background  The advent of new, atypical antipsychotics has created new opportunities for the treatment of borderline personality disorder (BPD).
aim  To find out whether the positive effects of treating BPD with atypical antipsychotics are based on convincing evidence.
method  A review of the literature, using Medline and Current Contents and using as key words borderline personality, in combination with olanzapine, quetiapine,clozapine, risperidone or antipsychotic.
results  Only one randomised clinical trial, four non-controlled open label studies and in combination eight case studies were retrieved. An analysis of these studies revealed a large diversity in the patient populations and a high drop-out rate. Nevertheless, all articles reported that olanzapine, clozapine, quetiapine and risperidone had positive effects on BPD-patients.
conclusion  A subgroup of BPD-patients with psychotic, impulsive or suicidal symptoms may derive some benefit from atypical antipsychotics. However, since the methodological quality of the reviewed articles is poor, further randomised placebo-controlled studies with longer follow-ups will have to be carried out before any firm conclusions can be drawn.