Bulimia Nervosa: Finding Ways to Predict Who May Drop Out of CBT

From 15% to 25% of patients with bulimia nervosa drop out of cognitive behavioral therapy (CBT) prematurely. According to some researchers, treatment attrition rates may be even higher (Waller, 1997).

Dr. Zachary Steel and a team of Australian researchers recently found that depression and hopelessness as well as wide fluctuations in adult weight put patients at higher than normal risk of dropping out of CBT treatment. In the authors’ small study, 43% of 14 clients with a DSM-IV diagnosis of bulimia nervosa dropped out of treatment early. The severity of bulimic symptoms wasn’t a major factor in the decision to leave treatment (Int J Eat Disord 2000; 8:214 ).

Before CBT was begun, the patients (97% of whom were women) were assessed with the Eating Disorder Inventory-2, the Body Satisfaction Questionnaire, the Beck Depression Inventory, the Beck Hopelessness Scale, the Locus of Control of Behavior Scale, and demographic and behavioral measures.

No differences in severity of bulimic symptoms were found between patients who completed CBT treatment and those who dropped out. However, non-completers had significantly higher depression and hopelessness scores as well as elevated levels of external locus of control. Clients who dropped out had greater fluctuations in weight. Those who completed treatment had an average weight range of 17.5 kg (SD=5.8 kg) and dropouts had an average weight range of 26.6 kg (SD=14.0 kg).

The authors note that their study results suggest a need to focus treatment directly on factors such as hopelessness and depression in addition to standard bulimia treatment, to make certain patients are better able to participate in CBT.