Beyond the Pill Bottle: Time to follow the treatment evidence for Borderline Personality Disorder

Abstract

Borderline personality disorder is arguably the most prevalent personality disorder seen in healthcare settings, characterised by emotional instability, impulsive behaviours, distorted thinking, and unstable relationships. This commentary explores the effectiveness of pharmacological treatments for borderline personality disorder, drawing on the findings from a Cochrane review. It highlights the limited evidence supporting the efficacy of psychotropic medications such as antipsychotics, antidepressants, or mood stabilizers in improving BPD symptoms, self-harm, suicidal behaviours, or psychosocial functioning. Despite limited evidence, many people with borderline personality disorder receive psychotropic medications, often long-term and with risks of polypharmacy. A cautious approach to psychotropic medication is needed in addition to improvements in research rigor for pharmacotherapy trials. The limited evidence urges judicious prescribing, addressing stigma in practice, and prioritising non-drug options. Non-pharmacological psychotherapies have more support, yet access barriers persist. Monitoring and deprescribing plans are also recommended, as is research examining prescriber behaviour and integration of persons with lived experience.