Definition of dropout
dysfunctional behavior, therapy-disrupting behaviors, Dysfunctional behaviors, non-suicidal self-injuries, maladaptive behavior, dysfunctional behaviors, BPD
To assess treatment discontinuation, we recorded whether the participant was discharged from our unit before week eight or before the final discharge date set at week six. The reasons for discontinuation were documented (by the patient or by the ward). In all cases, contingency management was the reason for discharge on part of the ward. It includes positive consequences for functional behaviors to reinforce these and increase the likelihood of their occurrence, as well as negative consequences for dysfunctional behaviors to extinguish these. Although dysfunctional behavior patterns are part of the clinical picture of BPD, reducing them is necessary in order to reduce negative consequences for the patients themselves and others on the ward, and furthermore to enable the use of adaptive strategies in the first place. Dysfunctional behaviors, on the one hand, depend on the goals of the patients. On the other hand, some dysfunctional behaviors are defined according to the DBT hierarchy: suicidal behaviors, severe non-suicidal self-injuries, drug use, and therapy-disrupting behaviors (missing sessions, violating general ward rules). When dysfunctional behavior occurs repeatedly (usually four times), a patient is discharged from treatment. If maladaptive behavior occurs, intensive work is done to build up adaptive problem-solving strategies. If maladaptive strategies repeatedly occur despite intensive coaching, treatment is discontinued (assuming that the therapy in its current form or at the current time is not helpful). The more a behavior is harmful to other patients on the ward, the sooner a patient will be discharged (e.g., assaulting a fellow patient leads to immediate discharge).