Dropout from psychological treatment for borderline personality disorder: A multilevel survival meta-analysis

A. Arntz, Kyra Mensink, Wouter Cox, Rogier Verhoef, Arnold A P van Emmerik, Sophie Rameckers, Theresa Badenbach, Raoul P P P Grasman

Research output: Contribution to journalReview articlepeer-review


BackgroundDropout from psychotherapy for borderline personality disorder (BPD) is a notorious problem. We investigated whether treatment, treatment format, treatment setting, substance use exclusion criteria, proportion males, mean age, country, and other variables influenced dropout. MethodsFrom Pubmed, Embase, Cochrane, Psycinfo and other sources, 111 studies (159 treatment arms, N = 9100) of psychotherapy for non-forensic adult patients with BPD were included. Dropout per quarter during one year of treatment was analyzed on participant level with multilevel survival analysis, to deal with multiple predictors, nonconstant dropout chance over time, and censored data. Multiple imputation was used to estimate quarter of drop-out if unreported. Sensitivity analyses were done by excluding DBT-arms with deviating push-out rules. ResultsDropout was highest in the first quarter of treatment. Schema therapy had the lowest dropout overall, and mentalization-based treatment in the first two quarters. Community treatment by experts had the highest dropout. Moreover, individual therapy had lowest dropout, group therapy highest, with combined formats in-between. Other variables such as age or substance-use exclusion criteria were not associated with dropout. ConclusionThe findings do not support claims that all treatments are equal, and indicate that efforts to reduce dropout should focus on early stages of treatment and on group treatment.
Original languageEnglish
Article numberPII S0033291722003634
Pages (from-to)668 - 686
Number of pages19
JournalPsychological Medicine
Issue number3
Early online date2022
Publication statusPublished - 1 Feb 2023


  • Borderline personality disorder
  • dropout
  • meta-analysis
  • psychotherapy
  • treatment retention


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