Clozapine as an Off‐Severe and Treatment‐Resistant (Auto‐)Aggressive Label Treatment for Behavior in a 40‐Year‐Old Patient With Mild Intellectual Disability and Borderline Personality Disorder

Background Clozapine has shown to be effective as an off‐label treatment for aggressive behavior in patients with borderline personality disorder (BPD) and mild intellectual disability (MID). However, there is a lack of empirical evidence for its efficacy in these patient populations and results are so far heterogeneous. Case Presentation A 40‐year‐old woman diagnosed with BPD and MID with severe and treatment‐resistant aggressive behavior was treated off‐label with clozapine. A carefully administered treatment with slow titration led to a significant reduction in self‐aggressive behavior and termination of aggressive behavior towards others over a 26‐week observation period. Conclusions Our case highlights the potential efficacy of clozapine as an off‐label treatment for severe and treatment‐resistant aggressive behavior in patients with combined BPD and MID. Clozapine should be considered as a therapeutic option in severe and complex cases.