Predictors of treatment acceptance and completion in anorexia nervosa: Implications for future study designs

Katherine A. Halmi, W. Stewart Agras, Scott Crow, James Mitchell, G. Terence Wilson, Susan W. Bryson, Helena C. Kraemer

Research output: Contribution to journalArticlepeer-review

251 Scopus citations

Abstract

Context: There have been very few randomized controlled treatment studies of anorexia nervosa. Objective: To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa. Design: Randomized prospective study. Setting: Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif. Patients: One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa. Interventions: Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year. Main Outcome Measures: Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks). Results: Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance. Conclusion: Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.

Original languageEnglish (US)
Pages (from-to)776-781
Number of pages6
JournalArchives of General Psychiatry
Volume62
Issue number7
DOIs
StatePublished - Jul 2005

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