Borderline personality disorder and violence

Objective: This paper aims to provide a selective review of the co-occurrence of borderline personality disorder (BPD) and violence, a much less explored aspect of aggression with this cohort. Conclusions: Violence in BPD patients is expressed particularly towards intimate partners and known persons, usually in the homes of perpetrators. Anger, impulsivity and avoiding abandonment are traits associated with violence while suicidal behaviour, identity disturbance and affective instability are not. These patients are disproportionately found in higher levels of secure care although most violence occurs in the community. In males it is more likely driven by substance use, often at transition from adolescence to adulthood, while more severe borderline pathology is implicated in women. Early identification of an at-risk cohort is recommended with development of collaborative safety plans with patients that include identification of a 'risk signature' that guides risk management. A multi-modal approach using risk management protocols with availability of contingency plans within a multi-agency forum in a local context is recommended.