Abstract

Background: Premature termination from treatment or dropout is prevalent among patients with borderline personality disorder (BPD). To our knowledge, no studies have examined which factors predisposes dropout from therapy among adolescents with BPD. The current study examined sociodemographic, clinical and psychological predictors of dropout among adolescents who attended a one-year treatment program with mentalization-based group treatment (MBT-G).

Methods: Participants were 89 female adolescent patients aged 14–18 years who attended MBT-G in a Danish child and adolescent psychiatric service and 56 matched controls who received non-manualized individual sessions (treatment as usual). Forty (45%) dropped out and 49 (55%) completed treatment in MBT-G. Pretreatment predictors included (1) sociodemographic variables such as age, schooling, relationship status and after-school job, (2) clinical measures of self-reported adolescent borderline personality features, depression, self-harm, internalizing and externalizing symptoms, and (3) psychological measures on self-reported reflective functioning (i.e., mentalizing) and attachment to peers and parents.

Results: Binary logistic regression analyses revealed that lower reflective functioning was the only significant predictor of dropout in MBT-G. No sociodemographic or clinical variables predicted dropout. No significant predictors of dropout were identified among participants who received treatment as usual.

Conclusions: Adolescents with BPD who report low reflective functioning are at increased risk of dropping out of MBT-G treatment but not treatment as usual. These findings highlight that clinicians need to consider level of reflective functioning among adolescents with BPD in MBT or in group therapy and adapt psychotherapy to the needs of the patient in order to reduce dropout.

摘要

背景：边缘性人格障碍（BPD）患者普遍因治疗或辍学而提前终止治疗。据我们所知，尚无研究检查哪些因素会导致BPD青少年退出治疗。本研究调查了参加以心理化为基础的团体治疗（MBT-G）的为期一年的治疗计划的青少年的社会人口统计学，临床和心理预测因素。

方法：参与者为89名年龄在14-18岁的女性青少年患者，他们在丹麦的儿童和青少年精神病学治疗中接受了MBT-G治疗，还有56名相匹配的对照组接受了非常规的个人治疗（照常治疗）。MBT-G中有40（45％）名退学，49（55％）名患者完成了治疗。治疗前的预测因素包括（1）社会人口统计学变量，例如年龄，学历，人际关系和课余工作；（2）自我报告的青少年边缘人格特征，抑郁，自我伤害，内在和外在症状的临床测量；以及（3 ）关于自我报告的反射功能（即心理状态）以及对同伴和父母的依恋的心理措施。

结果：二进制逻辑回归分析表明，较低的反射功能是MBT-G辍学的唯一重要预测因子。没有社会人口统计学或临床变量预测辍学。在接受常规治疗的参与者中，没有发现明显的辍学预测因素。

结论： BPD青少年的反射功能低，退出MBT-G治疗的风险增加，但不如往常那样。这些发现表明，临床医生需要考虑MBT或团体治疗中BPD青少年的反射功能水平，并使心理治疗适应患者的需求，以减少辍学。