What predicts failure to engage in or drop out from treatment for bulimia nervosa and what implications does this have for treatment?

Abstract

The aim of this review was to analyse and summarize the research findings regarding which factors predict failure to engage (FTE) or drop out from treatment for bulimia nervosa. A literature search was carried out with PubMed and PsychLit from 1985 to September 2000. Key terms searched were those classified as bulimia nervosa: outcome, FTE, drop-out and attrition. Outcome studies were also screened for inclusion of characteristics of those who failed to engage or dropped out. Twenty-eight studies were identified. They examined a range of factors -patient characteristics, patient-therapist and therapist factors. Three trials report different drop-out rates between treatments. Most samples studied are small and studies vary methodologically, making comparison difficult. FTE and drop-out is not a uniform phenomenon. The only robust finding for patient characteristics is that co-morbid borderline personality disorder increases the risk of FTE or drop-out. Discrepant expectations between patients and therapists may also contribute to drop-out. Drop-out is higher for medical treatment. Recommendations are made as to how clients may be more successfully engaged or maintained in treatment.

Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: One year follow-up

“…participants diagnosed with AN, BN, and EDNOS. Inclusion criteria were very broad, so it is safe to state that the sample is representative of patients seen in daily clinical practice (Mahon, 2000;Bell, 2001;Hass and Clopton, 2003). Conducting a one year follow-up also allowed us to demonstrate that the results are consistent and that they evolved as expected, which is a highly relevant aspect given eating disorder relapse rates.…”

Tratamiento de la imagen corporal en los trastornos alimentarios y cambio clínicamente significativo.

“…Una de las fortalezas de este trabajo es la muestra utilizada proveniente de un servicio de Salud Mental público, pacientes diagnosticadas de AN, BN y TCANE. Los criterios de inclusión eran muy amplios por lo que podemos afirmar que la muestra es representativa de las pacientes atendidas en la práctica clínica diaria (Bell, 2001;Haas y Clopton, 2003;Mahon, 2000). Además, el tamaño de la muestra es similar al encontrado en otros trabajos con muestra clínicas en los trastornos alimentarios (Nye y Cash, 2006).…”

Epidemiology of eating disorders part III: social epidemiology and case definitions revisited

“…To get around this problem, videoconferences involving a clinical specialist, and transacting with the general practitioner has been proposed (Comer & Barlow, 2014) Similar to web-based prevention studies attrition is a matter of concern. Drop-out is only a mouse-click away, resulting in drop-out rates from online intervention ranging from 3-81% across all disorders (Melville, Casey & Kavanagh, 2010), and from 20-40% for eating disorders (Bell, 2001;Dejong, Broadbent & Schmidt, 2012). A literature review (Brachel et al, 2014) shows similar reasons as in face-to-face treatments for drop-outs, i.e., symptom severity (e.g., low weight and a comorbid PD), and a poor treatment alliance (e.g., a disparity between patient and therapist expectations and a failure to engage the patient in the treatment).…”