Why Do Eating Disorder Patients Drop Out?

Abstract

Background: Dropout from psychotherapy is an important problem that has received little systematic attention. Although previous research suggests that the number of patients who drop out is considerable, it is not clear why they drop out or what might be done to limit the problem. The present study attempted to examine the role of the patient-therapist relationship as well as other variables for dropout among eating disorder patients. Methods: Eating disorder patients and their therapists were assessed on a measure of treatment expectations previously developed by the author: the former were also assessed on measures of psychiatric symptoms (Crown-Crisp Experiential Index) and eating disorder psychopathology (Eating Disorder Inventory), as well as relevant background and treatment variables. Patients were divided into those who had completed their course of treatment, and those who dropped out during assessment or treatment. Results: Lack of congruence between patients’ and therapists’ expectations of potential treatment interventions was associated with increased risk of dropout, whereas other patient-, therapist-and treatment-specific factors were not. In particular, dropouts had significantly greater expectations of being helped by insight-related interventions than their therapists. Conclusions: Dropout among eating disorder patients appears to be related to the patient-therapist relationship. It may be important for therapists to openly discuss patient expectations of treatment from the outset, and focus on particular areas of discrepancy to limit potential dropout.

Dropout from Brief Psychotherapy in Anorexia nervosa

“…These features are highly specific to the anorectic patient [27, 29, 47], and this might explain difficulties in finding specific effective treatments for AN and the actual weakness of predictors of dropout [48]. In contrast to other investigations, the patient-therapist relationship [17], treatment type [22]and motivation [20]were not considered in the present study; further studies should investigate whether these elements of psychotherapeutic treatment could modulate the anger found in patients who drop out.…”

“…The other two studies emphasized higher levels of borderline psychopathology [15]and a greater severity of bulimic cognition [15, 16]in dropouts than in completers. Moreover, some authors have considered dropout in patients with EDs as strictly linked to the patient-therapist relationship [17], the treatment pattern [18]and the motivation to change [19, 20]. …”

Factors Affecting Compliance with Treatment in an Outpatient Child Psychiatric Practice: A Retrospective Study in a Community Mental Health Centre in Athens

“…Finally, a common ground of therapist-client values and perspectives seems to be a necessary prerequisite for effective treatment. This is emphasized by Clinton [14]who found that dropping out among patients with eating disorders appears to be related to the patient-therapist relationship.…”

Motivo de abandono del tratamiento desde la perspectiva del paciente con un trastorno de la conducta alimentaria

“…En la literatura pocos estudios hacen referencia a este factor, sin embargo, Clinton (1996) observó que las diferencias de las expectativas entre el paciente y el terapeuta aumentaba el riesgo de abandono. Por tanto, parece importante que los terapeutas y los pacientes discutan abiertamente sobre las expectativas del tratamiento.…”

“…Existe evidencia en el área de la investigación que muestra la existencia de diferentes motivos de abandono en los tratamientos en pacientes con TCA, entre ellos y los más estudiados, están la relación terapeuta-paciente (Clinton, 1996;Watson et al, 2013), sin embargo, la escasa literatura impide estudiar el tema en profundidad sobre otros motivos de abandono desde la percepción del paciente con TCA. Waller et al (2009) refieren que el abandono del tratamiento tiene relación con el sexo: ser hombre y mujer; sin embargo parece que el hecho de ser varón o mujer y tener una edad u otra, no guarda relación con que un tratamiento psicológico sea más o menos prolongado (Ballesteros, Fernández, & Labrador, 2013).…”