Abstract
The aim of this review was to analyse and summarise the research findings regarding which factors predict failure to engage (FTE) or drop-out from treatment for bulimia nervosa. A literature search was carried out with PubMed and PsychLit from 1985 to September 2000. Key terms searched were those classified as bulimia nervosa: outcome, FTE, drop-out and attrition. Outcome studies were also screened for inclusion of characteristics of those who failed to engage or dropped-out. Twenty eight studies were identified. They examined a range of factors - patient characteristics, patient-therapist and therapist factors. Three trials report different drop-out rates between treatments. Most samples studied are small and studies vary methodologically, making comparison difficult. FTE and drop-out is not a uniform phenomenon. The only robust finding for patient characteristics is that co-morbid borderline personality disorder increases the risk of FTE or drop-out. Discrepant expectations between patients and therapists may also contribute to drop-out. Drop-out is higher for medical treatment. Recommendations are made as to how clients may be more successfully engaged or maintained in treatment.