Clinical practice guidelines for the treatment of borderline personality disorder: a systematic review of best practice in anticipation of MAiD MD-SUMC.

Background: Countries permitting assisted dying for mental disorder as the sole underlying condition (MD-SUMC) find that individuals with Borderline Personality Disorder (BPD) constitute a significant proportion of people requesting MAiD. In anticipation of forthcoming changes to Canadian MAiD legislation, clinical practise guidelines will be important in the decision-making process for eligibility to ensure that evidence-based treatments have been exhausted in making determinations of irremediability.

Aims: This is a systematic review of international, English-language treatment guidelines for BPD with two primary objectives: First, to identify areas of consensus and disagreement in best practise for the treatment of this disorder and second, to assess whether the guidelines offered insight into defining irremediable BPD and/or its management.

Methods: In accordance with PRISMA guidelines, we performed a systematic review of five databases and identified five clinical practise guidelines in the English language. Two authors independently performed data extraction on the core components of these treatment guidelines, which was synthesized into a narrative review.

Findings: Several conclusions may be drawn about the state of the evidence on BPD treatment. First, psychological therapies are broadly considered the preferred treatment modality for BPD but there is no consensus regarding whether any one intervention is preferable. Second, all guidelines suggest pharmacotherapy may have a role in the management of BPD, but the nature and extent of this is disputed. Third, there is no guidance alluding to, defining, or commenting on the management of irremediable BPD. Finally, there are no Canadian treatment guidelines for BPD. The implications of these findings for MAiD MD-SUMC are discussed.