People With Severe Personality Disorders Often Overprescribed Drugs By UK Psychiatrists

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Psychiatrists in the UK are disregarding their clinical guidelines when it comes to treating their patients with personality disorders, according to new research published in The Journal of Clinical Psychiatry.

Researchers surveyed 2,600 patients receiving psychiatric services for their diagnosed disorders, with more than two-thirds diagnosed with emotionally unstable personality disorder (EUPD). More commonly this disorder is referred to as borderline personality disorder (BPD). People with BPD experience “abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating image, as well as unpredictable and self-destructive actions,” Mental Health America (MHA) reported.

The results of the survey showed nearly every patient with EUPD was being treated with antidepressants or antipsychotics, which is “largely outside the licensed indications,” researchers said. Dr. Joel Paris provided commentary on the study; he explained drugs are so frequently prescribed because they require less time to work than therapy. As he noted:

… as reviewed in the [National Institute for Health and Care Excellence] guidelines, this approach is not particularly effective. That is why psychiatrists prescribe drugs outside of licensed indications. Faced with desperate patients, and with limited access to specialized psychotherapy, they do what they know how to do — they prescribe.

While treatment certainly varies, Paris believes “specialized treatments, such as dialectal behavior therapy and metallization-based treatment” more effectively treat patients with personality disorders. According to the MHA, therapy helps patients focus on what causes their symptoms, allowing patients to become more flexible. Therapy can also help patients reduce the behaviors interfering with their daily life.

“The current situation, in which patients with severe personality disorders receive almost routine polpharmacy is unsatisfactory,” Paris said. “The only way this situation can change is to make specialized psychotherapy more readily available. If it were, then psychiatrists would be slower to reach for their prescription pad and more likely to make referrals for psychological treatment.”

The Royal College of Psychiatrists found about one in 20 people living in the UK will live with a personality disorder. In the United States, the National Institute of Mental Health at the National Institutes of Health According reported about 1.6 percent of adults is diagnosed with EUPD or BPD each year. Regardless of location, disorders typically begin during adolescence or early adulthood, though some studies suggest symptoms can occur as early as childhood.

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