The 2024 APA borderline personality guideline was clear: no medication treats the core illness. Yet most patients with BPD walk into a psych NP visit on three to five different psychotropics. This Deep Dive cuts through the comfort prescribing that drives that stack. We unpack the small evidence base for targeting specific BPD symptoms — anger, transient psychosis, sleep, and impulsivity — and the prescribing patterns that look helpful in the moment but make patients worse over years. We cover the conversation script for de-escalating a 5-medication regimen, the role of DBT and what to say when there's no DBT therapist available, and the antidepressant trap that catches most new prescribers. If you're seeing BPD patients and feeling stuck between "do something" and "first do no harm," this is the episode. Based on the full guide at psychnpfellowshi ...