Mentalization-based Therapy for Borderline Personality Disorder: a 17-year Analysis of Hospitalization Trends using Portuguese Electronic Health Records

Abstract

Background: Borderline personality disorder (BPD) is a complex psychiatric disorder characterized by emotional dysregulation, impulsivity, and instability in interpersonal relationships. Treating BPD remains challenging, with psychosocial and psychological intervention approaches being the treatment of choice. Among these, mentalization-based therapy (MBT) is one of the most studied psychotherapeutic approaches for BPD, yet its effectiveness in different healthcare settings remains underexplored. Given this context, the present study aimed to evaluate the impact of a structured MBT program, implemented in 2013 in a Portuguese university hospital, on hospitalization trends and outcomes among BPD patients. Methods: This retrospective observational study used electronic health records to analyze hospitalization data of all episodes with a primary or secondary discharge diagnosis of BPD from 2008 to 2024. Hospitalization patterns and outcomes before and after the MBT implementation were compared, assessing variables such as admission type (urgent vs. programmed), primary diagnosis, main motives, demographic characteristics, and hospitalization length of stay (LoS). Additionally, to narrow the analysis, comparisons were conducted between MBT-enrolled and non-enrolled patients from 2013 onward. Results: A total of 203 hospitalization episodes were included in the analysis. Following the MBT implementation, hospitalized patients were significantly younger (p<0.001) and included a significantly higher proportion of students and female patients (p=0.004 and p=0.014, respectively). There was a significant decrease in urgent admissions (p<0.001), and a shift in chief complaints, with suicidal ideation becoming more prevalent, while suicide attempts or behavioral dysregulation decreased. Additionally, hospitalizations with BPD as the primary diagnosis increased, particularly among MBT-enrolled patients (p<0.001). However, LoS did not differ significantly before and after the MBT implementation. Conclusion: The present findings suggest that implementing an MBT program may have influenced hospitalization patterns by promoting earlier intervention and improving diagnostic recognition of BPD. The lack of significant differences in LoS may reflect the severity of the disorder at the time of the admission to a psychiatric inpatient unit, which is primarily reserved for crisis management, such as when a patient poses a significant risk to themselves or others that cannot be managed at a lower level of care. Despite these insights, limitations such as the use of secondary data and diagnostic variability highlight the need for further research using primary data collected to better assess the long-term impact of the MBT program on treatment outcomes and healthcare utilization.