Predicting Premature Termination from Bulimia Treatment

High dropout rates from cognitive-behavioral treatment for bulimia nervosa have been noted in the literature. Zachary Steel and colleagues from the University of New South Wales in Australia sought to identify those characteristics that would predict treatment dropout; their findings have been published in the September 2000 issue of the International Journal of Eating Disorders.

These researchers evaluated 32 consecutive referrals to their mental health service for bulimia nervosa treatment. Most of the individuals studied were female (97%) and averaged 23 years of age. Subjects had experienced symptoms for an average of five years prior to presentation.

Of this group, 18 individuals (57%) completed the treatment program, attending an average of 15 treatment sessions, while 14 individuals (43%) did not. In this latter group, the average number of treatment sessions attended was seven.

When comparing those who left treatment early with those who did not, there were no differences in core demographics or initial symptom severity. Those who dropped out of treatment did, however, manifest higher levels of pretreatment depression and hopelessness, as well as elevated feelings of ineffectiveness and a greater external locus of control than those who completed treatment. Together, these parameters could predict which individuals would end treatment prematurely with 90% accuracy.

Steel and colleagues suggest that interventions targeting depressed mood and hopelessness may assist in the retention of bulimic clients in treatment and should be administered in advance of standard cognitive-behavioral intervention for bulimia.

Source: Steel, Z., Jones, J., Adcock, S., Clancy, R., Bridgford-West, L., & Austin, J. (2000). Why the high rate of dropout from individualized cognitive-behavior therapy for bulimia nervosa? International Journal of Eating Disorders, 28(2), 209-214.

by Abraham Feingold, Psy.D.

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