Factors associated with dropout from treatment for eating disorders: a comprehensive literature review.
BACKGROUND
Dropout (DO) is common in the treatment of eating disorders (EDs), but the reasons for this phenomenon remain unclear. This study is an extensive review of the literature regarding DO predictors in EDs.


METHODS
All papers in PubMed, PsycINFO and Cochrane Library (1980-2009) were considered. Methodological issues and detailed results were analysed for each paper. After selection according to inclusion criteria, 26 studies were reviewed.


RESULTS
The dropout rates ranged from 20.2% to 51% (inpatient) and from 29% to 73% (outpatient). Predictors of dropout were inconsistent due to methodological flaws and limited sample sizes. There is no evidence that baseline ED clinical severity, psychiatric comorbidity or treatment issues affect dropout. The most consistent predictor is the binge-purging subtype of anorexia nervosa. Good evidence exists that two psychological traits (high maturity fear and impulsivity) and two personality dimensions (low self-directedness, low cooperativeness) are related to dropout.


CONCLUSIONS
Implications for clinical practice and areas for further research are discussed. Particularly, these results highlight the need for a shared definition of dropout in the treatment of eating disorders for both inpatient and outpatient settings. Moreover, the assessment of personality dimensions (impulse control, self-efficacy, maturity fear and others) as liability factors for dropout seems an important issue for creating specific strategies to reduce the dropout phenomenon in eating disorders.
Fassino
Secondo
S
Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy. secondo.fassino@unito.it
Pierò
Andrea
A
Tomba
Elena
E
Abbate-Daga
Giovanni
G
D000328:Adult; D000856:Anorexia Nervosa / Q000628:therapy; D015897:Comorbidity; D019992:Databases as Topic / Q000706:statistics & numerical data; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D010555:Personality Inventory; D011336:Probability; D011594:Psychometrics; D009626:Terminology as Topic