Pharmacological Management of Borderline Personality Disorder: The Role of Antipsychotics
A. RamiIntroduction
Borderline Personality Disorder (BPD) is a complex and heterogeneous psychiatric condition characterized by emotional instability, impulsivity, disturbed self-image, and recurrent suicidal behaviors. Despite the central role of psychotherapy,particularly dialectical behavior therapy (DBT),in its management, pharmacotherapy remains widely used to target specific symptom domains. Among psychotropic agents, antipsychotics are frequently prescribed, although their use in BPD is off-label and often debated.
Objectives
This literature review aims to synthesize current evidence regarding the efficacy, safety, and clinical rationale for prescribing antipsychotics in the treatment of borderline personality disorder.
Methods
A systematic search of the scientific literature published between 2010 and 2025 was conducted using PubMed, ScienceDirect, and PsycINFO. Randomized controlled trials, meta-analyses, and clinical guidelines were analyzed, focusing on both typical and atypical antipsychotics used in adult BPD populations.
Results
Evidence suggests that second-generation antipsychotics —such as olanzapine, aripiprazole, quetiapine, and risperidone —can produce modest but clinically meaningful improvements in specific symptom clusters, including impulsivity, anger, affective dysregulation, and cognitive-perceptual distortions . However, effects on core features such as interpersonal instability and chronic emptiness remain limited. Long-term efficacy is uncertain, and treatment discontinuation rates are high due to side effects like weight gain, metabolic disturbances, and sedation. Guidelines (e.g., NICE, APA, HAS) consistently recommend restricting antipsychotic use to short-term, symptom-targeted adjunctive therapy , in combination with structured psychotherapy.
Conclusions
Antipsychotics can be useful adjuncts for managing acute symptom exacerbations in borderline personality disorder, particularly when impulsivity or transient psychotic features are prominent. Nevertheless, their off-label status , modest efficacy , and adverse-effect profile warrant cautious and individualized use. Future research should clarify optimal treatment duration, dosing strategies, and predictive markers of pharmacological response, while reinforcing psychotherapy as the cornerstone of care in BPD.
Disclosure of Interest
None Declared