Clozapine as an Off‐Label Treatment for Severe and Treatment‐Resistant (Auto‐)Aggressive Behavior in a 40‐Year‐Old Patient With Mild Intellecutal Disability and Borderline Personality Disorder

TL;DR

Clozapine may help reduce severe aggressive behavior in a patient with borderline personality disorder and mild intellectual disability when other treatments fail.

Contribution

This case study provides evidence for clozapine's potential efficacy in treating aggressive behavior in patients with BPD and MID.

Findings

Clozapine significantly reduced self-aggressive behavior in the patient.

Aggressive behavior towards others was terminated during the 26-week treatment.

Slow titration of clozapine was key to achieving positive outcomes.

Abstract

Clozapine has shown to be effective as an off‐label treatment for aggressive behavior in patients with borderline personality disorder (BPD) and mild intellectual disability (MID). However, there is a lack of empirical evidence for its efficacy in these patient populations and results are so far heterogeneous.

A 40‐year‐old woman diagnosed with BPD and MID with severe and treatment‐resistant aggressive behavior was treated off‐label with clozapine. A carefully administered treatment with slow titration led to a significant reduction in self‐aggressive behavior and termination of aggressive behavior towards others over a 26‐week observation period.

Our case highlights the potential efficacy of clozapine as an off‐label treatment for severe and treatment‐resistant aggressive behavior in patients with combined BPD and MID. Clozapine should be considered as a therapeutic option in severe and complex cases.