Premature termination of hospitalised treatment for Anorexia nervosa: a multi-site examination of early changes in behaviour, motivation, and therapeutic alliance

• Main Author: Sly, Richard
• Published: St George's, University of London 2012
• Subjects: 616.85262
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589782

Background: Anorexia nervosa is a serious psychiatric condition, and is associated with low levels of quality of life, and high mortality rates. Reported treatment drop-out rates for anorexia nervosa are high, and have remained so over the course of time, across different treatment settings and modalities. Past research into this area has focussed on the examination of service user characteristics as predictors of drop-out, yet there has been little replicated evidence to support this stance. Instead, service user attitudes and responses to treatment may provide a better insight into treatment outcome. Objectives: To investigate the levels of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia nervosa. Participants were allocated to treatment outcome groups depending on whether they completed treatment as planned, or prematurely left treatment. Methods: 90 participants meeting DSM-IV criteria for anorexia nervosa were recruited at four specialist eating disorder treatment centres. Self- report data was collected at admission to treatment, and repeated after four weeks of treatment. Weight data was collected over this same time period to measure fluctuations in weight curves. At end of treatment, participants were categorised into completer or premature termination groups. Those in the premature termination group were subsequently also categorised regarding who initiated termination (service user or staff), and the timing of discharge. Results: The overall rate of premature termination was 57.8%. Those who prematurely terminated treatment left at a lower BMI (p <.0005), demonstrated less weight gain (p <.0005), and spent less time in treatment (p <.0005) than those who completed. Only first impressions of therapeutic alliance proved different between broad outcome groups at admission (p = .011). When examining sub-categorisations of treatment drop-out, initial perceptions of alliance predicted self-discharge (p = .006), and slow rate of weight gain predicted staff-initiated discharge (p = .005). Premature discharge that took place in the early weeks of treatment could be predicted by initial impressions of alliance (p = .016). Conclusions: Premature termination of treatment is a common yet complex event in the course of treatment for anorexia, with a number of interacting factors that may influence both timing and manner of discharge. Therapeutic alliance in particular appears to be an important factor in this area.