What Are Eating Disorders?

Take our Disordered Eating Test

Find a therapist to heal from an eating disorder

Dropout is common in eating-disorder therapy and leads to poorer outcomes and wasted resources.

Patients leave for many reasons such as demanding treatments, low motivation, weak alliance, or logistics.

Engagement strategies—shorter waitlists, patient choice, support tools—may improve retention.

Premature discontinuation of therapy is one of the most significant challenges in the treatment of eating disorders. Despite the development of effective psychological treatments over recent decades, many patients end therapy before achieving clinically meaningful improvement. This has important consequences for both patients and clinical services. Patients who discontinue treatment generally have poorer outcomes than those who complete it, and dropout also represents a waste of valuable therapeutic resources.

A recent article by Tracey Wade and Ulrike Schmidt in the International Journal of Eating Disorders proposes an interesting perspective on this issue. Rather than focusing solely on identifying predictors of dropout, the authors suggest using what we know about treatment discontinuation to improve treatments' ability to keep patients engaged.

This shift in perspective is important. Treatment dropout should not be interpreted solely as a problem of patient motivation, but also as a signal that invites reflection on the characteristics of treatments and the organization of clinical services.

Five categories of treatment discontinuation

Wade and Schmidt describe five main categories of treatment discontinuation. The first is patient-initiated dropout. Patients may decide to stop therapy for several reasons. Treatment may be perceived as too demanding, particularly in cognitive behavioral approaches that require early behavioral changes and tasks between sessions. In addition, the ego-syntonic nature of eating disorders may make it difficult for patients to give up aspects of the disorder they perceive as useful, such as a sense of control, a way of managing emotions, fear of weight gain, or a strong identification with the illness. Patients may also feel that treatment does not adequately address their needs or preferences. The quality of the therapeutic alliance is also important, as good collaboration on treatment goals and tasks is associated with better outcomes and greater treatment retention.

A second category is therapist-initiated discontinuation due to poor response or limited engagement. In some cases, therapists decide to stop treatment when patients show behaviors that interfere with therapy, such as repeated cancellations, persistent lateness, or failure to complete therapeutic tasks.

The third category occurs when therapy ends earlier than planned because both therapist and patient agree that stable remission has already been achieved. This situation is relatively uncommon and is generally not considered a true premature dropout.

The fourth category involves discontinuation due to clinical deterioration. In these cases, outpatient treatment is interrupted because the patient’s condition worsens and requires more intensive care. This occurs most often in anorexia nervosa when medical risk increases and hospitalization or more intensive treatment becomes necessary.

Finally, some interruptions occur for logistical reasons unrelated to the treatment itself, such as relocation, physical illness, or changes in healthcare services.

Why do patients drop out?

In studies of cognitive behavior therapy (CBT) for eating disorders, the mean dropout is about 24%. However, in treatments for anorexia nervosa, dropout rates generally range from roughly 25% to 44%, and in real-world settings, the dropout rate seems even greater. Lower rates are often observed among adolescents and young adults, probably because families are more actively involved in treatment.

Some characteristics present at the beginning of therapy have been associated with a higher risk of dropout, although findings are not always consistent. These include more severe eating disorder symptoms, stronger dietary restraint, lower motivation to change, older age, a history of trauma, difficulties in executive functioning, psychiatric comorbidity, and lower self-efficacy.

What Are Eating Disorders?

Take our Disordered Eating Test

Find a therapist to heal from an eating disorder

Another factor associated with dropout is the presence of long waiting lists before treatment begins. Research suggests that longer waiting times are linked to higher rates of treatment discontinuation. For example, one study found that dropout increased when waiting lists became longer during the COVID-19 pandemic and decreased when waiting times were reduced. Prolonged waiting may weaken patients’ motivation to start or continue therapy.

Strategies to improve treatment retention

Wade and Schmidt also discuss strategies to improve treatment retention. Maintaining some form of contact with patients while they are on waiting lists may help keep them engaged and increase the likelihood that they will start and continue treatment. Brief informational sessions, psychoeducational materials, guided self-help programs, and digital tools may support engagement.

Another possible strategy is coordinated multidisciplinary care that integrates psychotherapy with other forms of support, such as nutritional counseling and collaboration among healthcare professionals. Recovery-oriented support interventions, including educational materials, recovery stories, or mentoring by former patients, may also strengthen motivation for change.

Allowing patients some degree of treatment choice may further enhance motivation and reduce dropout. In addition, regular monitoring of treatment progress, with feedback to both the patient and the therapist, may help identify difficulties early and allow adjustments to treatment. Greater attention to personalization of treatment and to the therapeutic relationship may also improve engagement.

Premature discontinuation of therapy remains a major challenge in the treatment of eating disorders. The perspective proposed by Wade and Schmidt suggests that dropout should not be viewed simply as a patient problem, but as an opportunity to learn how treatments and services can be improved.

Understanding why patients interrupt therapy can help identify weaknesses in service organization and treatment delivery. Improving retention will likely require a combination of strategies, including better management of waiting lists, interventions that strengthen patient engagement, and careful attention to the therapeutic relationship. Ultimately, addressing dropout is not only about reducing treatment interruptions but about increasing the chances that more individuals with eating disorders complete therapy and achieve genuine recovery.

Wade, T. D., & Schmidt, U. (2026). Learning the Lessons of Premature Discontinuation of Eating Disorder Therapy: Informing Guidelines to Improve Retention. International Journal of Eating Disorders. https://doi.org/10.1002/eat.70060

© Psychology Today