Abhatoo - Centre Nationale de Documentation

Introduction: Borderline Personality Disorder (BPD) is a frequent and complex condition that leads to significant mortality and psychosocial disability and is associated with numerous comorbidities. Recent international guidelines
focus on psychotherapeutic approaches, relegating pharmacotherapy and hospitalization to secondary roles.

Objective:To assess the management attitudes of Borderline Personality Disorder (BPD) among psychiatrists in Morocco, and to provide an update on the new therapeutic strategies described in the literature.

Methods: This is a descriptive cross-sectional study conducted via an anonymous self-administered online questionnaire completed by psychiatry residents and specialists in Morocco. The findings are then contrasted with the latest recommendations described in the literature.

Results: Our study included 86 participants consisting 63 specialists and 23 residents, with years of experience in the field of psychiatry ranging from less than 5 years (31.4%), 5 to 10 years (23.3%), 10 to 20 years (23.3%), to more than 20 years (22.1%). Among these psychiatrists, 97.7% consider the management of patients with BPD to be difficult or very difficult. In our sample, only 39.5% of psychiatrists report adopting psychotherapy as the first therapeutic approach for patients with BPD. Cognitive Behavioral Therapy (CBT) is the most commonly offered (71%), followed by Schema Therapy and Family Therapy (33.7% both). When it comes to pharmacological management: in 54.7% of cases, monotherapy is the standard approach. As a first-line treatment, antidepressants are the most commonly prescribed psychotropic class (69.8%), followed by atypical antipsychotics (44.2%), and then mood stabilizers (34.9%). More than 67.4% of the psychiatrists surveyed recommend hospitalization for patients with BPD, particularly in cases of suicidal crisis (95.3%), self- or other-directed aggression (66.3%), substance use disorders (52.3%), or severe dissociation (15.1%). However, when asked about the long-term benefits of hospitalization for these patients, only 37.2% reported observing any lasting benefit.

Conclusion: The core of treatment of BPD lies in psychotherapy and outpatient follow-up. Hospitalization should be limited and structured. Pharmacological treatments should only be considered as adjunctive and used cautiously.