NICE Guidelines on Recognising and Managing Borderline Personality Disorder: 1.2 Recognition and management in primary care

The following guidance is based on the best available evidence. The full guideline gives details of the methods and evidence used to develop the guidance. People have the right to be involved in discussions and make informed decisions about their care, as described in your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.2.1 Recognition of borderline personality disorder

If a person presents in primary care who has repeatedly self-harmed or shown persistent risk-taking behaviour or marked emotional instability, consider referring them to community mental health services for assessment for borderline personality disorder. If the person is younger than 18 years, refer them to CAMHS for assessment.

1.2.2 Crisis management in primary care

When a person with an established diagnosis of borderline personality disorder presents to primary care in a crisis:

  • assess the current level of risk to self or others
  • ask about previous episodes and effective management strategies used in the past
  • help to manage their anxiety by enhancing coping skills and helping them to focus on the current problems
  • encourage them to identify manageable changes that will enable them to deal with the current problems
  • offer a follow-up appointment at an agreed time.

1.2.3 Referral to community mental health services

Consider referring a person with diagnosed or suspected borderline personality disorder who is in crisis to a community mental health service when:

  • their levels of distress and/or the risk to self or others are increasing
  • their levels of distress and/or the risk to self or others have not subsided despite attempts to reduce anxiety and improve coping skills
  • they request further help from specialist services.

© NICE (2009) Borderline personality disorder: recognition and management
Clinical guideline [CG78]. Available from All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.