Psychiatrists are giving drugs to most people with emotionally unstable personality disorders outside of the best-practice clinical guidelines, according to a study in the Journal of Clinical Psychiatry. And an accompanying editorial stated that the reason is because “therapy takes time.”

The researchers performed a cross-sectional survey of self-selected psychiatric services, and found that of 2,600 patients with a diagnosis of personality disorder, more than two-thirds (68%) had a diagnosis of emotionally unstable personality disorder (EUPD). Nearly all of these (92%) were being treated with antidepressants or antipsychotics. “The use of psychotropic medication in EUPD in the United Kingdom is largely outside the licensed indications,” concluded the researchers. This was a particular concern, they added, because the practices aren’t often systematically reviewed and monitored, “so opportunities for learning may be lost. Treatment may be continued long term by default.”

“(I)t is now known that specialized treatments such as dialectical behavior therapy and mentalization-based treatment can be helpful for most cases,” stated the accompanying editorial. “Although these more specific psychological treatments are known to be efficacious, they are not readily available. The reason is that therapy takes time and is expensive in human resources. This leaves harried clinicians with an inadequate set of options. The easiest choice is to focus on pharmacologic therapy for target symptoms rather than the personality disorder as a whole.”

The editorial argued that the problem may be even more widespread than found in the study, and stated, “Clearly, psychiatrists need to receive better education about evidence-based treatments for severe personality disorders. However, much of what they think they know is filtered through a climate of opinion shaped by neurobiological models and psychopharmacologic options.”

Paton, Carol, Michael J. Crawford, Sumera F. Bhatti, Maxine X. Patel, and Thomas R. E. Barnes. “The Use of Psychotropic Medication in Patients With Emotionally Unstable Personality Disorder Under the Care of UK Mental Health Services.” The Journal of Clinical Psychiatry, April 22, 2015, e512–18. doi:10.4088/JCP.14m09228. (Abstract)

Paris, Joel. “Why Patients With Severe Personality Disorders Are Overmedicated: (Commentary).” The Journal of Clinical Psychiatry, April 22, 2015, e521–e521. doi:10.4088/JCP.14com09441. (Full text)