The process of managing medications in patients with borderline personality disorder

Patients with borderline personality disorder (BPD) are a challenge to treat both psychotherapeutically and psychopharmacologically. While a set of effective psychotherapeutic interventions for BPD has now emerged, no hard evidence exists concerning the effectiveness of any psychopharmacologic agent for the core symptoms of BPD. Nonetheless, more than 75% of patients with BPD regularly take psychotropic medications. Given the complex interpersonal interactions of these patients as well as their obvious psychological pain, it would be helpful if we could begin to discuss the nuts and bolts of prescribing psychotropic medications for patients with BPD with the goal of assisting the psychopharmacologist in this process of prescribing. This paper is an attempt to begin such a discussion of the process of prescribing medications to patients with BPD. The suggestions presented in this article should be considered only the beginning of a dialogue that will surely become more complex and demand increased clinical acumen and more rigorous scientific study as we continue to learn more about these complicated and multi-faceted patients.