Guideline Statement Summary

APA recommends (1C) that the initial assessment of a patient with possible borderline personality disorder include the reason the individual is presenting for evaluation; the patient’s goals and preferences for treatment; a review of psychiatric symptoms, including core features of personality disorders and common co-occurring disorders; a psychiatric treatment history; an assessment of physical health; an assessment of psychosocial and cultural factors; a mental status examination; and an assessment of risk of suicide, self-injury, and aggressive behaviors, as outlined in APA’s Practice Guidelines for the Psychiatric Evaluation of Adults, 3rd Edition.

APA suggests (2C) that the initial psychiatric evaluation of a patient with possible borderline personality disorder include a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment.

APA recommends (1C) that a patient with borderline personality disorder have a documented, comprehensive, and person-centered treatment plan.

APA recommends (1C) that a patient with borderline personality disorder be engaged in a collaborative discussion about their diagnosis and treatment, which includes psychoeducation related to the disorder.

APA recommends (1B) that a patient with borderline personality disorder be treated with a structured approach to psychotherapy that has support in the literature and targets the core features of the disorder.

APA recommends (1C) that a patient with borderline personality disorder have a review of co-occurring disorders, prior psychotherapies, other nonpharmacological treatments, past medication trials, and current medications before initiating any new medication.

APA suggests (2C) that any psychotropic medication treatment of borderline personality disorder be time-limited, aimed at addressing a specific measurable target symptom, and adjunctive to psychotherapy.

APA recommends (1C) that a patient with borderline personality disorder receive a review and reconciliation of their medications at least every 6 months to assess the effectiveness of treatment and identify medications that warrant tapering or discontinuation.