Patients with borderline personality disorder often pose challenges in various inpatient settings. It is becoming more common for the patients that exhibit severe disturbed or high-risk behaviour within the context of this diagnosis to be transferred to psychiatric intensive care units (PICUs). The role of the PICU is widely regarded as one which can provide focused, short-term interventions for high-risk patients with mental illness; therefore, the very nature of borderline personality disorder contradicts such admission criteria. This chapter provides an overview of the common presentation and complexities of this patient demographic in a PICU and provides suggestions for management strategies. The chapter also advocates an emphasis on professionals being mindful of the patient pathway from PICU to discharge, with the aim to avoid a counterproductive admission which results in containment and overly restrictive practices.