Drop-out during in-patient treatment of anorexia nervosa: a clinical study of 133 patients.

Although anorexia nervosa patients are notorious for their 'resistance' to treatment, the phenomenon of drop-out during in-patient treatment of these patients is scarcely described in the literature. In a consecutive series of 133 hospitalized female anorexia nervosa patients the authors found a remarkably high drop-out rate of about 50 per cent, spread over different phases in the therapeutic process. In order to find some 'risk factors' concerning the probability of premature discharge against medical advice, some clinical, demographic and follow-up data were analysed in a retrospective way. Dropping-out appears to be a function of age at admission, duration of illness, educational level, social class and treatment method. These findings are interpreted with respect to different types of resistance to psychotherapeutic treatment both on the part of the patient and her family. In most cases a drop-out has to be considered as a crisis-related event in the treatment process. It does not only require specific attention, but also reconsideration of the whole therapeutic approach to anorexia nervosa patients.