Borderline personality disorder (BPD) is characterised by emotional instability, impulsive behaviours, distorted thinking and unstable relationships and causes significant impairment in general functioning and distress to those living with the condition. It is also associated with multiple medical and psychiatric comorbidities. Many people with BPD are prescribed psychotropic medicines, often long-term and with risks of polypharmacy and adverse effects, yet there is limited evidence to support this treatment option in this population.

The authors of this article provide a commentary on a Cochrane review of pharmacological interventions for people with BPD. The Cochrane review confirmed that there is limited evidence of the efficacy of pharmacological interventions in improving BPD symptoms, incidents of self-harm, suicidal behaviours or psychosocial functioning. The authors therefore urge judicious prescribing alongside monitoring and deprescribing plans, addressing stigma in prescribing practice and prioritising non-pharmacological treatment options.