Dropout rates from psychotherapy trials for borderline personality disorder: A meta-analysis.

Borderline personality disorder (BPD) is a serious mental illness associated with heightened disability, risk for suicide, and costs to society. This study aims to meta-analytically quantify dropout rates from psychotherapies of BPD, identify moderators, and assess reasons for dropout and time taken to dropout. PubMed, PsycINFO, and MEDLINE were screened from database inception to March 2020 for trials that investigated psychotherapies for individuals with BPD reporting dropout rates. The primary outcomes were pooled dropout rates and differential treatment retention across all studies, all randomized controlled trials (RCT), all outpatient studies, and all outpatient RCTs. Random effects meta-analysis, metaregression analyses, and publication bias tests were conducted. Information on reasons for dropout and time to dropout was synthesized qualitatively. Dropout rates were 22.3% considering all studies, and 28.2% when only considering outpatient randomized controlled trials. Odds of dropout were not significantly higher in the control condition than in the intervention condition. Longer duration, randomization, phone coaching, and outpatient setting were associated with higher dropout rates, but only when considering all studies. Publication bias-adjusted dropout rates were as high as 29.9%. Reasons for dropout included dissatisfaction with treatment, expulsion from treatment, and lack of motivation. Most dropouts occurred in the first half of treatment. Dropout is an important and prevalent issue in BPD psychotherapies. Reported rates are minimized by publication bias, and moderators of dropout rates are inconsistent. Subsequent research should identify obstacles to completing treatment and investigate ways to organize treatment allocation to enhance treatment retention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The hypothalamic-pituitary-adrenal axis in borderline personality disorder: a review.

BACKGROUND: borderline personality disorder (BPD) is a psychiatric diagnosis characterized by high exposure, reactivity, and vulnerability to stress. Given these abnormalities in stress reactivity in BPD, there is a question of whether the hypothalamic-pituitary-adrenal (HPA) axis functions normally in BPD, since the activation of the HPA axis normally occurs to coordinate both behavioral and physiologic responses to stress. Several studies have investigated the functioning of the HPA axis in BPD and have shown varied results. This review seeks to summarize and interpret the findings of this growing literature. METHODS: Pubmed search for English language articles on borderline personality disorder and hypothalamic-pituitary-adrenal axis. RESULTS: findings are mixed but suggest that important variables relevant to between-group differences include comorbid depression, comorbid posttraumatic stress disorder, dissociative symptoms, and history of childhood abuse. DISCUSSION: comorbid diagnoses and clinical features such as trauma history and symptom severity may have variable, interacting influences on the psychoneuroendocrine profile in BPD. Also explored here are the implications of these findings for developing possible models of HPA-axis dysfunction in BPD, for identifying potential targets for treatment, and for improving the methodology of future studies.