Predicting premature termination of hospitalised treatment for anorexia nervosa: The roles of therapeutic alliance, motivation, and behaviour change

ObjectivesThis study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia.Methods90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups.ResultsThe overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p < .0005), and weight gain (p < .0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p = .004).DiscussionEnd-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.

► Rates of dropout averaged 57.8% across four specialist treatment centres.
► Completers had significantly better weight and time-in-treatment outcomes.
► First impressions of alliance significantly predict outcome.