Treatment of severe borderline personality disorder with clozapine

Patients with borderline personality disorder (BPD) show significant impairment in the domain of interpersonal and social functioning and may use the resources of health and social services extensively, with little beneficial outcome. At present there are no clear guidelines in literature for the use of pharmacotherapy in the management of BPD. According to the scanty literature available in the form of case reports and small studies, clozapine has been demonstrated to be effective in the management of BPD. The case presented here describes the effectiveness of clozapine in a young female patient with severe BPD (without psychotic features), who had repeated and prolonged periods of hospitalization and was successfully treated with a moderate dose of clozapine, following a failure to improve with other psychotropic medications. More studies are suggested to evaluate the efficacy of clozapine in patients with BPD, both with and without psychotic features, to find out the optimum dose and to weigh the risk and benefits of clozapine.