Borderline and antisocial personality disorders: summary of NICE guidance

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. 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. ### The role of psychological treatment