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Objectives To explore the patient and informal-carer reported factors that influence prescribing decisions in the management of borderline personality disorder (BPD).Design The study employed a qualitative methodology of semi-structured interviews with patients and informal carers to examine perspectives on prescribing decisions and the factors shaping them.Setting Interviews were conducted across both primary and secondary care settings in England.Participants A total of 10 participants were recruited for the study, comprising eight females and two males, all aged 18 years or older. Participants either had a formal diagnosis of BPD or were informal carers of individuals diagnosed with BPD. All participants had experience with the prescribing of medication for the management of BPD.Results Thematic analysis, employing both inductive and deductive strategies and informed by agency theory, yielded three interrelated themes: prescribing for symptom relief, the impact of risk on prescribing and difficulties in accessing services. Participants described medication as a necessary means of managing distress, especially when access to psychological therapies was constrained. Despite awareness of potential adverse effects, many expressed a strong desire to make their own decision around medication.Conclusions Improving clarity around the likelihood of both symptomatic relief and potential adverse effects through co-designed informational resources may support more informed decision-making in the treatment of BPD. Furthermore, to change prescribing patterns, systemic gaps in the provision of long-term psychological therapies must be addressed.