relationships, and system constraints.
Hyperlinks
Main paper
Confue J, Maidment I, Jones S, Jones M (2025) Elements that affect prescribing in borderline persona dysfunction: a scientific evaluate. Character and Psychological Well being 19(2): e70014.
Different references
Bridler, R., Häberle, A., Müller, S. T., Cattapan, Okay., Grohmann, R., Toto, S., Kasper, S., & Greil, W. (2015). Psychopharmacological remedy of 2195 in-patients with borderline persona dysfunction: A comparability with different psychiatric problems. European Neuropsychopharmacology, 25(6), 763–772.
Gartlehner G, Crotty Okay, Kennedy S et al (2021) Pharmacological therapies for borderline persona dysfunction: a scientific evaluate and meta-analysis. CNS Medicine 35: 1053-67.
Nationwide Institute for Well being and Care Excellence (2009) Borderline persona dysfunction: recognition and administration. NICE Medical Guideline CG78.
Paton, C., Crawford, M. J., Bhatti, S. F., Patel, M. X., & Barnes, T. R. (2015). Using psychotropic remedy in sufferers with emotionally unstable persona dysfunction below the care of UK psychological well being providers. The Journal of scientific psychiatry, 76(4), e512–e518.
Shah R, Zanarini MC (2018) Comorbidity of borderline persona dysfunction: present standing and future instructions. Psychiatr Clin North Am 41:583–593.
Tennant, M., Frampton, C., Mulder, R., & Beaglehole, B. (2023). Polypharmacy within the remedy of individuals recognized with borderline persona dysfunction: Repeated cross-sectional research utilizing New Zealand’s nationwide databases. BJPsych Open, 9(6), e200.
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Harned, A. L., & Fitzmaurice, G. M. (2015). Charges of psychotropic remedy use reported by borderline sufferers and axis II comparability topics over 16 years of potential follow-up. Journal of Medical Psychopharmacology, 35(1), 63–67.
