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Factors affecting dropout in outpatient eating disorder treatment

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Objective: To evaluate the incidence and effects of factors potentially influencing eating disordered patients’ dropping out of outpatient cognitive-behavioural therapy (CBT). Method: Sixty-seven (64 female, 3 male) patients with eating disorders participated in the study. All patients followed a multidisciplinary team approach for a median period of 9 months. Several factors potentially affecting dropout were retrospectively assessed prior to treatment. Results: The dropout rate was significantly higher in patients with purging anorexia nervosa (AN) compared to those with restrictive AN, bulimia nervosa and eating disorder not otherwise specified (33% vs. 27%, 25% or 21%, respectively, p<0.05). Among several factors influencing dropout, there was a significant association of patient low cooperativeness, purging episodes, restrictive eating, use of several weight control practices and psychiatric co-morbidity in patients who dropped out compared to completers (all p<0.05). Conclusions: In outpatient eating disorder treatment, non-compliance and premature interruption of therapy are affected primarily by factors which are related to patients’ attitude and behaviour. These factors should be carefully addressed in patients with eating disorders to improve outcome.

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References

  1. Becker A.E., Grinspoon S.K., Klibanski A., Herzog D.: Eating disorders. N. Engl. J. Med., 340, 1092–1098, 1999.

    Article  PubMed  CAS  Google Scholar 

  2. Clinton D.N.: Why do eating disorder patients drop out? Psychother. Psychosom., 65, 29–35, 1996.

    CAS  Google Scholar 

  3. Fassino S., Daga G.A., Piero A., Rovera G.G.: Dropout from brief psychotherapy in anorexia nervosa. Psychother. Psychosom., 71, 200–206, 2002.

    Article  PubMed  CAS  Google Scholar 

  4. Halmi K.A., Agras W.S., Crow S., Mitchell J., Wilson G.T, Bryson S.W., Kraemer H.C.: Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch. Gen. Psychiatry, 62, 776–781, 2005.

    Article  PubMed  Google Scholar 

  5. Zeeck A., Hartmann A., Buchholz C., Herzog T.: Drop outs from in-patient treatment of anorexia nervosa. Acta Psychiatr. Scand., 111, 29–37, 2005.

    Article  PubMed  CAS  Google Scholar 

  6. Woodside D.B., Carter J.C., Blackmore E.: Predictors of premature termination of inpatient treatment for anorexia nervosa. Am. J Psychiatry., 161, 2277–2281, 2004.

    Article  PubMed  Google Scholar 

  7. Pike K.M., Walsh B.T., Vitousek K., Wilson G.T., Bauer J.: Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. Am. J. Psychiatry, 160, 2046–2049, 2003.

    Article  PubMed  Google Scholar 

  8. Kahn C., Pike K.: In search of predictors of dropout from in patient treatment for anorexia nervosa. Int. J. Eat. Disord., 30, 237–244, 2001.

    Article  PubMed  CAS  Google Scholar 

  9. Vandereycken W., Pierloot R.: Drop-out during inpatient treatment of anorexia nervosa: a clinical study 133 patients. Br. J. Med. Psychol., 56, 145–156, 1983.

    Article  PubMed  Google Scholar 

  10. McKisack C., Waller G.: Why is attendance variable at groups for women with bulimia nervosa? The role of eating psychopathology and other characteristics. Int. J. Eat. Disord. 20, 205–209, 1996.

    Article  PubMed  CAS  Google Scholar 

  11. Steel Z., Jones J., Adcock S., Clancy R., Bridgford-West L., Austin J.: Why the high rate of dropout from individualized cognitive-behaviour therapy for bulimia nervosa? Int. J. Eat. Disord., 28, 209–214, 2000.

    Article  PubMed  CAS  Google Scholar 

  12. Coker S., Vize C., Wade T., Cooper P.J.: Patients with bulimia nervosa who fail to engage in cognitive-behaviour therapy. Int. J. Eat. Disord., 13, 35–40, 1993.

    Article  PubMed  CAS  Google Scholar 

  13. Blouin J., Schnarre K., Carter J., Blouin A., Tener L., Zuro C., Barlow J.: Factors affecting dropout rate from cognitive-behavioural group treatment for bulimia nervosa. Int. J. Eat. Disord., 17, 323–329, 1995.

    Article  PubMed  CAS  Google Scholar 

  14. Waller G.: Drop-out and failure to engage in individual outpatient cognitive behaviour therapy for bulimic disorders. Int. J. Eat. Disord., 22, 35–41, 1997.

    Article  PubMed  CAS  Google Scholar 

  15. Fassino S., Abbate-Daga G., Piero A., Leombruni P., Rovera G.G.: Drop-out from brief psichotherapy within a combination treatment in bulimia nervosa: role of personality and anger. Psychother. Psychosom., 72, 203–210, 2003.

    Article  PubMed  Google Scholar 

  16. Carter J.C., Olmsted M.P., Kaplan A.S., McCabe R.E., Mills J.S., Aime A.: Self-help for bulimia nervosa: a randomized controlled trial. Am. J. Psychiatry, 160, 973–978, 2003.

    Article  PubMed  Google Scholar 

  17. Swan-Kremeier L.A., Mitchell J.E., Twardowski T., Lancaster K., Crosby R.D.: Travel distance and attrition in outpatient eating disorders treatment. Int. J. Eat. Disord., 38, 367–370, 2005.

    Article  PubMed  Google Scholar 

  18. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. Washington, DC, American Psychiatric Association, 1994.

    Google Scholar 

  19. World Health Organization (WHO). ICD-10 Classificazione statistica internazionale delle malattie e dei problemi sanitari correlati, Decima revisione, 3 vol. Roma, Istituto Poligrafico dello Stato, 2000.

    Google Scholar 

  20. Guaraldi G.P., De Girolamo G., Mazzi F., Morosini P., Lussetti M.: Structured Clinical Interview for DSM-IV: versione italiana. Firenze, Organizzazioni Speciali, 2000.

    Google Scholar 

  21. Pfohl B., Blum N., Zimmerman M.: Structured Interview for DSM-IV Personality (SIDP-IV). Arlington, American Psychiatric Publishing, Inc., 1997.

    Google Scholar 

  22. Derogatis L.R.: SCL-90-R, administration, scoring and procedures manual-I for the revised version. Baltimore, MD, Johns Hopkins University School of Medicine, 1977.

    Google Scholar 

  23. Garner D.M.: Eating disorder inventory-2. Professional manual. Odessa, FL, Psychological Assessment Resources, 1991.

    Google Scholar 

  24. Garner D.M., Olmsted M.P., Bohr Y., Garfinkel P.E.: The eating attitudes test: psychometric features and clinical correlates. Psychol. Med., 12, 871–878, 1982.

    Article  PubMed  CAS  Google Scholar 

  25. Horowitz L.M., Rosenberg S.E., Baer B.A., Ureno G., Villasenor V.: Inventory of interpersonal problems: psychometric properties and clinical applications. J. Consult. Clin. Psychol., 56, 885–892, 1988.

    Article  PubMed  CAS  Google Scholar 

  26. Fassino S., Amianto F., Gramaglia C., Facchini F., Abbate Daga G.: Temperament and character in eating disorders: ten years of studies. Eat. Weight Disord., 9, 81–90, 2004.

    Article  PubMed  CAS  Google Scholar 

  27. Fairburn C.G., Jones R., Peveler R., Hope R.A., O’Connor M.: Psychotherapy and bulimia nervosa. Arch. Gen. Psychiatry, 50, 419–428, 1993.

    Article  PubMed  CAS  Google Scholar 

  28. Safer D.L., Telch C.F., Agras W.S.: Dialectical behaviour therapy for bulimia nervosa. Am. J. Psychiatry, 158, 632–634, 2001.

    Article  PubMed  CAS  Google Scholar 

  29. Prochaska J.O., DiClemente C.C.: Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy, theory, research and practice, 19, 276–288, 1982.

    Article  Google Scholar 

  30. Mahon J.: Dropping out from psychological treatment for eating disorders: what are the issues? Eur. Eat. Dis. Rev., 8, 198–216, 2000.

    Article  Google Scholar 

  31. Di Pietro G., Valoroso L., Fichele M., Bruno C., Sorge F.: What happens to eating disorder outpatients who withdrew from therapy? Eat. Weight Disord., 7, 298–303, 2002.

    Article  PubMed  Google Scholar 

  32. Van Furth E.F., Van Strien D.C., Martina L.M., Van Son M.J., Hendrickx J.J., Van Engeland H.: Expressed emotion and the prediction of outcome in adolescent eating disorders. Int. J. Eat. Disord., 20, 19–31, 1996.

    Article  PubMed  Google Scholar 

  33. Surgenor L., Maguire S., Beumont P.: Drop-out from inpatient treatment for anorexia nervosa: can risk factors be identified at point of admission? Eur. Eat. Dis. Rev., 12, 94–100, 2004.

    Article  Google Scholar 

  34. Probst M., Vandereycken W., Van Coppenolle H., Pieters G.: Body experience in eating disorders before and after treatment: a follow-up study. Eur. Psychiatry, 14, 333–340, 1999.

    Article  PubMed  CAS  Google Scholar 

  35. Rubel J.A.: The function of self-help groups in recovery from anorexia nervosa and bulimia. Psychiatr. Clin. North Am., 7, 381–394, 1984.

    PubMed  CAS  Google Scholar 

  36. Mahon J., Bradley S.N., Harvey P.K., Winston A.P., Palmer R.L.: Childhood trauma has dose-effect relationship with dropping out from psychotherapeutic treatment for bulimia nervosa: a replication. Int. J. Eat. Disord., 30, 138–148, 2001.

    Article  PubMed  CAS  Google Scholar 

  37. Griffiths R.A., Beumont P.J., Giannakopoulos E., Russell J., Schotte D., Thornton C., Touyz S.W., Varano P.: Measuring self-esteem in dieting disordered patients: the validity of the Rosenberg and Coopersmith contrasted. Int. J. Eat. Disord., 25, 227–231, 1999.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Eating Disorder Centre, Section of Clinical Nutrition, Department of Internal Medicine, Via E. Dal Pozzo, 06126, Perugia, Italy

    S. Bandini, G. Antonelli, S. Pampanelli & Gabriele Perriello MD, PhD

  2. Section of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy

    P. Moretti & R. Quartesan

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  1. S. Bandini
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  2. G. Antonelli
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  3. P. Moretti
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  4. S. Pampanelli
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  5. R. Quartesan
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  6. Gabriele Perriello MD, PhD
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Correspondence to Gabriele Perriello MD, PhD.

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Bandini, S., Antonelli, G., Moretti, P. et al. Factors affecting dropout in outpatient eating disorder treatment. Eat Weight Disord 11, 179–184 (2006). https://doi.org/10.1007/BF03327569

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