What non-pharmacological interventions are recommended for managing BPD in primary care?

The primary role of primary care in managing borderline personality disorder (BPD) is focused on crisis management and appropriate referral to specialist services ¹. Comprehensive psychological treatments for BPD are typically provided by community mental health services ¹.

When a person with an established diagnosis of BPD presents to primary care in a crisis, non-pharmacological interventions include:

• Assessing the current level of risk to themselves or others ¹.
• Asking about previous episodes and effective management strategies used in the past ¹.
• Helping to manage their anxiety by enhancing coping skills and helping them to focus on the current problems ¹.
• Encouraging them to identify manageable changes that will enable them to deal with the current problems ¹.
• Offering a follow-up appointment at an agreed time ¹.

General principles for crisis management, which may also be useful for General Practitioners (GPs) with a special interest in BPD, include:

• Maintaining a calm and non-threatening attitude ¹.
• Trying to understand the crisis from the person's point of view ¹.
• Exploring the person's reasons for distress ¹.
• Using empathic open questioning, including validating statements, to identify the onset and course of the current problems ¹.
• Seeking to stimulate reflection about solutions ¹.
• Avoiding minimising the person's stated reasons for the crisis ¹.
• Refraining from offering solutions before receiving full clarification of the problems ¹.
• Exploring other options before considering admission to a crisis unit or inpatient admission ¹.
• Offering appropriate follow-up within a time frame agreed with the person ¹.

It is important to note that brief psychological interventions (of less than 3 months' duration) specifically for BPD or its individual symptoms should not be used outside of specialist services ¹.