Dr. Gupta is a licensed psychologist and professor at Barnard College, Columbia University. She specializes in the treatment of anxiety and eating/weight issues at 
Who is likely to do better or worse in eating disorder treatment?
April 25, 2013
While we have promising treatments available for binge eating and bulimia, not everyone responds to them. Some people respond quickly and are able to reduce their binge eating and purging within a couple months while others are in treatment much longer or instead drop out. Two new studies looked at women who were either in weekly outpatient therapy or in a hospital day program to see what factors predicted who responded quickly or who dropped out.
Most people’s experience with psychological treatments starts with seeing a therapist once a week. A group of women living in Germany sought help in the form of cognitive behavior therapy at an outpatient clinic affiliated with a university. Researchers surveyed these women and made sure they received solid therapy based on research. Their findings were released online this month. Among the women suffering from bulimia, 41% dropped out of treatment prematurely.
What does it mean to drop out early? In this study, the therapist made unique plans with each patient for how long therapy would last and dropping out meant ending the treatment before that original plan and also against the therapist's recommendation (if the therapist and patient both agreed there was much improvement early on, it didn't count as a drop out). On average, the women who dropped out stayed in therapy for 18 sessions whereas the rest of women stayed for an average of 39 sessions.
Comparing women with bulimia who drop out of treatment early to those who stay longer, the drop-outs tended to have stronger symptoms of depression. There weren’t any significant differences between the two groups before treatment in terms of age, BMI, or severity of eating disorder symptoms. The study authors speculate that as some women’s symptoms of depression improved, they may have lost motivation to continue working on other issues. We could see this from a totally different angle – people were “dropping out” because they felt better and therapy helped. In fact, 37% of the people who ended treatment early did in fact report less binge eating and purging. It would be interesting to see how the women compared a year or two after therapy ends – how different would the eating disorder symptoms appear between people who were in therapy for about 20 vs 40 sessions?
While most people start with once-a-week therapy in outpatient settings, what about those who need something more intensive? Another study looked at women who sought treatment in a day program to see if they could predict which women responded quickly or slowly to the treatment. The study, published this month in the International Journal of Eating Disorders, included women in Canada suffering from binge eating and/or purging.
The authors couldn’t point to any differences between women who binged and/or purged less than 2 times in the first month of treatment (considered rapid responders) versus those who binged and/or purged 3 or more times (considered slow responders). It may be surprising that someone with more intense symptoms before starting the day program wasn’t any less likely to respond quickly to treatment. At the same time, this may be motivating for those who feel their eating disorder is too severe for treatment.
Based on these two new studies, we can’t reliably look at someone’s level of eating disorder symptoms and use that to predict who would drop out of outpatient therapy or who will respond quickly/slowly to day programs. Though it migh have been nice to make such predictions, we can view these studies as encouraging for those who might otherwise be convinced treatment won't help them.
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Dr. Gupta is a professor at Barnard College of Columbia University and provides individual therapy at Tribeca Psychology
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