Psychedelics as a potential treatment for borderline personality disorder: A narrative review

Borderline personality disorder (BPD) is a serious mental illness with high rates of morbidity and stigma; however, successful remission is frequently limited by a paucity of accessible treatment options. In an era of growing interest in psychedelics as novel psychiatric treatment modalities, patients with BPD are often excluded from research due to perceived safety risks, particularly pertaining to suicide and substance misuse. However, there is evolving evidence that psychedelic treatment may effectively target core BPD symptoms, in addition to those of the mood and anxiety disorders frequently comorbid with BPD. As such, characterizing the therapeutic potential of psychedelics in BPD represents an important opportunity to enhance patient outcomes. This narrative review aims to broadly analyze the existing literature on experiences with psychedelics in this population. Data were coalesced from multiple electronic databases (Ovid MEDLINE, PsychInfo, and Embase) to characterize the current evidence for psychedelic safety and effectiveness in individuals with BPD. The 22 studies included in this review encompass a broad range of study designs and outcomes involving ketamine, esketamine, and psilocybin. There is some preliminary evidence that these psychedelics may be implemented as safe and effective treatments to improve core BPD symptoms and socio-occupational functioning. However, further high-quality evidence focusing on BPD-specific outcomes is needed to better elucidate their potential role as a treatment modality.