Factors that influence prescribing in borderline personality disorder: a systematic review

Borderline personality disorder (BPD) is a psychiatric condition characterised by pervasive patterns of thinking and feeling, which can lead to social dysfunction and poor mental health. BPD has a significant impact not just on individuals with the diagnosis but also on those around them. Currently, no medication is licenced for BPD. Despite this, it is common for people with BPD to be prescribed multiple psychotropics. All psychotropic medications are associated with adverse events. A systematic review was conducted to explore factors that influence prescribing in adult BPD patients. Searches were conducted of EMBASE, PsycINFO, PubMed, EThOS and Web of Science. One-hundred and two unique studies were identified, of which 13 suitable studies with diverse methodologies were included in the final synthesis. Of these, seven studies produced quantitative results, whereas the remaining six produced qualitative results. The synthesis identified several demographic factors statistically associated with prescribing. Most notably, prescribing was more likely in older patients and those with comorbid conditions. In addition to demographic factors identified, two key themes were generated from analysis of qualitative data from both healthcare professionals (HCPs) and patients discussing drivers: that the patient-HCP relationship and the care pathway are crucial to the prescribing process from both perspectives. Prescribing medications for BPD is common, but there is limited data on the factors that affect this prescribing choice. HCPs must be aware of their own roles and perceptions in their relationships with BPD patients so that patients receive the most suitable treatment.