Influences on prescribing in borderline personality disorder: insights from health care professionals: a qualitative interview study

Joshua Confue; Ian Maidment; Matthew Jones

doi:10.1186/s12888-026-08104-y

Influences on prescribing in borderline personality disorder: insights from health care professionals: a qualitative interview study

Joshua Confue^*
, Ian Maidment
, Matthew Jones

^*Corresponding author for this work

University of Bath & Lincolnshire Partnership Foundation Trust
University of Bath

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition that significantly impacts not only individuals but also wider society. Despite the absence of licensed medication for BPD, there is substantial evidence of high rates of prescribing and polypharmacy within this population. This has raised concerns, given the potential adverse effects of psychotropics. This study aimed to explore the potential factors influencing prescribing decisions in patients with BPD. Method: We conducted semi-structured interviews with healthcare professionals involved in prescribing for individuals with BPD. Participants included doctors, non-medical prescribers, and pharmacists from both primary and secondary care settings. Data was analysed using thematic analysis utilising both inductive and deductive approaches. Findings: Twenty interviews were completed, generating five key themes believed to influence prescribing decisions. These themes indicate that prescribing occurs at least in part to manage specific symptoms; address perceived risks; maintain or strengthen the therapeutic relationship; compensate for the lack of alternative treatment options; and respect patient autonomy and choice. Conclusions: Participants highlighted the complexities involved in treating individuals with BPD, indicating that prescribing decisions were often more than simple risk-benefit assessments of the prescribed medication. In particular, they highlighted the challenge of balancing risks while maintaining a therapeutic relationship. Additionally, the findings indicate that a patient's preference for medication may lead prescribers to embrace a greater risk tolerance when prescribing. Trial registration: The study was registered with and received a favourable outcome from the Human Research Authority (IRAS 330510) and was approved at the London - Camberwell St Giles Research Ethics Committee (REC) on the 12th of December 2023.

Original language	English
Article number	462
Number of pages	14
Journal	BMC Psychiatry
Volume	26
Issue number	1
Early online date	27 Apr 2026
DOIs	https://doi.org/10.1186/s12888-026-08104-y
Publication status	E-pub ahead of print - 27 Apr 2026

Bibliographical note

Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Borderline personality disorder
Prescribing
Qualitative study

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10.1186/s12888-026-08104-yLicence: CC BY 4.0

Influences on prescribing in borderline personality disorder_VoR
Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
Final published version, 2.29 MBLicence: CC BY 4.0

Cite this

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abstract = "Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition that significantly impacts not only individuals but also wider society. Despite the absence of licensed medication for BPD, there is substantial evidence of high rates of prescribing and polypharmacy within this population. This has raised concerns, given the potential adverse effects of psychotropics. This study aimed to explore the potential factors influencing prescribing decisions in patients with BPD. Method: We conducted semi-structured interviews with healthcare professionals involved in prescribing for individuals with BPD. Participants included doctors, non-medical prescribers, and pharmacists from both primary and secondary care settings. Data was analysed using thematic analysis utilising both inductive and deductive approaches. Findings: Twenty interviews were completed, generating five key themes believed to influence prescribing decisions. These themes indicate that prescribing occurs at least in part to manage specific symptoms; address perceived risks; maintain or strengthen the therapeutic relationship; compensate for the lack of alternative treatment options; and respect patient autonomy and choice. Conclusions: Participants highlighted the complexities involved in treating individuals with BPD, indicating that prescribing decisions were often more than simple risk-benefit assessments of the prescribed medication. In particular, they highlighted the challenge of balancing risks while maintaining a therapeutic relationship. Additionally, the findings indicate that a patient's preference for medication may lead prescribers to embrace a greater risk tolerance when prescribing. Trial registration: The study was registered with and received a favourable outcome from the Human Research Authority (IRAS 330510) and was approved at the London - Camberwell St Giles Research Ethics Committee (REC) on the 12th of December 2023.",

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N2 - Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition that significantly impacts not only individuals but also wider society. Despite the absence of licensed medication for BPD, there is substantial evidence of high rates of prescribing and polypharmacy within this population. This has raised concerns, given the potential adverse effects of psychotropics. This study aimed to explore the potential factors influencing prescribing decisions in patients with BPD. Method: We conducted semi-structured interviews with healthcare professionals involved in prescribing for individuals with BPD. Participants included doctors, non-medical prescribers, and pharmacists from both primary and secondary care settings. Data was analysed using thematic analysis utilising both inductive and deductive approaches. Findings: Twenty interviews were completed, generating five key themes believed to influence prescribing decisions. These themes indicate that prescribing occurs at least in part to manage specific symptoms; address perceived risks; maintain or strengthen the therapeutic relationship; compensate for the lack of alternative treatment options; and respect patient autonomy and choice. Conclusions: Participants highlighted the complexities involved in treating individuals with BPD, indicating that prescribing decisions were often more than simple risk-benefit assessments of the prescribed medication. In particular, they highlighted the challenge of balancing risks while maintaining a therapeutic relationship. Additionally, the findings indicate that a patient's preference for medication may lead prescribers to embrace a greater risk tolerance when prescribing. Trial registration: The study was registered with and received a favourable outcome from the Human Research Authority (IRAS 330510) and was approved at the London - Camberwell St Giles Research Ethics Committee (REC) on the 12th of December 2023.

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VL - 26

JO - BMC Psychiatry

JF - BMC Psychiatry

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ER -

Influences on prescribing in borderline personality disorder: insights from health care professionals: a qualitative interview study

Abstract

Bibliographical note

UN SDGs

Keywords

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