Borderline character dysfunction (BPD) is a psychological well being situation that impacts how folks 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 folks usually disagree concerning the label for this situation, what really issues is guaranteeing folks entry evidence-based assist once they want it most.
Many individuals don’t realise this, however no treatment is formally authorised to deal with BPD within the UK, US or Europe (Gartlehner, 2021, NICE, 2009). As a substitute, the fundamental therapy advisable by specialists is psychological remedy (NICE, 2009).
However right here’s the real-world twist: regardless of these suggestions, psychiatric drugs are generally prescribed, usually throughout a number of sorts of medicine. These embody antidepressants, antipsychotics, sedatives, and temper stabilisers (Paton, 2015). A big European examine of over 2,000 hospitalised sufferers with BPD discovered that 9 out of ten sufferers have been on treatment, with greater than half taking three or extra medicine directly (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 drugs (Tennant, 2023). Even long-term, knowledge confirms that folks with BPD are persistently extra possible than these with different character issues to take a number of psychiatric medicine (Zanarini, 2015).
On the similar time, some newer analysis suggests there could also be short-term advantages from sure drugs. For instance, a Finnish inhabitants examine, not too long ago summarised in a Psychological Elf Weblog, discovered that antipsychotics have been linked with decrease charges of suicide makes an attempt and violent behaviour in folks with character issues (Herttua, 2023).
So, why is prescribing in BPD so widespread? And what does it inform us about psychological well being in observe?
A current examine led by Joshua Confue and colleagues (2025) explored this query. Their findings present an necessary glimpse into how psychological well being take care of BPD truly works and the place it would want to enhance.
Whereas psychological therapies are therapy advisable in pointers, it’s common for folks with a BPD analysis to be prescribed treatment.
Strategies
The researchers did a scientific evaluate, a sort of examine taking a look at all of the related analysis on a subject to attract conclusions. They looked for research revealed since 1994 and targeted on why drugs are prescribed for adults with BPD, together with sufferers with different co-existing psychological well being situations (comorbidity).
They examined a number of main analysis databases, overlaying a broad vary of examine varieties, together with each numbers-driven analysis and research that discover folks’s experiences. This mix helps seize the complexity of prescribing treatment for BPD, which includes each medical knowledge and human components.
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 revealed in mainstream journals and databases weren’t captured.
Outcomes
The 13 research different in pattern dimension, from 9 to 550 individuals.
Folks with BPD have been extra more likely to be prescribed drugs if:
- They have been older
- That they had different psychological well being situations (often despair or anxiousness)
- That they had been hospitalised prior to now
- They have been seen as posing a danger to themselves or others.
In different phrases, prescribing wasn’t nearly BPD, it was usually about what else was happening.
In some research, greater than 50% of sufferers have been prescribed three or extra psychiatric drugs.
Research that appeared into the experiences of execs prescribing drugs and sufferers gave a extra detailed image of the explanations behind the numbers. Nevertheless, solely two research checked out affected person views.
The researchers counsel that medical doctors usually really feel stress to behave, particularly in disaster conditions. Prescribing can really feel like “doing one thing” within the face of affected person struggling.
Additionally they counsel that some sufferers might anticipate drugs, and never prescribing them can pressure the therapeutic relationship.
Lastly, the evaluate workforce counsel that nationwide pointers are troublesome to use within the context of real-world complexity as restricted entry to therapies or constrained service time can enhance reliance on treatment.
Professionals stated that nationwide pointers have been laborious to implement in actual world complicated situations.
Conclusions
The authors concluded that though medical steerage advises in opposition to routine treatment use for BPD, prescribing is widespread and influenced by a number of components. These embody affected person components similar to age, different situations and presenting signs but in addition clinician emotion, relationships between clinicians and sufferers, and systemic pressures.
This evaluate highlights the explanations behind the disconnect between evidence-based suggestions and the medical actuality, but in addition recognises that restricted analysis exists on the components at play.
General, whereas additional analysis is required, this evaluate offers a promising basis for understanding prescribing behaviours in BPD and growing methods to enhance outcomes for these sufferers.
There’s a disconnect between evidence-based suggestions and medical actuality, however restricted analysis exists on the components at play.
Strengths and limitations
This is likely one of the first systematic opinions to convey collectively proof on what drives prescribing selections in BPD. That alone makes it an necessary contribution, as a result of regardless of excessive charges of treatment use in observe, the explanations behind this have hardly ever been synthesised in a structured approach.
An enormous energy of this evaluate is the best way it combines very several types of proof. As a substitute of focusing solely on numbers, the authors introduced collectively statistical research and qualitative analysis that included affected person and clinician views. This offers a richer image of why prescribing occurs.
The authors discovered that comorbidity performs a job in prescribing selections. Nevertheless, due to the character of the research included, it’s not all the time potential to find out whether or not drugs have been prescribed for BPD signs or for co-existing situations similar to despair or anxiousness.
Following worldwide requirements (PRISMA) ensured the evaluate was carried out transparently and systematically. Nonetheless, solely 13 research met inclusion standards, and most had comparatively small pattern sizes. This limits how confidently the findings could be utilized to all sufferers with BPD.
Numerous proof offers perception, however small examine numbers restrict how extensively the conclusions could be utilized.
Implications for observe
This evaluate highlights that prescribing in borderline character dysfunction is never an easy, guideline-driven determination. As a substitute, it’s formed by a mixture of medical, relational, and organisational components.
Sure affected person demographics similar to age, comorbidity, and symptom profile are necessary when making prescribing selections. Nevertheless, expectations of care and relationships between professionals and sufferers additionally have an effect on the chance of individuals with BPD receiving drugs. 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 obtainable. This factors to a sensible reality: enhancing prescribing in BPD isn’t solely about following pointers, 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 grow to be a default.
Given the excessive prevalence of prescribing regardless of restricted proof of profit, there’s a have to systematically monitor, and examine potential drawbacks, unintended effects, or long-term issues of those drugs in folks with BPD.
As BPD usually co-exists with different psychological well being situations (Shah, 2018), some prescriptions might goal co-occurring situations like despair or anxiousness somewhat than BPD itself. Understanding this helps clarify a part of the image.
Within the medical world, it will be important that:
- Clinicians are clear with sufferers about why drugs are prescribed, together with what treatment can and can’t do, so expectations are practical.
- Clinicians can replicate on prescribing selections. Is treatment is getting used for signs, to protect the connection, or due to stress?
- Healthcare providers prioritise continuity of care as sufferers worth consistency and belief, which may 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 alternate options.
Prescribing in BPD sits on the intersection of proof, human relationships, and system constraints. Recognising this complexity may 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
Major paper
Confue J, Maidment I, Jones S, Jones M (2025) Elements that affect prescribing in borderline character dysfunction: a scientific evaluate. Persona 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 therapy of 2195 in-patients with borderline character dysfunction: A comparability with different psychiatric issues. European Neuropsychopharmacology, 25(6), 763–772.
Gartlehner G, Crotty Okay, Kennedy S et al (2021) Pharmacological therapies for borderline character dysfunction: a scientific evaluate and meta-analysis. CNS Medicine 35: 1053-67.
Nationwide Institute for Well being and Care Excellence (2009) Borderline character dysfunction: recognition and administration. NICE Scientific Guideline CG78.
Paton, C., Crawford, M. J., Bhatti, S. F., Patel, M. X., & Barnes, T. R. (2015). The usage of psychotropic treatment in sufferers with emotionally unstable character dysfunction below the care of UK psychological well being providers. The Journal of medical psychiatry, 76(4), e512–e518.
Shah R, Zanarini MC (2018) Comorbidity of borderline character 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 therapy of individuals identified with borderline character dysfunction: Repeated cross-sectional examine 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 treatment use reported by borderline sufferers and axis II comparability topics over 16 years of potential follow-up. Journal of Scientific Psychopharmacology, 35(1), 63–67.
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