This week, Mad in America examines three new articles around psychiatric drug use in people diagnosed with a personality disorder. The first article reports that people diagnosed with borderline personality disorder (BPD) in France are likely overmedicated. The second finds that people diagnosed with BPD in the UK are often ambivalent towards psychiatric drugs and believe negative effects of these medications should be regarded as central to the treatment experience. The third finds that people diagnosed with a personality disorder in Sweden report that psychiatric prescriptions often feel arbitrary and blame themselves when these drugs fail to treat their issues.
People Diagnosed with Borderline Personality Disorder Likely Overmedicated
A new article published in Annales Médico-psychologiques reports that people diagnosed with borderline personality disorder in France are likely overmedicated with psychiatric drugs which are linked to increased risk of death, suicide, and rehospitalization. Led by Fabrice Berna from the University of Strasbourg in France, the authors examine structural and provider factors that drive overprescription in this population.
The goal of this paper is to analyze factors that contribute to overprescription of psychiatric drugs in people diagnosed with BPD. The authors also propose strategies to reduce overprescription.
The researchers report that although therapeutic recommendations in France call for limited, short-term use of psychiatric drugs in people diagnosed with BPD, 96% of this population is prescribed at least one drug, with 50% taking three or more. These drugs are also typically prescribed long-term for people with a BPD diagnosis. Randomized controlled trials have failed to show clinical efficacy for psychiatric drugs in these populations and other studies have found drug treatments to be associated with suicide, death, and readmission.
The authors identify BPD’s shaky diagnostic criteria and high comorbidity with other psychiatric diagnoses as likely leading to overdiagnosis and unnecessary prescriptions. Psychiatrists training programs are typically centered around psychopharmacology, causing clinicians to be biased towards possible benefits of drug treatment, often neglecting or downplaying iatrogenic risks and harms. The authors also point to structural issues such as a lack of reimbursement for therapy as leading to overmedication.
The authors recommend enhanced training for clinicians that emphasizes psychotherapy education, improving access and reimbursement for for psychotherapy, and implementing tapered drug discontinuation protocols to avoid withdrawal effects.
Ambivalence, Agency, and the Role of Psychiatric Drugs in BPD Care
A new study published in the Journal of Applied Social Science finds that people diagnosed with borderline personality disorder (BPD) report ambivalence towards psychiatric drugs. The research, led by Nicholas Norman Adams from Robert Gordon University in the UK, additionally reports that negative “side” effects should be regarded as central to the treatment experience as they can affect identity, agency, emotional experience, and overall recovery. The authors also believe that the prescription of psychiatric drugs sometimes serves a symbolic function, communicating “care” and professional authority.
The goal of this study was to examine how people diagnosed with BPD experience psychiatric drug use and what role prescriptions play in their relationship to clinicians and mental health services. The authors recruited 16 people from North-East Scotland to participate in semi-structured interviews. Six participants were diagnosed with BPD and had experience with psychiatric drugs. The remaining 10 participants were connected to the first six, including family, mental health nurses, and psychiatrists. The main analysis focused on the six interviews with the participants diagnosed with BPD. These interviews were not designed around psychiatric drug use experiences, but the repeated fixation on medications in the interview data caused the researchers to shift the focus of the study.
The authors found five central themes in the interview data. (1) “Blunt or symbolic intervention” was related to using psychiatric drugs as a stand in for “care,” to demonstrate risk management, and to communicate professional authority rather than for their actual biomedical effects. According to the authors, using drugs this way frames distress as something treatable. Participants reported feeling a gap between their actual needs and this kind of symbolic intervention. Rather than getting deeper, more engaged forms of care, participants were often shuffled from drug to drug rapidly for reasons that were unclear.
(2) “Embodied harms and destabilisation” dealt with negative effects of the drugs. Participants reported that negative effects were central to their experience of psychiatric drug use. Switching between drugs and having adjustments made to their prescriptions rapidly was particularly distressing for participants. The authors argue that:
“The continual adjustments of prescriptions and dosages, administered through narrow diagnostic thresholds, construct a framework of distant control that separates clinician from patient. Such routinisation reorders distress into categories that appear objective while displacing the possibility of genuine relational knowledge, of meeting the individual in the fullness of their context.”
In other words, the mental health system performs “care” through a routine of prescription and adjustment. The distance between provider and patient created by this routine often makes genuine interaction impossible.
(3) “Agency, resistance, and refusal” dealt with patients questioning prescriptions and discontinuing psychiatric drugs. While some mental health professionals label this “non-compliance,” the authors view this as the patients asserting autonomy and control over their own bodies.
(4) “Systemic and relational gaps” involved participants experiences with fragmented services, limited access to psychiatrists, and lack of communication. One participant reported that decisions about their treatment were often made by a psychiatrists that was not familiar with their situation. The authors believe that clinicians sometimes use drugs as a substitute for relational care due to overburdened mental healthcare systems.
(5) “Ambivalence and paradox” dealt with participants contradictory ideas around psychiatric drugs. Patients described these drugs as helpful and harmful, necessary but intolerable, an expression of care and a mechanism of control. The authors note that these experiences existed alongside each other. Participants could recognize benefits from these drugs while also experiencing negative effects, loss of autonomy, and frustration with rapid changes to their prescriptions. This ambivalence highlights the complexity of participants’ relationships with psychiatric drugs.
People Diagnosed with Personality Disorders Experience Psychiatric Prescriptions as Arbitrary and Blame Themselves when the Treatment Fails
A new study published in Frontiers in Psychiatry finds that patients and service users with a personality disorder diagnosis often experience psychiatric prescribing as arbitrary and blame themselves when drugs do not have the intended results. This research, led by Flavio Di Leone from the Sahlgrenska University Hospital in Sweden, also reports that patients’ participation in decision-making around prescriptions was disregarded while they were left to bear the responsibility of managing their own psychiatric drug use, monitoring effects, and advocating for proper care.
The goal of this study was to examine patients’ experiences of psychiatric drug prescribing, including their expectations, how involved they were in decisions related to prescriptions, and whether follow-up care was transparent, understandable, and collaborative. The authors recruited 10 people with a personality disorder diagnosis from two outpatient clinics in Sweden to participate in semi-structured interviews around their experiences with psychiatric drug prescription. The authors then coded the interviews for recurring themes.
The researchers identified two overarching themes in the interview data. (1) “Belief in the perfect match – and what happens when it fails” included participants’ hopes that psychiatric drugs could lead to greater emotional stability, reduced reactivity, and feeling more like themselves. One participant described the the beneficial effects of psych drugs as feeling “like you’re actually doing something and making progress. And it’s quite simple too, just taking the medication, compared with having to do tasks or other things you would otherwise need to manage.” Others had more mixed experiences:
“It was the first time I could get in touch with certain feelings again, and I realised: my god, I haven’t laughed in I don’t know how long … It saved me in some situations, but in many others it wasn’t helpful at all.” Another participant said “I’ve felt a bit like I’ve lost part of my personality. But overall, I still think the medication helps.” Some also reported that the negative effects canceled out any benefits. “Maybe I’ve been in a better mood and more social, but with the side effects it becomes plus minus zero.”
Some participants were unsure whether the drugs had made a difference or not, while others described initial benefits that rapidly faded. “It felt better at first … but then it stopped working. Even when they raised the dose, nothing happened.” They also felt afraid of having to take these medications long-term if they did work. “What if they work—does that mean I have to take them for the rest of my life?”
Many patients and service users blamed themselves when the drugs did not have the intended effect. “I feel it simply doesn’t help, and when someone says it should, I think there’s something wrong with me for it not working. Sometimes I wonder if I’m just imagining that it doesn’t work.” Little acknowledgment from mental health professionals about the struggles of people taking psychiatric drugs also made some participants feel responsible for the treatment’s failure.
(2) “Bearing the whole burden” included treatment feeling arbitrary, participants feeling that their contribution to decision-making in their treatment was superficial, and patients having to manage their own prescription drug use, monitor their effects, and advocate for proper care. One participant said “Since I’ve tried so many different types of medication, sometimes it feels like they’re just guessing.” Another reported that having to monitor the effects of prescribed drugs increased their anxiety. “The more you look and measure, the more unsure you get. It can even become a bit dangerous … it creates more fixation and worry.”
The previous two studies had three main limitations. The small sample size, while appropriate for a qualitative study, limits generalizability. All participants were recruited from the same geographical location, further limited generalizability. People with particularly strong opinions of psychiatric drugs may have been more likely to participate, possibly biasing the data.
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Adams, N. N., & Warrender, D. (2026). “another problem, another pill”: Analysing lived experience crisis accounts of psychiatric drug treatment for people diagnosed with “borderline personality disorder.” Journal of Applied Social Science. (Link)
Berna, F., Musso, M., Weibel, S., & Brunn, M. (2026). Psychotropes et Personnalité Borderline : Prescrire, Ne Pas prescrire, déprescrire ? Annales Médico-Psychologiques, Revue Psychiatrique, 184(5), 340–346. (Link)
Di Leone, F., Fransson, J., Sundquist, M., Strand, J., Liljedahl, S. I., & Sand, P. (2026). “it seems like they are guessing”: A qualitative study of the prescribing process from the perspective of individuals diagnosed with personality disorder. Frontiers in Psychiatry, 17. (Link)
