Concerns over the prescription of clozapine for people diagnosed with “borderline personality disorder” in private locked psychiatric units

Purpose: The use of long-term anti-psychotic medication for borderline personality disorder contravenes prescribing guidelines in the UK. There is evidence to suggest clozapine can be beneficial yet anecdotally it is prescribed almost exclusively in locked settings. A single study suggests a substantial proportion of psychiatrists disapprove of this practice. The purpose of this paper is to articulate concerns about the use of clozapine for “BPD” that are absent from current literature.

Design/methodology/approach: This paper summarises the reflections and experiences of the authors lived experience, academic and clinical backgrounds. 

Findings: The published literature is uniformly positive when describing the prescription of clozapine for those diagnosed with BPD; however, this in no way reflects the experience of the authors. There is no body of material reflecting a study showing that a substantial number of psychiatrists have issues with this practice. 

Research limitations/implications: While it is a fact that there is a discrepancy between psychiatrists attitudes towards clozapine prescription for “BPD” and the published literature, the described concerns in this paper are based solely on the authors’ experiences and observations. 

Practical implications: Those seeking literature to articulate concerns about the use of clozapine with this population will likely be disheartened by the paucity of published literature. 

Originality/value: To the best of the authors’ knowledge, this paper is the first to raise substantial concerns about the use of clozapine for those diagnosed with “BPD” and the circumstances in which it is prescribed.