Guideline sources The following summarized guidelines for the evaluation and management of borderline personality disorder are prepared by our editorial team based on guidelines from the National Health and Medical Research Council of Australia (NHMRC 2019). 1 Guidelines 1. Screening and diagnosis Identification and diagnostic assessment (adults): Consider assessment for borderline personality disorder or referral for psychiatric assessment in patients with any of the following: frequent suicidal or self-harming behavior marked emotional instability multiple co-occurring psychiatric conditions nonresponse to established treatments for current psychiatric symptoms a high level of functional impairment. C Show 2 more https://web.pathway.md/diseases/recHQKjxNXMr3WQiR 1/5 6/29/23, 3:20 AM Borderline personality disorder Pathway Identification and diagnostic assessment (children and adolescents): Consider assessment for borderline personality disorder in patients 12-18 years old with any of the following: frequent suicidal or self-harming behavior marked emotional instability multiple co-occurring psychiatric conditions nonresponse to established treatments for current psychiatric symptoms a high level of functional impairment. C Show 3 more 2. Medical management Setting of care: Use community-based mental health services (public and private) for the majority of a patient's treatment for borderline personality disorder. B Offer treatment for borderline personality disorder through a range of services, as appropriate to the individual's current clinical presentation, course of illness, needs and (if applicable) preferences. B Multimodal therapy: Do not routinely add pharmacotherapy to psychological interventions in the treatment of patients with borderline personality disorder. D Consider psychoeducation, family therapy and/or group sessions in addition to one-to-one psychological therapies, as appropriate to the patient's needs. C Pharmacotherapy: do not use medications as primary therapy for borderline personality disorder, because they have only modest and inconsistent effects, and do not change the nature and course of the disorder. D Show 6 more Management of co-occuring health conditions: manage co-occurring mental illness (such as substance use disorder, mood disorder or eating disorder), if present, concurrently with the management of borderline personality disorder. B Show 4 more 3. Inpatient care Indications for inpatient admission: consider acute inpatient admission to provide structured crisis intervention for the treatment of patients who are suicidal or have significant co-occurring mental health conditions. C Show 3 more Family, partner and carer needs: https://web.pathway.md/diseases/recHQKjxNXMr3WQiR 2/5 6/29/23, 3:20 AM Borderline personality disorder Pathway Consider the needs of children and arrange assessment of their mental health and welfare needs if necessary when caring for parents with borderline personality disorder. C Determine whether the patient with borderline personality disorder (particularly during a crisis) has dependent children, and ensure that they are properly cared for (such as refer to a social worker). B 4. Nonpharmacologic interventions Structured psychological therapy: provide structured psychological therapies that are specifically designed for borderline personality disorder to patients with borderline personality disorder, conducted by one or more adequately trained and supervised health professionals. B Show 2 more Dialectical behavior therapy: As per NHMRC 2019 guidelines: Offer comprehensive dialectical behavior therapy in female patients with borderline personality disorder when reduction in self-harm is a treatment goal. B Offer comprehensive dialectical behavior therapy in female patients with borderline personality disorder when reduction in anger, anxiety, or depression is a treatment goal. B 5. Specific circumstances Adolescent patients: offer time-limited structured psychological therapies that are specifically designed for borderline personality disorder to patients 14-18 years old with borderline personality disorder or with clinically significant features of borderline personality disorder. B Show 3 more 6. Follow-up and surveillance Referral for specialized service: consider referring patients with severe and/or enduring borderline personality disorder to a suitable specialized borderline personality disorder service (where available) for assessment and ongoing care, if appropriate. C Supporting family, partners and caregivers: refer families, partners, and carers of patients with borderline personality disorder to support services and/or psychoeducation programs on borderline personality disorder, where available. B Show 5 more Caring for families, partners and caregivers: Support families, partners and carers by referring or directing them to: general family counselling and psychoeducation with a focus on borderline personality disorder structured family programs specific to borderline personality disorder https://web.pathway.md/diseases/recHQKjxNXMr3WQiR 3/5 6/29/23, 3:20 AM Borderline personality disorder Pathway peer support programs such as carer-led programs that educate families/carers on borderline personality disorder respite services. B Show 4 more 7. Quality improvement Health professionals' roles: Health professionals at all levels of the healthcare system and within each type of service setting should: acknowledge that borderline personality disorder treatment is a legitimate use of healthcare services be able to recognize borderline personality disorder presentations be aware of general principles of care for patients with borderline personality disorder and specific effective borderline personality disorder treatments provide appropriate care (including non-specific mental health management, specific treatments for borderline personality disorder and treatment for co-occurring mental illness) according to their level of training and skill refer the patient to a specialized borderline personality disorder service or other services as indicated undertake continuing professional development to maintain and enhance their skills. B Coordinating care: clinicians treating patients with borderline personality disorder should follow a stepped-care approach in which an individual's usual care is based on the least intensive treatment (such as general practice care and regular contact with a community mental health service), and referral to more intensive treatment (such as crisis intervention, a specialized borderline personality disorder service, or specialized borderline personality disorder programs) is provided when indicated. B Show 6 more Supporting healthcare professionals: those responsible for planning or managing services that provide care for patients with borderline personality disorder should ensure that health professionals receive training in borderline personality disorder management. B Show 4 more References 1. Michael H Stone. Clinical Practice Guideline for the Management of Borderline Personality Disorder. Psychodyn Psychiatry. Spring 2019;47 1 5 26. Open 2. James Sall, Lisa Brenner, Amy M Millikan Bell et al. Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med. 2019 Sep 3;171 5 343 353. Open https://web.pathway.md/diseases/recHQKjxNXMr3WQiR 4/5 6/29/23, 3:20 AM Borderline personality disorder Pathway 3. Cardasis W, Hochman JA, Silk KR. Transitional objects and borderline personality disorder. Am J Psychiatry. 1997 Feb;154 2 250 5. Open https://web.pathway.md/diseases/recHQKjxNXMr3WQiR 5/5