Treatment of patients with borderline personality disorder in the emergency room? A scoping review.

Background: Borderline personality disorder (BPD) is frequently encountered in emergency departments. Acute emotional crises, suicidal behaviors, and severe interpersonal distress often precipitate care. Despite the high clinical burden and elevated suicide risk associated with this disorder, guidance for emergency decision-making remains fragmented and sometimes contradictory. Objective: This scoping review aimed to identify key elements informing emergency psychiatric assessment, disposition decisions, and acute management strategies for adults diagnosed with BPD. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, four electronic databases were searched for studies published between January 1 Results: Twelve studies met inclusion criteria. Three interrelated domains emerged: structured suicide risk assessment contextualized within chronic vulnerability; preference for brief, goal-directed crisis hospitalization over prolonged inpatient admission; and cautious, symptom-targeted pharmacological use limited primarily to short-term management of acute agitation. Evidence consistently highlighted a paradox in which individuals with BPD often present with severe distress but are admitted less frequently than other psychiatric populations. Emerging clinical pathways emphasize voluntary short stays, rapid follow-up, and linkage to outpatient services to reduce recurrent emergency presentations and iatrogenic harm. Overall, pharmacotherapy plays an adjunctive rather than a central role in emergency care. Conclusions: Emergency encounters with individuals living with BPD represent critical inflection points in trajectories often marked by recurrent crises and suicide risk. Current evidence supports structured, formulation-based assessment, time-limited crisis stabilization, and integration with outpatient services, while underscoring significant gaps in high-quality research. Strengthening system-level pathways may enhance safety, continuity, and therapeutic engagement in this high-risk population.