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Practice Guidelines

Borderline and antisocial personality disorders: summary of NICE guidance

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b93 (Published 28 January 2009) Cite this as: BMJ 2009;338:b93
  1. Tim Kendall, joint director1, deputy director 2, consultant psychiatrist and medical director3,
  2. Stephen Pilling, joint director4, director 5, consultant psychologist6,
  3. Peter Tyrer, professor of community psychiatry7, honorary consultant psychiatrist8,
  4. Conor Duggan, professor of forensic mental health9, honorary consultant psychiatrist10,
  5. Rachel Burbeck, systematic reviewer4,
  6. Nicholas Meader, systematic reviewer1,
  7. Clare Taylor, editor1
  8. On behalf of the guideline development groups
  1. 1National Collaborating Centre for Mental Health, Royal College of Psychiatrists’ Research and Training Unit, London E1 8AA
  2. 2Royal College of Psychiatrists’ Research and Training Unit, London E1 8AA
  3. 3Sheffield Health and Social Care Trust, Sheffield S10 3TH
  4. 4National Collaborating Centre for Mental Health, British Psychological Society—CORE, Sub-Department of Clinical Health Psychology, University College London, London WC1E 7HB
  5. 5Centre for Outcomes Research and Effectiveness, University College London, London WC1E 7HB
  6. 6Camden and Islington Foundation Trust, London NW1 0PE.
  7. 7Imperial College, London SW7 2AZ
  8. 8West London Mental Health NHS Trust, Southall UB1 3EU
  9. 9The University of Nottingham, Nottingham NG7 2RD
  10. 10Nottinghamshire Healthcare Trust, Nottingham NG3 6AA
  1. Correspondence to: T Kendall Tim.Kendall{at}shsc.nhs.uk

    Why read this summary?

    Personality disorders are common, with an estimated prevalence in the community of 4.4%.1 They can significantly impair personal and social functioning, with considerable cost to health services, society, the criminal justice system, and the individual. Of the 10 classified types of personality disorder, borderline and antisocial personality disorder are the most prominent in forensic and general psychiatric settings. People with borderline personality disorder tend to have volatile relationships, an unstable self image, labile affects, and impulsiveness; they also frequently self harm. People with antisocial personality disorder characteristically break rules routinely; engage in criminal behaviour; and have a strong tendency to be reckless, irresponsible, and deceitful. People with both disorders often report a history of serious family problems, domestic violence, abuse, and inconsistent and often violent punishment in childhood.

    Separate guidelines were developed for these two disorders because of differences in diagnostic criteria and contact with services. People with borderline personality disorder tend to be “treatment seeking,” whereas the antisocial group are “treatment resisting,”2 and they are unlikely to come into contact with services except for the treatment of comorbid conditions or when legally mandated to attend treatment programmes.3

    This article summarises the key recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of both borderline and antisocial personality disorder.2 3 Because about 50% of children with conduct disorder develop antisocial personality disorder, the guideline for this disorder includes preventive strategies—namely, interventions for conduct disorder in childhood and adolescence.

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Recommendations for borderline personality disorder

    The role of psychological treatment

    • When providing psychological treatment, especially for people with multiple comorbidities or …

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