Drop-out and failure to engage in individual outpatient cognitive behavior therapy for bulimic disorders.

OBJECTIVE: It was the aim of this study to explore the characteristics of bulimics who fail to complete therapy. Noncompleters were divided into those who failed to engage and those who dropped out, so that these groups could be directly compared.
METHOD: Participants were 50 women (bulimia nervosa or anorexia nervosa of the bulimic subtype) recruited from a case series of referrals to an eating disorders clinic, who were offered individual cognitive-behavior therapy. The women (28 completers; 7 failure to engage; 15 drop-outs) were compared on standardized measures of eating, psychological, and family characteristics.
RESULTS: The noncompleting groups both had high levels of borderline psychopathology and more severe perceived bulimic characteristics than the completers. However, the "drop-out" and "failures to engage" had very different patterns of perceived family emotional involvement, with the failures to engage reporting relatively healthy functioning. DISCUSSION: Our understanding of the eating disorders (and of the effectiveness of treatment) is skewed by the nature of the samples involved. The characteristics of noncompleters could be used at initial assessment to target clinical work towards lowering rates of drop-out and failure to engage.