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Borderline Personality Disorder — MRCPsych Paper B MCQ

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ModeratePersonality DisordersBorderline Personality DisorderMRCPsych Paper B

A 25-year-old woman with borderline personality disorder attends the emergency department after another episode of self-harm. She has no comorbid disorder currently requiring pharmacological treatment. After urgent physical healthcare, which management approach would be contrary to NICE guidance?

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Correct answer: C — Prescribing medication specifically for borderline personality disorder or repeated self-harm

The correct answer is C. NICE advises that drug treatment should not be used specifically for borderline personality disorder or its associated symptoms and behaviours, including repeated self-harm, emotional instability and transient psychotic symptoms. Medication may still be used for a diagnosed comorbid disorder, and cautious short-term sedative medication may occasionally form part of crisis management, usually for no longer than 1 week; it must not replace more appropriate interventions. Wound care and other necessary physical treatment remain essential. NICE self-harm guidance supports timely comprehensive psychosocial assessment. During a crisis, clinicians should use a calm, validating approach with empathic open questioning, consult or subsequently review the crisis plan, and arrange appropriate follow-up.

Reference: National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management (CG78), sections 1.3.5 and 1.3.7. Published 2009; updated information July 2024. https://www.nice.org.uk/guidance/cg78/chapter/Recommendations