Are Patients with Emotionally Unstable Personality Disorder Overmedicated?

Abstract

Emotionally Unstable Personality Disorder (EUPD) is often considered as treatment resistant clinical challenge. While effectiveness of psychological therapies for EUPD is widely acknowledged, there is less supportive evidence for pharmacotherapy use and patients with EUPD are perceived as overmedicated.

Objectives and aims

The purpose of the study was to review prescribing guidelines and clinical practices for EUPD.

Methods

MEDLINE and PsycINFO were searched for all English-language articles published 2000-2016 and containing the keywords “emotionally unstable personality disorder”, “borderline personality disorder”, “pharmacotherapy”, “drug treatment” and “treatment guidelines”.

Results

NICE guidelines (2009) recommend pharmacotherapy should not be used for EUPD but for comorbid conditions only. In line with the American Psychiatric Association practice guideline, the Dutch and German guidelines recommend antipsychotics for cognitive-perceptual symptoms. However, in contrary to mood stabilisers they question the efficacy of antidepressants on impulsivity and affective dysregulation.

Studies on clinical practice showed 68% of borderline patients without comorbid disorder in UK were using antidepressants, 59% antipsychotics, 59% sedatives and 23% mood stabilizers. Similar results reported Paolini et al with polypharmacy in 83.5% of cases.

Conclusions

All international guidelines recommend psychological therapies as the first-choice in EUPD treatment but diverge with respect to pharmacotherapy use. NICE and Australian guidelines abstain from psychotropics what may prevent to some degree counterproductive polypharmacy, but also can refrain from temporary pharmacological support when needed. More RCTs for pharmacotherapy use in EUPD are needed but meanwhile using pharmacotherapeutic algorithms for specific symptom domains might be the way forward.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.