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May 10, 2026Research in Psychotherapy Psychopathology Process and Outcome1 citationsOpen Access

Holding the treatment frame: borderline features, personality functioning, and psychotherapy dropout in a youth mental health service

FSFrancesca De SalveUniversità Cattolica del Sacro CuoreCRChiara RossiUniversità Cattolica del Sacro CuoreOOOsmano OasiUniversità Cattolica del Sacro Cuore

Key Points

  • This study investigates how baseline personality traits and borderline symptoms affect psychosocial functioning and psychotherapy dropout.
  • 124 young adults assessed at intake in a youth mental health service in Milan, Italy.
  • Measures included PID-5, BSL-23, and SOFAS with multiple linear regression analysis and Bayesian logistic regression.
  • Participants included a subsample of 63 in psychotherapy, tracking dropout rates.
  • Higher borderline symptom severity correlated with lower functioning (B=-2.86, β=-.21, 95% CI [-5.27, -0.46]).
  • Dropout was most influenced by disinhibition (BF_inclusion = 3.36), though credible intervals included zero for predictors.

Abstract

Baseline personality pathology may shape both everyday functioning and engagement in psychotherapy. This study tested whether maladaptive personality trait domains and borderline symptom severity were associated with psychosocial functioning at intake and whether these variables were related to subsequent psychotherapy dropout within the same clinical pathway. Participants were 124 young adults (M age = 20. 81, SD=2. 30; 51. 6% male and 48. 4% female) assessed at intake in a youth mental health early intervention service in Milan, Italy (2024-2025). Measures included the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PID-5), the Borderline Symptom List-23 (BSL-23), and the Social and Occupational Functioning Assessment Scale (SOFAS). SOFAS was examined using stepwise multiple linear regression including PID-5 domains, BSL-23, sex, and age. Dropout was examined using Bayesian logistic regression and model comparison in the psychotherapy-only subsample (n=63; 13 dropouts, 20. 6%). In the full sample, the final regression model retained only BSL-23, F (1, 122) =5. 57, p=. 020, R2=. 04, indicating that higher borderline symptom severity was associated with lower functioning (B=-2. 86, β=-. 21, 95% CI -5. 27, -0. 46). For dropout, inclusion evidence was strongest for disinhibition (Bayes factor for inclusion BFᵢnclusion = 3. 36), followed by BSL-23 (2. 39) and SOFAS (2. 23), although model-averaged 95% credible intervals (CrIs) included zero for all predictors. Clinically, these findings suggest that disinhibition and borderline severity may be better understood as markers of relational intensity requiring a structured yet reflective therapeutic stance rather than as straightforward dropout risks.

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Cite This Study

Salve et al. (2026) studied this question.

synapsesocial.com/papers/6a002087c8f74e3340f9b6c2https://doi.org/10.4081/ripppo.2026.893
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