Feasibility of standard Dialectical-Behavioral Therapy for Borderline Personality Disorder: a real-world study in Italian outpatient services

Background: Dialectical-Behavioral Therapy (DBT) is an effective multimodal psychotherapeutic intervention for patients with Borderline Personality Disorder (BPD). However, there is limited evidence regarding the feasibility and effectiveness of DBT in Italian outpatient public mental health services. Methods: This retrospective, longitudinal observational study presents preliminary data on the feasibility (assessed through patient enrollment compared to initial referrals, dropout, and participation rates) of a one-year standard DBT program implemented in three Community Mental Health Centers in Bologna, Italy, from 2013 to 2020. An additional outcome includes exploring the effectiveness of this intervention, evaluated by comparing the incidence of non-suicidal self-harm behaviors, unplanned outpatient visits, emergency department (A&E) admissions, and hospitalizations (frequency and duration) in the year before and after the DBT program. Participants were outpatients aged 18-45 years who met DSM-5 criteria for BPD. Data were analyzed using descriptive statistics, unpaired and paired t-test, Chi-square tests, logistic regression, and McNemar's test. Results: Of 132 initial referrals, 51 outpatients were enrolled in the standard DBT program, and 37 completed it. The enrollment gap was primarily due to low motivation, negative attitudes toward psychotherapy, and scheduling conflicts with personal, work, or study commitments. High participation among completers (72.5%) and low dropout rate (27.5%) indicate good feasibility of standard DBT. Dropouts were significantly older than completers (35.4 +/- 8.2 vs. 29.8 +/- 8.0; p = 0.032), with age emerging as a significant predictor of dropout (OR = 1.15; p = 0.039). Regarding effectiveness, significant reductions in self-harm behaviors, unscheduled outpatient visits, and hospitalizations are consistent with prior research findings. Conclusions: Our findings suggest that standard DBT may be a feasible treatment for outpatient mental health services as part of a stepped-care approach. Furthermore, this study supports the effectiveness of DBT while valuable into its real-world