Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs.
BACKGROUND
There have been very few randomized controlled treatment studies of anorexia nervosa.


OBJECTIVE
To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa.


METHODS
Randomized prospective study.


METHODS
Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif. Patients One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa.


METHODS
Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year.


METHODS
Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks).


RESULTS
Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance.


CONCLUSIONS
Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.
Halmi
Katherine A
KA
Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY 10605, USA. kah29@cornell.edu
Agras
W Stewart
WS
Crow
Scott
S
Mitchell
James
J
Wilson
G Terence
GT
Bryson
Susan W
SW
Kraemer
Helena C
HC
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011336:Probability; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012649:Self Concept; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors