Premature termination of inpatient eating disorder treatment: Does timing matter?

ABSTRACT

BACKGROUND: Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS: Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS: Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS: Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.

Patients being unable to complete inpatient treatment is serious problem in the treatment of eating disorders. Prior research attempting to identify differences between patients who can complete treatment and those who cannot has had mixed results. This study was designed to explore whether patients who leave treatment at different times differ from each other. To do this we compared eating disorder symptoms, eating disorder thoughts, depressive symptoms and emotional regulation symptoms of patients who left treatment early (0­4 weeks), later (after 4 weeks but before completion) and those who completed treatment. Results showed that patients who left treatment early reported the most severe eating disorder beliefs and depressive symptoms. They also had the most difficulties engaging in goal directed behaviours when experiencing intense emotions. They were not found to have differences in body weights or rates of eating disorder behaviors (i.e. self-induced vomiting). These results suggest that patients who leave treatment early are the most unwell and may benefit from learning emotional regulation skills prior to, or early in, treatment.