Treatment dropout in a family-based partial hospitalization program for eating disorders
Treatment dropout is a significant challenge in the treatment of eating disorders. In day hospital/partial hospitalization program settings, little is known about factors associated with treatment dropout. The purpose of the present study was to assess factors associated with treatment dropout in a partial hospitalization program for adolescents and young adults with anorexia nervosa. Patients and parents completed self-report and interview-based measures at baseline and at end of treatment in the partial hospitalization program. Few factors were found that differentiated the two groups. Those who dropped out had lower body weight at end of treatment, were less likely to have purged in the previous month, and had fathers who scored higher on the criticism subscale of expressed emotion. Patients who are purging may be seen as having more severe symptoms, thus possibly reducing the chances of parents prematurely discontinuing treatment. Parental criticism is a potentially modifiable factor in treatment. Further research is needed to identify effective ways to reduce parental criticism, and to identify additional modifiable factors associated with treatment dropout to reduce dropout rates in this population.
Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.
KeywordsTreatment dropout Adolescents Partial hospitalization program Eating disorders Expressed emotion
Compliance with ethical standards
Conflict of interest
Dr. Rienecke receives consulting fees from the Training Institute for Child and Adolescent Eating Disorders, LLC.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors. The study was approved by the Institutional Review Board of the University of Michigan.
All participants provided informed consent prior to their participation.
- 4.Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B (2010) Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatr 67:1025–1032. https://doi.org/10.1001/archgenpsychiatry.2010.128 CrossRefGoogle Scholar
- 6.Agüera Z, Sánchez I, Granero R, Riesco N, Steward T, Martín-Romera V, Jiménez-Murcia S, Romero X, Caroleo M, Segura-García C, Menchon JM, Fernández-Aranda F (2017) Short-term treatment outcomes and dropout risk in men and women with eating disorders. Eur Eat Disord Rev 25:293–301. https://doi.org/10.1002/erv.2519 CrossRefGoogle Scholar
- 7.Watson HJ, Levine MD, Zerwas SC, Hamer RM, Crosby RD, Sprecher CS, O’Brien A, Zimmer B, Hofmeier S, Kordy H, Moessner M, Peat CM, Runfola CD, Marcus MD, Bulik CM (2017) Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial. Int J Eat Disord 50:569–577. https://doi.org/10.1002/eat.22644 CrossRefGoogle Scholar
- 14.Herpertz-Dahlmann B, Schwarte R, Krei M, Egberts K, Warnke A, Wewetzer C, Pfeiffer E, Fleischhaker C, Scherag A, Holtkamp K, Hagenah U, Bühren K, Konrad K, Schmidt U, Schade-Brittinger C, Timmesfeld N, Dempfle A (2014) Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet 383:1222–1229. https://doi.org/10.1016/S0140-6736(13)62411-3 CrossRefGoogle Scholar
- 19.Lock J, Le Grange D (2013) Treatment manual for anorexia nervosa: a family-based approach, 2nd edn. Guilford Press, New YorkGoogle Scholar
- 21.Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatr 59:22–33Google Scholar
- 22.Sheehan DV, Sheehan KH, Shytle RD, Janavs J, Bannon Y, Rogers JE, Milo KM, Stock SL, Wilkinson B (2010) Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). J Clin Psychiatr 71:313–326. https://doi.org/10.4088/JCP.09m05305whi CrossRefGoogle Scholar
- 23.Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan KH, Janavs J, Dunbar GC (1997) The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatr 12:224–231. https://doi.org/10.1016/S0924-9338(97)83296-8 CrossRefGoogle Scholar
- 24.Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16:363–370. https://doi.org/10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#Google Scholar
- 28.Pharoah F, Mari J, Rathbone J, Wong W (2010) Family intervention for schizophrenia. Cochrane DB Syst Rev 12: https://doi.org/10.1002/14651858.CD000088.pub2