To identify key elements informing emergency psychiatric assessment, disposition decisions, and acute management strategies for adults diagnosed with BPD.
Approach:
Search Strategy: A systematic search of four electronic databases was conducted for studies published between January 1st, 2000, and December 31st, 2025, focusing on evaluation, orientation, or management of adults with BPD in emergency settings.
Key Findings:
Twelve studies met inclusion criteria, revealing three interrelated domains: 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.
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.
Interpretation:
Emergency encounters with individuals living with BPD represent critical inflection points in managing recurrent crises and suicide risk, supporting structured assessment and integration with outpatient services.
Limitations:
Significant gaps in high-quality research on the management of BPD in emergency settings, particularly regarding effective interventions and long-term outcomes.
Conclusion:
Current evidence supports structured assessment, time-limited crisis stabilization, and integration with outpatient services.
