Treatment Dropout in Borderline Personality Disorder: Patient Perceptions of a Specialized Treatment Program

Borderline Personality Disorder (BPD) is a multifaceted mental illness characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affect and marked impulsivity, beginning by early adulthood and presenting in a variety of contexts. The treatment of personality disorders is labeled as difficult, with various challenges identified in the literature, especially described in those with BPD. One of the challenges associated with BPD is treatment dropout, in which patients abandon their treatment schedules and protocols. The authors aim to explore the underlying motives for therapeutic abandonment in this population as well as discuss potential intervention methods to reduce this outcome during follow-up, whilst promoting regular adherence and active treatment participation. A cross-sectional study of patients that joined and subsequently dropped out of a specialized treatment program for Borderline Personality Disorder in a Portuguese hospital from 2014 to 2023 was realized utilizing data collected from surveys conducted through telephone interviews. Of the patients, 39 were identified as having dropped out of the program during the stipulated timeframe. Of these, five (12.8%) refused to participate, fourteen (35.8%) did not respond to contact attempts and two (0.05%) patients subsequently reintegrated into the program. Therefore, 18 (46.2%) agreed to respond to the questionnaire and were considered in the current study. The majority were female (94.4%) of single marital status and with secondary-level education. The main motivators for treatment dropout described by these patients included the large intervals between consultations, the loss of motivation and/or interest, as well as dissatisfaction with the program. Other variables were explored in the work, such as the desire to return to the program, the maintenance of other types of treatment, feelings after dropout and the evaluation of the usefulness of the program. Treatment dropout is an important problem in the treatment of BPD, as it stifles progress and therapeutic benefits through maintenance of the previous state, conditioned by impulsivity and marked instability. Although the current study attempts to clarify the motivating factors underlying abandonment in this population, further research is necessary in attempting to further reduce the lacuna regarding this common phenomenon and to develop interventions to promote positive outcomes.