Abstract
Abstract Purpose Understanding the high rate of treatment attrition in trials of people with eating disorders is important as it can compromise the quality of the trials. In clinical practice, it may also contribute to illness chronicity, relapse, and costs. Thus, we investigated factors associated with treatment attrition to a new manualised psychotherapy HAPIFED compared to CBT-E, for individuals with Bulimia Nervosa or Binge Eating Disorder comorbid with overweight or obesity. Methods In total, 98 participants were recruited with 50 randomised to HAPIFED and 48 to the control intervention CBT-E, all administered in groups of up to 10 participants. An investigator external to the site conducted the random allocation, which was concealed from the statistician involved in the analysis, and known only to the therapists until the finalization of the 12-month follow-up after the end of active treatment. Three scenarios in the timeline treatment of a total of 30 sessions were assessed: 33% or 60% or 75% of presence. Logistic regression analysis was performed to find the correlates of attrition. Results None of the six variables - frequency of binge eating episodes, purging, eating disorder symptom severity, weight, illness duration and mental health-related quality of life - significantly predicted attrition at 33%, but longer illness duration predicted lower treatment attrition at both 60% and 75% presence of the interventions. Also for 75% presence, lower body weight predicted lower treatment attrition. Conclusions Lower attrition due to late treatment completion was associated with longer binge eating illness length and a lower body weight. More research is needed to recognize factors that may interfere with engagement in treatments aiming to avoid early dropout. Keywords binge eating disorder, bulimia nervosa, cognitive therapy, obesity, patient dropout Trial registration US National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015.
Highlights
A challenge in the care of people with eating disorders is the high rate of treatment attrition, varying between 29% and 73% in outpatient studies [1]
We investigated factors associated with treatment attrition to a new manualised psychotherapy HAPIFED compared to Cognitive Behavioural Therapy (CBT)-E, for individuals with Bulimia Nervosa or Binge Eating Disorder comorbid with overweight or obesity
Similar results for sociodemographic aspects and eating disorder severity were found in a comprehensive review, but the authors noted that general psychopathology favours the nonsequence of treatment, and that binge-purging subtype of anorexia nervosa, two borderline personality disorder traits and two psychological traits are predictors for dropouts in eating disorders treatment [1]..In another systematic review and meta-analyses [3], weight suppression, more frequent binge eating and purging behaviours, less motivation for the treatment and avoidant attachment associated with binge/purge subtype were more likely to predict dropout
Summary
None of the six variables - frequency of binge eating episodes, purging, eating disorder symptom severity, weight, illness duration and mental healthrelated quality of life - significantly predicted attrition at 33%, but longer illness duration predicted lower treatment attrition at both 60% and 75% presence of the interventions.
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