<p>Borderline personality disorder (BPD) is characterized by a&#xa0;pervasive pattern of instability in interpersonal relationships, self-image and affect as well as profound impulsivity. The complexity of BPD is associated with significant psychological distress and requires specialized therapeutic approaches. Within the German healthcare system, the primary evidence-based forms of treatment for BPD include dialectical behavior therapy (DBT), mentalization-based therapy (MBT), transference-focused psychotherapy (TFP) and schema-focused therapy (SFT), all of which are recommended by the <i>German S3 medical guidelines borderline personality disorder</i>; however, only a&#xa0;subset of patients has access to first-line treatment. Many individuals with BPD face barriers that impede access to effective psychotherapy, including comorbidities, long waiting lists, severe self-harming behavior and homelessness. As a&#xa0;result, individuals with BPD are overrepresented in psychiatric emergency departments. Disorder-specific, low-threshold treatment options and structured crisis interventions based on evidence-based psychotherapy represent important components of the care system for patients with BPD. The present article provides an overview of established forms of treatment for BPD as well as current challenges in the clinical practice and presents a&#xa0;DBT-oriented treatment proposal for acute psychiatric settings based on a&#xa0;fictional case example. Randomized controlled trials and practice-oriented research are needed to evaluate the efficacy and effectiveness of specialized psychotherapeutic interventions for BPD in general and acute psychiatric care.</p>