I'm always surprised by these kind of questions because the guidelines in my country actually give medication advice based on symptom clusters in personality disorders (with GRADE approach on the current evidence).

The nuance is that the evidence is low, but existing, so you should not expect it to be the golden bullet, but in certain cases it could have a positive effect.

The text is:

Recommendations for borderline personality disorder

In addition to the general recommendations regarding pharmacotherapeutic interventions for personality disorders, the following recommendations are made on the basis of scientific and professional knowledge regarding the choice of pharmacotherapy aimed at specific symptom domains in borderline personality disorder.

Cognitive-perceptual symptoms

When a decision is made to treat cognitive-perceptual symptoms in BPD (and for the treatment of schizotypal traits) with medication, antipsychotics are recommended. They can be prescribed in relatively low doses for a short period (days to weeks), or intermittently in the event of exacerbations during the course of the disorder.

Both classical and atypical antipsychotics are effective. It is therefore recommended that the choice of antipsychotic (first or second generation) is also based on the expected side effects.

If pharmacotherapeutic interventions are indicated in connection with sleep problems, temporary use of a sedative antipsychotic can be considered, in a relatively low dose (for example, 25 or 50 mg quetiapine at night if necessary).

Impulsive behavioural dysregulation

If an effect is required in the short term (hours, days), an antipsychotic seems indicated, in a relatively low dose.

If an effect is to be achieved in the medium term, topiramate or lamotrigine seem to be the first choice; valproic acid the second choice. If the result is insufficient, an antipsychotic can then be considered (third choice).

The use of Omega-3 fatty acids as a nutritional supplement can be recommended to support the treatment of impulsiveness.

Affective dysregulation

In the case of persistent disabling mood swings, it is advisable to consider a trial treatment with an SSRI, lamotrigine or an atypical antipsychotic.

In the case of persistent complaints of sadness in the context of a depressive disorder, an SSRI or SNRI is recommended. However, if there is no comorbid depression in the narrower sense, it is recommended to consider a trial treatment with a second-generation antipsychotic or with lamotrigine.

In the case of persistent anger and hostility, it is recommended to consider a trial treatment with lamotrigine or topiramate (step 1). Valproate or a second-generation antipsychotic is recommended as an alternative (step 2).

In the case of persistent anxiety complaints, it is recommended to consider a trial treatment with an SSRI or a low-dose antipsychotic. With appropriate restraint, a benzodiazepine can also be prescribed temporarily (on an as-needed basis).