Do broken relationships in childhood relate to bulimic women breaking off psychotherapy in adulthood?
OBJECTIVE
The case notes of 111 women presenting consecutively to an outpatient eating disorders clinic with bulimia nervosa or atypical bulimia nervosa were reviewed for pretreatment factors that predicted dropout in a retrospective study. Dropping out was conceptualized as not just a patient characteristic but as a transaction between patient and therapist. Factors believed to influence this transaction included experiences of childhood trauma, severity of eating disorder characteristics and comorbid psychiatric symptoms, demographic characteristics, waiting times for assessment and therapy, distance traveled to the clinic, previous experience of psychiatric treatment, and Eating Disorder Inventory (EDI) and Rosenberg Self-Esteem questionnaire results.


RESULTS
Witnessing parental breakup, being younger, being employed outside the home, and having previous experience of psychiatric treatment predicted dropping out in logistic regression models. Experiences of childhood trauma had a dose-effect relationship with dropping out. Having lower overall severity of eating disorder characteristics may also relate to dropping out.


CONCLUSIONS
An impaired ability to trust resulting from disturbed attachments may link childhood trauma and dropping out.
Mahon
J
J
Department of Psychiatry, University of Leicester, Leicester, United Kingdom.
Winston
A P
AP
Palmer
R L
RL
Harvey
P K
PK
D000328:Adult; D002032:Bulimia / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D011582:Psychological Theory; D011613:Psychotherapy / Q000379:methods*; D012189:Retrospective Studies; D012649:Self Concept; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires