Objective: This scoping review aims to synthesize the current literature on peer support interventions for individuals with BPD, focusing on their benefits, risks, and implementation challenges.
Methods: Following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, a comprehensive search was conducted across six databases (Medline, PsycINFO, EMBASE, Cochrane Library, CINAHL, and Google Scholar) and grey literature sources. The inclusion criteria were defined using the Population–Concept–Context (PCC) framework. Eleven studies published between 2019 and 2025 were included. Data extraction focused on study design, participant characteristics, intervention content and structure, outcomes, and implementation challenges.
Results: Peer support interventions varied from structured and manualized programs to flexible and community-based formats. Reported benefits included improved emotion regulation, reduced isolation, enhanced empowerment, and increased hope. Peer workers also reported personal growth and a strengthened sense of purpose. However, challenges such as emotional exhaustion, role ambiguity, inadequate supervision, and limited engagement in online settings were frequently noted. Only a few studies included quantitative measures of symptom change, and methodological heterogeneity limited cross-study comparisons.
Conclusions: Peer support interventions show promising psychosocial benefits for individuals with BPD, particularly in domains related to relational connectedness, emotional coping, and subjective recovery. However, evidence remains limited by a lack of standardized models and rigorous evaluation. Future studies should employ mixed-method and controlled designs to better assess clinical outcomes and ensure safe, effective, and sustainable peer-led programs for this population.
1 Introduction
Borderline personality disorder (BPD) is characterized by emotional instability, tumultuous interpersonal relationships, marked impulsivity, intense fear of abandonment, and self-destructive behaviors (1). These symptoms can significantly disrupt daily functioning and diminish quality of life (2). Individuals living with BPD often struggle to maintain consistent relationships (3), manage daily responsibilities and regulate their emotions effectively (4, 5). These challenges can lead to considerable difficulties in various aspects of life, including their personal, social, and professional spheres, ultimately reducing their overall sense of fulfillment and well-being (6). Additionally, individuals with BPD are at increased risk for premature death, primarily due to elevated suicide rates and high burden of physical health complications (7, 8). BPD is estimated to affect approximately 1.9% of the general population (9) but accounts for 15–28% of patients in psychiatric settings, including clinics and hospitals, as well as a significant number of individuals seeking psychological support in general healthcare facilities (10).
1.1 Challenges in accessing and retaining effective treatment for BPD
Clinical guidelines generally recommend psychotherapy as the first-line treatment for BPD, with Dialectical Behavior Therapy (DBT) often highlighted, despite no consensus regarding the superiority of any psychological intervention (11). However, access to adequate treatment for BPD remains limited in most countries because of significant shortage of qualified professionals, insufficient funding and ongoing stigmatization of this population within the healthcare system (12–14). As a result, many individuals are left without access to the recommended care, as the demand for these services far exceeds the available supply (13). Individuals with BPD frequently report dissatisfaction with the services they receive, citing a significant disparity between their needs and the care provided, while also facing critical stigmatization (15). Although DBT and other psychotherapies are recognized as the most effective treatments, meta-analyses have shown only moderate effect sizes in reducing BPD symptoms with psychotherapy (16). Additionally, a meta-analysis indicates that the dropout rate for outpatient psychotherapies is 28.2% (17), highlighting the challenges of retaining patients in these therapeutic programs.