The article presents a critical review regarding the premature termination of eating disorder’s treatment among inpatients and outpatients, with the aim of identifying—emotional, psychodynamic and family-related aspects involved. The search strategy used the following MeSH terms combined by Boolean operators: “eating disorders” AND “treatment” OR “patient dropouts” OR “drop-out/dropouts” OR “attrition” OR “premature termination” AND “empirical study” OR “qualitative research”, for on Medline/PUBMED, PsycINFO and EMBASE databases. This article follows the PRISMA Guidelines. A total of 26 studies composed this review, of which 24 were original research articles, 1 was a review and 1 a theoretical article. Only two articles applied qualitative methods analyzing categories of content obtained by in-depth interviews, three combine quantitative and qualitative methods and other three present qualitative analyses while discussing quantitative studies. Further qualitative studies should be carried out to clarify meanings of dropout, premature termination of treatment, and attrition. Different expectations held by patients and by therapeutic teams, and the interpersonal difficulties of these types of patients, stand out as difficulties in constructing “therapeutic alliances”, with impacts on dropout, premature termination and attrition rates.
References
[1]
Vandereycken, W. and Pierloot, R. (1983) Drop-Out during In-Patient Treatment of Anorexia Nervosa: A Clinical Study of 133 Patients. British Journal of Clinical Psychology, 56, 145-156. https://doi.org/10.1111/j.2044-8341.1983.tb01542.x
[2]
Sly, R. (2009) What’s in a Name? Classifying “the Dropout” from Treatment for Anorexia Nervosain. European Eating Disorders Review, 17, 405-407. https://doi.org/10.1002/erv.964
[3]
Campbell, M. (2009) Drop-Out from Treatment for Eating Disorders: A Problem for Clinicians and Researchers. European Eating Disorders Review, 17, 239-242. https://doi.org/10.1002/erv.934
[4]
Wallier, J., Vibert, S., Berthoz, S., Huas, C., Hubert, T. and Godart, N. (2009) Dropout from Inpatient Treatment for Anorexia Nervosa: Critical Review of the Literature. International Journal of Eating Disorders, 42, 636-647. https://doi.org/10.1002/eat.20609
[5]
Mahon, J. (2000) Dropping out from Psychological Treatment for Eating Disorders: What Are the Issues? European Eating Disorders Review, 8, 198-216. https://doi.org/10.1002/(SICI)1099-0968(200005)8:3<198::AID-ERV356>3.0.CO;2-3
[6]
Seidinger-Leibovitz, F.M., Rodrigues, L., Garcia Júnior, C. and Vieira, C.M. (2016) Dropout in Treatment for Anorexia Nervosa and Bulimia: A Critical Review. Rev Interface, 11, 120-137.
[7]
Clinton, D., Almlöf, L., Lindström, S., Manneberg, M. and Vestin, L. (2014) Drop-In Access to Specialist Services for Eating Disorders: A Qualitative Study of Patient Experiences. Eating Disorders, 22, 279-291. https://doi.org/10.1080/10640266.2014.912553
[8]
Leavey, G., Vallianatou, C., Johnson-Sabine, E., Rae, S. and Gunputh, V. (2011) Psychosocial Barriers to Engagement with an Eating Disorder Service: A Qualitative Analysis of Failure to Attend. Eating Disorders, 19, 425-440. https://doi.org/10.1080/10640266.2011.609096
[9]
Surgenor, L.J., Maguire, S. and Beumont, P.J.V. (2004) Drop-Out from Inpatient Treatment for Anorexia Nervosa: Can Risk Factors Be Identified at Point of Admission? European Eating Disorders Review, 12, 94-100. https://doi.org/10.1002/erv.539
[10]
Zanetti, T., Favaro, L.C.A. and Santonastaso, P. (2005) Middle Term Outcome in Anorexia Nervosa Outpatients Who Dropped Out from Therapy. Rivista di Psichiatria, 40, 149-155.
[11]
Vandereycken, W. and Devidt, K. (2010) Dropping Out from a Specialized Inpatient Treatment for Eating Disorders: The Perception of Patients and Staff. Eating Disorders, 18, 140-147. https://doi.org/10.1080/10640260903585557
[12]
Zeeck, A. and Herzog, T. (2000) Behandlungsabbrüche bei der stationären Behandlung der Anorexia nervosa. Der Nervenarzt, 71, 565-572. https://doi.org/10.1007/s001150050627
[13]
Zeeck, A., Hartmann, A., Buchholz, C. and Herzog, T. (2005) Drop Outs from In-Patient Treatment of Anorexia Nervosa. Acta Psychiatrica Scandinavica, 111, 29-37. https://doi.org/10.1111/j.1600-0447.2004.00378.x
[14]
Pham-Scottez, A., Huas, C., Perez-Diaz, F., Nordon, C., Divac, S., Dardennes, R., Speranza, M. and Rouillon, F. (2012) Why Do People with Eating Disorders Drop Out from Inpatient Treatment: The Role of Personality Factors. The Journal of Nervous and Mental Disease, 200, 807-813. https://doi.org/10.1097/NMD.0b013e318266bbba
[15]
Sly, R., Mountford, V.A., Morgan, J.F. and Lacey, J.H. (2014) Premature Termination of Treatment for Anorexia Nervosa: Differences between Patient-Initiated and Staff-Initiated Discharge. The International Journal of Eating Disorders, 47, 40-46. https://doi.org/10.1002/eat.22190
[16]
Weiss, C.V., Mills, J.S., Westra, H.A. and Carter, J.C. (2013) A Preliminary Study of Motivational Interviewing as a Prelude to Intensive Treatment for an Eating Disorder. Journal of Eating Disorders, 1, Article No. 34. https://doi.org/10.1186/2050-2974-1-34
[17]
Pingani, L., Catellani, S., Arnone, F., De Bernardis, E., Vinci, V., Ziosi, G., Turrini, G., Rigatelli, M. and Ferrari, S. (2012) Predictors of Dropout from In-Patient Treatment of Eating Disorders: An Italian Experience. Eating and Weight Disorders, 17, e290-e297. https://doi.org/10.1007/BF03325140
[18]
Vandereycken, W. and Vansteenkiste, M. (2009) Let Eating Disorder Patients Decide Providing Choice May Reduce Early Drop-Out from Inpatient Treatment. European Eating Disorders Review, 17, 177-183. https://doi.org/10.1002/erv.917
[19]
Masson, P.C., Perlman, C.M., Ross, S.A. and Gates, A.L. (2007) Premature Termination of Treatment in an Inpatient Eating Disorder Program. European Eating Disorders Review, 15, 275-282. https://doi.org/10.1002/erv.762
[20]
Clinton, D. (1996) Why Do Eating Disorder Patients Drop Out? Psychotherapy and Psychosomatics, 65, 29-35. https://doi.org/10.1159/000289028
[21]
Mahon, J., Winston, A.P., Palmer, R.L. and Harvey, P.K. (2001) Do Broken Relationships in Childhood Relate to Bulimic Women Breaking off Psychotherapy in Adulthood? International Journal of Eating Disorders, 29, 139-149. https://doi.org/10.1002/1098-108X(200103)29:2<139::AID-EAT1003>3.0.CO;2-I
[22]
Peake, K.J., Limbert, C. and Whitehead, L. (2005) Gone, but Not Forgotten: An Examination of the Factors Associated with Dropping Out from Treatment of Eating Disorders. European Eating Disorders Review, 13, 330-337. https://doi.org/10.1002/erv.645
[23]
Campbell, M.A., Waller, G. and Pistrang, N. (2009) The Impact of Narcissism on Drop-Out from Cognitive-Behavioral Therapy for the Eating Disorders: A Pilot Study. The Journal of Nervous and Mental Disease, 197, 278-281. https://doi.org/10.1097/NMD.0b013e31819dc150
[24]
Carter, O., Pannekoek, L., Fursland, A., Allen, K.L., Lampard, A.M. and Byrne, S.M. (2012) Increased Wait-List Time Predicts Dropout from Outpatient Enhanced Cognitive Behaviour Therapy (CBT-E) for Eating Disorders. Behaviour Research and Therapy, 50, 487-492. https://doi.org/10.1016/j.brat.2012.03.003
[25]
Bandini, S., Antonelli, G., Moretti, P., Pampanelli, S., Quartesan, R. and Perriello, G. (2006) Factors Affecting Dropout in Outpatient Eating Disorder Treatment. Eating and Weight Disorders, 11, 179-184. https://doi.org/10.1007/BF03327569
[26]
Bjork, T., Bjorck, C., Clinton, D., Sohlberg, S. and Norring, C. (2009) What Happened to the Ones Who Dropped Out? Outcome in Eating Disorder Patients Who Complete or Prematurely Terminate Treatment. European Eating Disorders Review, 17, 109-119. https://doi.org/10.1002/erv.911
[27]
Fassino, S., Abbate-Daga, G., Pierò, A., Leombruni, P. and Rovera, G.G. (2003) Dropout from Brief Psychotherapy within a Combination Treatment in Bulimia Nervosa: Role of Personality and Anger. Psychotherapy and Psychosomatics, 72, 203-210. https://doi.org/10.1159/000070784
[28]
Swan-Kremeier, L.A., Mitchell, J.E., Twardowski, T., Lancaster, K. and Crosby, R.D. (2005) Travel Distance and Attrition in Outpatient Eating Disorders Treatment. International Journal of Eating Disorders, 38, 367-370. https://doi.org/10.1002/eat.20192
[29]
Stein, K.F., Wing, J., Lewis, A. and Raghunatha, T. (2011) An Eating Disorder Randomized Clinical Trial & Attrition: Profiles & Determinants of Dropout. International Journal of Eating Disorders, 44, 356-368. https://doi.org/10.1002/eat.20800
[30]
Von Brachel, R., Hötzel, K., Hirschfeld, G., Rieger, E., Schmidt, U., Kosfelder, J., Hechler, T., Schulte, D. and Vocks, S. (2014) Internet-Based Motivation Program for Women with Eating Disorders: Eating Disorder Pathology and Depressive Mood Predict Dropout. Journal of Medical Internet Research, 16, e92. https://doi.org/10.2196/jmir.3104
[31]
De Jong, H., Broadbent, H. and Schmidt, U. (2012) A Systematic Review of Dropout from Treatment in Outpatients with Anorexia Nervosa. International Journal of Eating Disorders, 45, 635-647. https://doi.org/10.1002/eat.20956
[32]
Connan, F., Dhokia, R., Haslam, M., Mordant, N., Morgan, G., Pandya, C. and Waller, G. (2009) Personality Disorder Cognitions in the Eating Disorders. Behaviour Research and Therapy, 47, 77-82. https://doi.org/10.1016/j.brat.2008.10.010
[33]
Gabriel, C. and Waller, G. (2014) Personality Disorder Cognitions in the Eating Disorders. The Journal of Nervous and Mental Disease, 202, 172-176. https://doi.org/10.1097/NMD.0000000000000088
[34]
Magallón-Neri, E., González, E., Canalda, G., Forns, M., De La Fuente, J.E., Martínez, E. and Castro-Fornieles, J. (2014) Prevalence and Severity of Categorical and Dimensional Personality Disorders in Adolescents with Eating Disorders. European Eating Disorders Review, 22, 176-184. https://doi.org/10.1002/erv.2268
[35]
Waller, G., Ormonde, L. and Kuteyi, Y. (2013) Clusters of Personality Disorder Cognitions in the Eating Disorders. European Eating Disorders Review, 21, 28-31. https://doi.org/10.1002/erv.2209
[36]
Gaudios, S. and Dakanalis, A. (2017) Personality and Eating and Weight Disorders: An Open Research Challenge. Eating and Weight Disorders, 23, 143-147. https://doi.org/10.1007/s40519-017-0463-0
[37]
Eivors, A., Button, E., Warner, S. and Turner, K. (2003) Understanding the Experience of Drop-Out from Treatment for Anorexia Nervosa. European Eating Disorders Review, 11, 90-107. https://doi.org/10.1002/erv.492
[38]
Sheridan, G. and McArdle, S. (2016) Exploring Patients’ Experiences of Eating Disorder Treatment Services from a Motivational Perspective. Qualitative Health Research, 26, 1988-1997. https://doi.org/10.1177/1049732315591982
[39]
Thapliyal, P., Mitchison, D. and Hay, P. (2017) Insights into the Experiences of Treatment for an Eating Disorder in Men: A Qualitative Study of Autobiographies. Behavioral Sciences, 7, 38. https://doi.org/10.3390/bs7020038
Tong, A., Sainsbury, P. and Craig, J. (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-Item Checklist for Interviews. International Journal for Quality in Health Care, 19, 349-357. https://doi.org/10.1093/intqhc/mzm042
