IntroductionPsychiatric medications are frequently prescribed for adults with personality disorders (PD), despite clinical guidelines emphasizing psychotherapy as first-line treatment and limited evidence regarding patients' experiences of pharmacological care. This study explored how adults with PD experience the prescription and follow-up of psychiatric medications in outpatient psychiatric services.MethodsTen adults with a registered PD diagnosis and experience of prescribed psychiatric medication were purposively recruited from outpatient psychiatric clinics in a metropolitan area in Sweden. Semi-structured interviews explored participants' experiences of medication use, prescribing processes, shared decision-making, and follow-up. Data were analyzed using inductive thematic analysis.ResultsTwo overarching themes were identified. Belief in the Perfect Match—and What Happens When It Fails described participants' hopes that medication would reduce emotional instability while raising concerns about losing aspects of their identity or authenticity. Bearing the Whole Burden reflected experiences of prescribing as arbitrary or procedural, limited involvement in treatment decisions, inconsistent follow-up, and a tendency to internalize responsibility when medications did not produce the expected benefits. Participants often perceived medication as a temporary substitute for more comprehensive care rather than as a meaningful therapeutic intervention.DiscussionExperiences of pharmacological treatment for PD extended beyond symptom management to encompass issues of identity, responsibility, and trust in healthcare. These findings underscore the need for transparent treatment rationales, shared decision-making, and structured follow-up, alongside integration of pharmacological treatment within broader psychosocial interventions. Such an approach may strengthen therapeutic relationships, reduce self-blame, and improve treatment engagement for individuals with PD.