A national audit of psychiatric wards in the United Kingdom has revealed that women diagnosed with personality disorders are disproportionately subjected to rapid tranquilisation.
In the study published in BJPsych Open, more than eight in ten episodes of acutely disturbed behavior involved female patients, and they were nearly twice as likely as men to receive intramuscular sedatives.
Rapid tranquillisation (RT) refers to the use of parenteral medication—such as intramuscular benzodiazepines, antihistamines, or antipsychotics—to quickly sedate patients in crisis. This reliance on pharmacological restraint carries particular risks for women. As the authors note:
“Women who self-harm often have a history of abuse and may perceive being restrained and having their clothing moved to administer parenteral medication into the buttock or thigh as provocative and re-traumatising.”
Although guidelines recommend prioritizing psychological skills and voluntary approaches for people with personality disorders, the researchers found that in practice, “these episodes are often characterised by self-harm and frequently managed with rapid tranquillisation.”
Personality disorder diagnoses, particularly borderline personality disorder, have long been marked by stigma, a problem documented in research and acknowledged by the creator of DBT, Marsha Linehan. That same stigma extends to individuals who self-harm, where it can deepen distress and compound feelings of isolation. The new study notes that when stigma and retraumatization intersect with the frequent use of rapid tranquillisation, patients are not only at risk of further psychological harm but may also face an unnecessary burden of medication side effects.
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