What happens to the drop outs?

Eating disorder research is made especially difficult due to the large number of patients who prematurely drop out of treatment (which is examined in depth here). Sometimes, this happens in such numbers that the studies are, essentially, invalid. This is also why studies of eating disorders in adolescents are much more successful than those in adults: parents can usually (but not always) be called upon to insist that their child receive care, even when the child isn't exactly enthusiastic about the whole idea.

Some researchers asked "What happened to the ones who dropped out?"* They didn't necessarily look at why people dropped out, but what happened in terms of treatment outcome. In other words, despite not participating in the study, how have these people fared?

No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts.

What I couldn't find out was whether these people obtained non-study-related treatment, nor if the treatment in the study produced clinically meaningful changes. I think these are two quite major variables, although it doesn't necessarily take away from my conclusion.

The moral of the story here is that we really don't know a whole lot about how to treat eating disorders in adults. Because if people getting treatment essentially look the same as those not getting treatment, then what does this say about the treatments?

*Which can be performed to the tune of "Beauty School Dropout" from Grease for extra bonus points. At least, that's what I'm humming right now...

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marcella said...

am I missing a "not" here? It would seem that there ARE significant differences if "When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts"

Carrie Arnold said...


This part confused me a bit, too. Because they also said the two groups didn't differ significantly in terms of outcome (though "outcome" wasn't defined in the abstract). So it could be a bit of statistical magic going on.

Still, it makes me wonder why there isn't a difference in terms of overall treatment outcome for treatment vs. non-treatment.

mary said...

As someone who knows an adult "drop out" who went forward to create her own recovery I suspect there may be many others uncounted who've found other support in which to fight this.
I recall a "group" looking for people who had a success story to share but ours was too boring...too simple...not enough deep analyzing for them. I would think that if they had serious intentions of finding a path that works they'd be begging for answers from those who did it. Privately she's helped a few people and I try to direct folks to a FBT I know to be a swifter path. These are the stories I sought for inspiration. I had a hard time listening to those who said "plan on years of this" as this didn't seem like a healthy attitude or option.
There's valuable information in a story that tells what turned an ED around! It great you found a way to share Carrie. And that you keep moving forward regardless of the difficulties you've faced.

Anonymous said...

I was a NYSPI dropout, and no one followed up with me, so I don't know how they come up with comparisons. I agreed to participate b/c my insurance benefits at the time were exhausted for the year. I needed the structure and the intervention, but I wasn't invested enough to stay the course that far from home when I had a huge, great team at home. I *did* return to treatment. I found a number of years of remission ... and then I found a number of years in relapse, where I remain. I don't see that the care offered through the NYSPI studies I was part of, in and of themselves, were helpful or "curative." The protocol offered refeeding, though, which is a place to start. My studies were all about my donating my blood, genetic material, body composition data, serotonin status, and my answers to numerous interview questionnaires and inventories. The potential for helpfulness, I think, isn't comparable to studies which might offer some kind of CBT or therapy-based (vs. biological) trial. Other protocols that involve family therapy or relationship-based approaches also would likely have inherently different outcomes among dropouts and completers.

Carrie Arnold said...


I did think of your daughter when I was writing, and I know that not every approach works with every person. So I think it would be crucial to know whether the person sought additional care.


An interesting point you make. Thanks for sharing.

Life Works said...

Thanks for your article. Struggling with an eating disorder can cause profound isolation, fear and hopelessness. Because this illness thrives in secret, people with anorexia, bulimia and compulsive overeating hide their behaviours from those closest to them, hoping that no one will notice whilst hoping that someone will.
In order to begin the process of recovery, secrecy must give way to self awareness and honesty, and this can only happen in a safe, structured and caring environment.
I would also like to suggest another website with lots more information about eating disorders as well as addictions. http://www.lifeworkscommunity.com
Life Works Community Blog also gives a source of information and inspiration from some of the leading counselors at Life Works. http://www.lifeworkscommunity.com/resources/life-works-community-blog.asp

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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